You cannot substitute anything else for the required items. The application process is not complete without the required items. Copy of insurance card, front and back (if already covered).An insurance bill that doesn’t show funds have been paid for health insurance.You can’t use the following as proof of payment: A letter on company letterhead from your insurance company stating you paid for health insurance.A letter on company letterhead from your employer stating you paid for health insurance.A bank statement that shows funds were withdrawn from your bank account to pay for health insurance.A copy of the front and back of a deposited check that shows you paid for health insurance.A copy of your paystub that shows a portion of your pay was deducted to pay for health insurance.You can use any of the following as proof of payment: For example, if you are submitting a proof of payment in January of 2017, the date on your proof of payment must be January of 2017. The date on the proof of health insurance payment must be the same month of submission. Proof of health insurance payment if you already are covered.A rate sheet is an informational document that shows the insurance premium amounts you pay each month. Your employer can provide your insurance plan's rate sheet. Employer-sponsored health insurance plan’s rate sheet.You also will need to submit the following required items: To apply, you can either complete the application form or call 80. Medicaid Supplemental Payment & Directed Payment Programs.
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