Documents to Confirm Eligibility

Covered California

Covered California compares the information you enter on your application with government data sources or information you've provided before. If the data is inconsistent, we ask you to submit documents to confirm the new information.

Proof of Social Security Number (SSN)

Submit a copy of one of the following documents.

  1. Your Social Security card.
  2. Tax form(s).
  3. Benefit or income statement from Social Security containing the Social Security number.
  4. Pending application for an SSN.
  5. Letter from the Social Security Administration stating that the applicant is not eligible for an SSN or is only eligible for a non-work SSN.
  6. Letter stating that the applicant refuses to obtain an SSN for established religious objections (SSN Waiver).

Proof of Identity

Submit a copy of one of the following documents.

  1. Driver’s license issued by a state or territory showing either a photograph of the individual and/or other identifying information of the individual such as name, age, sex, race, height, weight or eye color.
  2. School identification card that includes a photograph.
  3. Voter Registration Card.
  4. U.S. Military card, draft record or Military dependent’s identification card.
  5. Identification card issued by the federal, state, or local government that contains a photograph.
  6. U.S. or foreign passport, U.S. passport card (expired passport may be used) or identification card issued by a foreign embassy or consulate that contains a photograph.
  7. Certificate of Naturalization (Form N-550 or N-570) or Certificate of U.S. Citizenship (Form N-560 or N-561).
  8. Permanent Resident Card or Alien Registration Receipt Card (Form I-551).
  9. Employment Authorization Document that contains a photograph (Form I-766).
  10. Native American tribal document with photograph.
  11. For children under the age of 16:
    • A clinic, doctor, hospital, or school record.
    • In the absence of the previous, a written statement signed under penalty of perjury by the parents or guardian stating date and place of birth (cannot be used in conjunction with a citizenship affidavit).
  12. U.S. Coast Guard Merchant Mariner card.
  13. Finding of identity from a federal agency or state government agency including but not limited to public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual.
If you cannot provide a copy of any of the identity documents listed above, you must provide copies of two of the following documents:
  1. Birth certificate.
  2. Social Security card.
  3. Marriage certificate.
  4. Divorce decree.
  5. Employer identification card.
  6. High school or college diploma (including high school equivalency diplomas).
  7. Property deed or title document.
  8. Adoption decree.
  9. Foreign school record that contains a photograph.
  10. Notice from public benefits agency.
  11. Union or worker’s center identification card.

Proof of Citizenship or U.S. National Status

Submit a copy of one of the following documents.
Primary (Stand-Alone) Evidence of Citizenship

  1. U.S. Passport or U.S. Passport Card, current or expired (issued without limitation).
  2. Certificate of U.S. Citizenship.
  • Form N-560.
  • Form N-561.
  1. Certificate of Naturalization.
  • Forms N-550, N-570.
  1. Documentary evidence issued by a federally recognized American Indian or Alaska Native tribe. Documents must identify the individual by name and confirm the individual’s membership, enrollment, or affiliation with a tribe. Documents include but are not limited to:
  • Tribal enrollment card.
  • Certificate of Degree of Indian Blood.
  • Tribal census document.
  • Documents on Tribal letterhead, issued under the signature of the appropriate Tribal official.

Secondary evidence of citizenship If you do not have any of the above primary (standalone) evidence, provide copies of two documents (secondary evidence): one from List A and one from List B. List A
  1. U.S Public Birth Certificate

  2. Consular Report or Certificate of Child Born Abroad.

    • Department of State Form FS-545.

    • Department of State Form FS-240.

    • Department of State Form DS-1350.

  3. Individual Fee Register receipt (INS Form G-711).

  4. U.S. Citizen Identification Card (I-197 or the prior version I-179).

  5. Federal or State census record showing U.S. citizenship or U.S. place of birth.

  6. A Northern Mariana Identification Card issued to a collectively naturalized citizen, who was born in the CNMI before November 4, 1986 (I-873).

  7. Adoption Decree.

    • A final adoption decree showing the child’s name and U.S. place of birth; or

    • If the adoption is not finalized, a statement from a state-approved adoption agency that shows the child’s name, U.S. place of birth, and birthdate or age (the adoption agency must state in the certification that the source of the place of birth information is an original birth certificate).

  8. Documentation of a foreign-born child (including a foreign-born adopted child) who received automatic U.S. citizenship through (IR3 or IH3) or the Child Citizenship Act. Documentation must clearly show the child’s name and date of birth.

  9. U.S. military records showing a U.S. place of birth.

  10. Evidence of U.S. Civil Service employment before June 1, 1976.

  11. U.S. medical records, including but not limited to hospital, clinic, midwife, or physician records or admission papers from a nursing facility, skilled care facility, or other institution.Records must:

    • Indicate U.S. place of birth.

    • Be signed and on hospital letterhead.

    • Be established at the time of the person's birth.

  12. U.S. insurance records showing a U.S. place of birth.Records must:

    • Indicate U.S. place of birth.

    • Be created at least five years before the initial Covered California application date, unless the applicant is under the age of five.

  13. Official religious records recorded in the U.S.Records must:

    • Be created within three months of birth.

    • Indicate U.S. place of birth.

    • Indicate the date of the birth or the individual's age at the time the record was made.

    • Be an official record recorded with the religious organization.

  14. School records including pre-school, Head Start, and daycare records.Records must:

    • Indicate the child’s name.

List B
  1. Driver's license issued by a State or Territory, or ID card issued by the federal, state, or local government.
  2. School identification card.
  3. U.S. military card or draft record or Military dependent’s identification card.
  4. U.S. Coast Guard Merchant Mariner card.
  5. A clinic, doctor, hospital, or school record, including preschool or day care records (for children under 19 years old).
  6. Two documents containing consistent information that proves the applicant’s identity, such as:
    • Birth Certificate.
    • Social Security card.
    • Marriage Certificate.
    • Divorce Decree.
    • Employer identification card.
    • High School or College Diploma (including high school equivalency diplomas).
    • Property deed or title document.

Proof of Immigration Status or Lawful Presence

Proof of Income

Proof of Non-Incarcerated Status

Submit a copy of one of the following documents.

  • Official release papers from the institution or Department of Corrections.
  • Parole papers.
  • Non-Incarceration Attestation Form.

Proof of Lack of Minimum Essential Coverage (MEC)

Proof of American Indian and Alaska Native Status

Notification of a Deceased Covered California Member