Fill in Your Nevada Check Up Application Form

• The Nevada Check Up Application is designed for families seeking low-cost health coverage for uninsured children under 19 years of age.

• Before filling out the application, ensure you have all necessary documentation ready, including Social Security numbers and proof of income.

• Indicate if you want your application referred to Nevada Medicaid if your children may be eligible. This could impact your enrollment in Nevada Check Up.

• List all adults in the household, regardless of their relationship to the children. This includes providing details like names, birth dates, and Social Security numbers.

• When listing children, include all minors in the household, even if they are not U.S. citizens. Accurate information is crucial for eligibility.

• Be aware that the application process may take up to 45 days. This period begins once a complete application is submitted.

• Failure to report changes in household status, such as moving or changes in income, can lead to denial or termination of benefits.

• Health services covered under Nevada Check Up include medical, dental, and vision care. Most medically necessary services are included.

• Families may be required to pay a quarterly premium based on income and family size. This premium is assessed per family, not per child.

• If your application is denied or you disagree with any decision, you have the right to request a hearing within 30 days of receiving the denial letter.

When applying for the Nevada Check Up program, you may need additional forms and documents to support your application. These documents help ensure that your application is complete and that you receive the appropriate benefits for your children. Below are some commonly required documents that you may encounter during the application process.

• Proof of Income: This document verifies the household's income and may include pay stubs, tax returns, or bank statements. It is essential for determining eligibility based on income guidelines.
• Proof of Citizenship: To confirm eligibility, applicants must provide documents such as birth certificates or immigration papers for each child. This helps establish citizenship or lawful permanent resident status.
• Health Insurance Information: If any family members have health insurance, details about the coverage must be provided. This includes the name of the insurance provider and policy numbers, which are important for determining any existing coverage.
• Notice to Quit Form: In cases of eviction, ensure compliance with relevant laws by using the essential Notice to Quit form resources that detail landlord and tenant responsibilities.
• Child Support Documentation: If applicable, proof of child support payments should be included. This documentation helps assess the financial situation of the household.
• Medical Records: In some cases, medical records may be required to provide information about any ongoing health issues or special needs that the children may have.

Gathering these documents ahead of time can streamline the application process and help avoid delays. If you have questions about any of these forms or need assistance, don't hesitate to reach out to the Nevada Check Up program for guidance. They are there to help you navigate the application process effectively.