Are You Eligible

Eligibility requirements vary based on the benefit plan. You are eligible for CHAND if you qualify as a:

• Traditional applicant
• Health Insurance Portability and Accountability Act of 1996 (HIPAA) applicant
• Federal Trade Adjustment Assistance Reform Act of 2002 (TAARA) applicant
• Age 65 and Over or Disabled Supplement applicant

Medicare-eligible applicants may also enroll through the Traditional plan. To learn more about the requirements, choose a listed plan.

Traditional Brochure
HIPAA Brochure
TAARA Brochure
Standard Supplement Brochure
Basic Supplement Brochure

Qualifying Previous Coverage

You may be eligible to reduce the number of waiting period days on your CHAND benefit plan. If it has been less than 63 days since your prior coverage terminated, please provide information regarding that coverage on your application. If you have documentation to assist in verifying prior coverage, please include it with your application.

How Do I Apply?

Contact any agent who is licensed to sell health insurance in North Dakota or complete an application.

Applications must be mailed to:
PO Box 857668
Minneapolis, MN 55485-7668

Forms

Please note if you are a Traditional applicant, you must review the Creditable Coverage Disclosure Notice.

Traditional Application
HIPAA Application
TAARA Application
Supplement Application
Creditable Coverage Disclosure Notice

Authorized Representative Form
Please complete an Authorized Representative Form and include it with your application.