Language
  • English (US)
  • Spanish (Latin America)
  • Enrollment Application

    Enrollment Application

    Customer Service: 866-291-8691 or planmanagement@ihpmi.org
  • Application available in English & Español. Select a language. Seleccione idioma.

    --------------

    Please complete this brief screening to determine if you may be eligible for Ingham Health Plan (IHP).

    A separate IHP application is required for each household member seeking coverage.

  • 1. Verify your home address is Ingham County. Complete a zip-code-lookup

    (Click on the drop down arrow to view County information.)

  • 2. Verify your HOUSEHOLD GROSS INCOME falls within income eligibility guidelines for IHP (See Chart Below).  This is income before taxes and deductions.  If income is at or below Medicaid eligibility, please apply for Medicaid health coverage first. IHP is for people who don't have or qualify for other health coverage such as Medicaid, Medicare or commerical.

    • Family size includes yourself, spouse or other parent, children (19 and under), tax dependents living the household.
    • Household income includes ALL wage earners in household. Include income such as wages, unemployment benefits, workers' comp, child support, SSI, RSDI, rental property, alimony, and self-employment income.

      

       2025 income Eligibility Chart

  • Sorry, it appears you are not eligible for Ingham Health Plan. You may be eligible for Medicaid or health insurance on the Federal Marketplace.

  • Ingham Health Plan logo

    Enrollment Application

    Customer Service: 866-291-8691 or planmanagement@ihpmi.org
  • Based on your screening, it appears you MAY be eligible to apply for IHP.

    Completing the application does not guarantee enrollment in IHP. 

    IHP is not insurance and has limited coverage benefits (View Covered Services & Non-Covered Services)

    Application and ALL required documents must be submitted for application to be considered complete.  Once application and supporting documents are reviewed by an Enrollment Specialist, enrollment status will be determined.

    You will be notified of your enrollment status within 3 business days by email.

    Before proceeding gather the following information to assist with the application process:

    • Proof you live in Ingham County- driver's license/ID, piece of mail received in applicant's name at the physical address provided
    • Proof of Income: Must be from within the last 30 days (2 bi-weekly or 4 weekly) for ALL wage earners - paycheck stubs, Medicaid denial or other verification of income from DHHS, unemployment benefits, workers' comp, SSI, RSDI, rental property, alimony, self-employment income, and child support should all be included
    • Medicaid application within last 6 months and/or pending/denial/redetermination letter, if applicable

    Supporting documents will need to be uploaded to the application before submitting.

    You are able to 'Save' your application and 'Continue Later' if needed.  Due to HIPAA, you will be required to create a JotForm account.  The link to complete your application will be sent to the email provided on the application.  You must complete your application within 2 weeks.  After that, any incomplete applications will be deleted and you'll need to start from the beginning.

  •  - -
  •  - -
  •  
  •  


  •  - -
  •  - -
  • Choose your Doctor's Office: If IHP application is approved, Applicant will be "assigned" a primary care Office. Please review the list of IHP participating provider offices.  Please select an office of your choice. 

    *Note: McLaren offices are closed to all IHP members.

  • Ingham Health Plan logo

    Self Employment Verification Form

  • You are being asked to complete this form because you indicated one of the following:

    1) You have not filed a Schedule C tax document, or

    2) The Schedule C you filed is not an accurate representation of your current year's income.

  •  
  • Clear
  •  - -
  • FINAL STEP:

  • To complete the application you will need to upload, in PDF or JPEG format, copies of the required supporting documents. 

    You can scan documents using an app or take a picture with a cell phone.

    All documentation MUST be legible.

    1. Picture Identification 

    2. Proof of you live in Ingham County (at least one of following)

    • Valid Michigan driver’s license or ID card
    • Other ID which provides a name and address
    • Recent mortgage, lease, or rent receipt
    • W2 or 1040 tax form
    • Ingham County voter’s registration card
    • Recent utility or home services bill with name and address printed on it
    • Recent paycheck or other income documentation with name and address printed on stub
    • A letter dated within the last 30 days stating applicant resides at address list on application

    3. Proof of income must be recent (within the past 30 days) for ALL wage earners in household (at least one of following for ALL wage earners)

    • Paycheck stubs within the last 30 days (2 biweekly or 4 weekly)
    • Medicaid denial letter or other verification on income from DHHS
    • Other statement of income from employer
    • Unemployment statement
    • Social Security benefit statement
    • Account interest statement or other statement of unearned income
    • Most recent tax form(s) for applicants who are self employed

    4. Immigration Documents, if applicable (visa, green card, permanent residency card)

    5. Medicaid status documents, if applicable

    • Medicaid application completed within last 6 months
    • Pending, Denial, Redetermination or appeal letter from Medicaid
  • Upload Files
    Cancelof
  • Clear
  •  - -
  • Should be Empty: