WebxI declare under the penalty of perjury, under the laws of the state of California, that what I stated above is true and correct. Applicant’s Signature: _____ Date: MM DD YYYY Send your form in one of the following ways: Fax (888)329-3700 Mail Covered California P.O. Box 989725 West Sacramento, CA 95798-9725 WebOver 90 percent of people enrolled in Covered California receive financial assistance to help them pay for their health coverage. This is primarily through a tax credit, which can be applied throughout the year to lower your premiums, or claimed at tax time. Please call us at 1.855.222.4239 (TTY 711) and we’ll help see if you qualify. Contact us.
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Many Californians Can Get Health Coverage for as Little …
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