Preview Plans

Tell us a little bit about yourself.

Your information will help us find out if you qualify for help paying for health coverage.

Coverage Year:

What is your Zip Code? *

What is your total income per year? *

How many people are in your household? *

Enter the age of each person in your household, and tell us if they need coverage.

Age of Head of Household *

Needs Coverage?

Is anyone in your household pregnant? *

Yes No

Is anyone in your household blind or disabled? *

Yes No

What is this page for?

A:This page allows you to view the household data you entered along with your potential coverage options based upon the data you entered.

Questions and Answers

Q: What does the Back button do?

A: Clicking the button takes you to the previous page.

Q: What does the See My Results button do?

A: Clicking the button will take you to the My Options page.

Label	Element Type	Description	Validation
Preview Plans for	Dropdown box	Displays a drop-down box to select the latest enrollment year or prior enrollment year.	N/A
What is your Zip Code?	Textbox	Displays a textbox to enter the zip code	5 digit numeric entry
What is your total income per year?	Textbox	Displays a textbox for entering the income	Numeric characters
How many people are in your household?	Dropdown box	Displays a dropdown box with values from 1 till 25	N/A
Age of Head of Household	Textbox	Displays a textbox to enter the age of Head of the Household	Numeric characters
Needs Coverage?	Checkbox	Indicates if the person needs coverage	At least one person must need coverage
Is anyone in your household pregnant?	Radio buttons	Displays Yes and No radio buttons to answer the question.	N/A
Is anyone in your household blind or disabled?	Radio buttons	Displays Yes and No radio buttons to answer the question.	N/A

Covered California