Ccfrm604 application 2025

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4.9 out of 5

45 votes

The document is an application for health insurance through Covered California, designed to help individuals and families access affordable health coverage, including Medi-Cal. It outlines the application process, eligibility criteria, required information, and available assistance programs. The document emphasizes that applicants can qualify for free or low-cost insurance based on their income and family size, and provides resources for support in multiple languages.

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Click ‘Get Form’ to open the ccfrm604 application in the editor.
Begin by filling out Step 1, which requires the main contact's first name, middle name, last name, and suffix. Ensure you provide a valid home address and contact number.
Continue to Step 2 where you will provide information about yourself and your family. Include details such as income, family size, and any health insurance currently held.
If applicable, complete Attachment A for American Indians or Alaska Natives. Provide necessary documentation if required.
In Step 3, read through the privacy statement and sign the application. Make sure all information is accurate to avoid delays.
Finally, review your application for completeness before submitting it via mail or electronically through our platform.

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Versions	Form popularity	Fillable & printable
2013	4.9 Satisfied (45 Votes)

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How long does it take to process a Medicare Part B application?

Processing your application can take several weeks because Medi-Cal must first determine eligibility by verifying your income and personal assets before coverage can be approved. You may request Medi-Cal to pay retroactively for the three months prior to the month in which you apply.

What is a CCFRM604?

Your destination for affordable health insurance, including Medi-Cal. STATE OF CALIFORNIA Health Insurance Application. (11/13) | CCFRM604.

What forms do I need to apply for Medicaid?

What documents and information do you need for your Medicaid application? Your name and date of birth. Your Social Security number. Your monthly payment amounts for rent, mortgage, or utilities. Proof of citizenship or immigration status. Proof of income, like paystubs or W-2s.