HCA Marketplace Required Documentation Samples
Listed below are samples of documentation you need to send us for proof of your Marketplace plan. You can upload them by filling out the Healthcare Cost Assistance Benefits Request Form or by logging in to MyCarewell503.org (currently available in English).
Oregon
Premium Bill Samples
Healthcare.gov Sample
Go to your healthcare.gov account and go to “My plans & programs.”
Providence Premium Bill Sample
The Providence premium bill does not show your plan name. Go to your healthcare.gov account and go to “My plans & programs.”
Oregon
Marketplace Eligibility Notice Samples
Washington
Marketplace Eligibility Notice Samples
For more information
Visit these pages to learn more about your benefits and how to use them if you are eligible:
Forms Webpage
Healthcare Cost Assistance Webpage
FAQs Webpage
MyCarewell503