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STANDARD HEALTH QUESTIONNAIRE FOR WASHINGTON STATE Use for Individual Coverage Beginning On or After October 1, 2009, Revised for Coverage Beginning on or after March 23, 2012, Important Information

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What is use for individual coverage?

Use for individual coverage is a form that must be filled out to report individual health insurance coverage.

Who is required to file use for individual coverage?

Individuals who have health insurance coverage must file use for individual coverage.

How to fill out use for individual coverage?

Use for individual coverage can be filled out online or by mail with all relevant information about the individual health insurance coverage.

What is the purpose of use for individual coverage?

The purpose of use for individual coverage is to report and verify individual health insurance coverage to comply with regulations.

What information must be reported on use for individual coverage?

Information such as name, address, social security number, and details of the health insurance coverage must be reported on use for individual coverage.

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