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1. Download and complete an Indian exemption application form (PDF)

2. Gather documentation of membership in a federally recognized tribe or eligibility for services through an Indian health care provider for EACH member of your tax household. See the full list of acceptable documentation types on page 5 of the exemption application (PDF).

3. Mail the signed and completed application with supporting documentation to: Health Insurance Marketplace – Exemption Processing 465 Industrial Blvd. London, KY 40741

4. The Marketplace will send you an eligibility determination letter in the mail after we process your exemption application. If you qualify for this exemption, we’ll give you an Exemption Certificate Number (ECN).

5. Once you have an Exemption Certificate Number, complete Part I of IRS Form 8965—Health Coverage Exemptions (PDF). Enter the name, Social Security number, and ECN for each member of your household who’s eligible for the exemption.

6. Be sure to include your completed Form 8965 when you file your tax return.

Posted in: Individuals