Health Insurance Enrollment

Necessary Paperwork:

To Make Your Insurance Enrollment Process As Easy As Possible; Please Bring Any Of The Following That May Apply:

Proof of Identity & Citizenship Documents:

If You Are 16 Years Old Or Younger Please Bring One Of The Following:

• Birth Certificate or U.S. Issued Passport
• An affidavit signed under perjury by a parent or guardian attesting to the child’s identity
• Statement of Physician or Midwife who was in attendance at the time of birth

If you are 16 years old or older please bring ONE of the following:

• U.S. Issued Passport

OR

• Birth Certificate AND ONE of the following:
• Current MA License
• School ID with a photograph of the Individual
• US Military or Draft Record
• Legal Permanent Resident Card
• Student, Work or Tourist Visa

Proof of Income Documents:

Please bring ONE of the following:

• 2 Consecutive Pay Stubs
• Last Tax Return – Schedule C if Self-Employed
• Social Security, Retirement, or Unemployment Statement of Benefits

AND (any that apply):

• Alimony Payment Order
• SSI Documentation
• Letter from employer

Proof MA Residency:

Please bring ONE of the following:

• Lease or Mortgage
• Utility Bill (Gas or Electric) With Your Name and Address Listed
• Or a notarized letter from whomever you reside with

Patients can get help from the Health Safety Net if they are undocumented non-citizens/unlawfully present. Immigration status does not matter for this program. Undocumented non-citizens who meet the eligibility requirements can get HSN funds. Social Security number is not needed.

NSCH ensures that no one will be denied access to health services due to their inability to pay. Our sliding fee-program allows us to reduce or “slide” the fees for the medical and dental care of you and your family depending on your household size and annual income. You can apply for the program if you need assistance to help you pay for your care