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West Virginia Department of Health and Human ResourcesApplication for Health Coverage & Help To pay Costs Use this application to see what coverage choices you qualify for. Who can use this application?

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01

Gather all necessary information and documents required for the application

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Individuals who are required to provide additional information or details that are not covered in the main application form

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What is supplement to application for?

Supplement to application is for providing additional or missing information that is necessary to complete the application.

Who is required to file supplement to application for?

Individuals or entities who are requested by the organization or agency to provide additional information are required to file supplement to application.

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Supplement to application should be filled out accurately, following the instructions provided by the organization or agency requesting the information.

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The purpose of supplement to application is to ensure that all necessary information is provided in order to complete the application process.

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The specific information that must be reported on supplement to application will depend on the requirements of the organization or agency requesting the information.

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