• 楊玫保險2021健保新客戶申請表

    2021 HEALTHCARE NEW CLIENT APPLICATION
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  • * 請填寫家庭成員信息- (請列出家庭報稅表上的全部家庭成員,不需要申请健保的家庭成员也请提供姓名,性别,生日。请向右滑动屏幕填写所有问题). *

    Family Members Information (Please include all the family members in your family annual tax report, for those members in tax report but no need health insurance can provide the personal information without visa type), please click the Add a new row beside for adding additional family members.

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  • *公民或持有綠卡五年以上的19歲以下孩子,如果最近沒有被Medicaid/PeachCare拒絕過,健保中心根據家庭收入狀況,有可能將孩子的申請自動送入GA Medicaid/PeachCare Program.

    Children under the age of 19 who are citizen or have held a green card for more than five years, if they have not been rejected by Medicaid/PeachCare recently, the health insurance center may automatically send the child's application to the GA Medicaid/PeachCare Program based on family income level.

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