Maryland Health Connection
You hereby authorize Stride Health, Inc. to act as your Producer of Record in connection with this Application, and you acknowledge and agree that Stride Health, Inc. may use your personally identifiable information in order to complete the eligibility and enrollment process on the Maryland Health Connection. By submitting your application, you agree to the Maryland Health Connection Privacy Notice, Policies and Accessibility. You also acknowledge and agree to the following:
###User Acceptance Agreement###
####Introduction#### In order to apply for any of the plans or programs available through Maryland Health Connection, you will need to create a User ID and password. Your User ID and password verify your identity so that you may have access to your information while restricting access by unauthorized individuals.
####Creating your account#### If you want to establish a Maryland Health Connection account, which allows you to enroll in available plans or programs and provides you with electronic information about benefits and programs you may qualify for, you will be prompted to provide Maryland Health Connection with some basic information and to create a User ID and password. The information you provide will be stored in your user profile and will be managed as described below.
Personally identifiable information is information about an individual that is linked or linkable to a specific individual in a way that can be used to readily identify that individual. We do not collect any personally identifiable information about you, unless you authorize Maryland Health Connection to collect the information. If you choose not to provide the requested information, you will not be able to use the Maryland Health Connection account function.
To create your Maryland Health Connection account, you must provide your first and last name. You will also be required to answer four security questions. These questions, and the answers you provide, are necessary in case you forget your User ID or password.
####Protecting your account#### Your Maryland Health Connection account User ID and password are your keys to obtaining secure information from Maryland Health Connection. To ensure that there is no unauthorized use of the information that Maryland Health Connection has about you, you should not share your Maryland Health Connection account User ID or password with anyone. Your password is confidential and known only to you; if you share it with anyone else; you do so at your own risk.
Maryland Health Connection will secure your password and store it in an encrypted format. If you wish to change your password, you may do so.
If you learn that there has been any unauthorized access to or use of your password or any of the information in your Maryland Health Connection account, please notify Maryland Health Connection as soon as possible by calling 1-855-642-8572 or 1-855-642-8573 for the deaf or hearing impaired. You may not have access to anyone else’s Maryland Health Connection account unless you have received that person’s express consent to do so and you must not falsely represent to Maryland Health Connection that you have such consent. Unless you have consent, you may not use Maryland Health Connection or your Maryland Health Connection account to attempt to access any other individual or household’s personal data other than your own.
####Use and Disclosure of Your Maryland Health Connection Account Information#### Use and disclosure of your data that is stored and managed by Maryland Health Connection is governed by state and federal statutes, regulations, policies and other relevant sources of law. Except as required by law or court order, the information that Maryland Health Connection collects about you is confidential and used and disclosed only for purposes directly connected with the administration of its plans or programs. Maryland Health Connection has taken appropriate steps to safeguard the integrity of this information and to prevent access by unauthorized persons. Violators may be subject to prosecution, fines or other sanctions
Maryland Health Connection will not sell the information managed in your user profile, in either a specific or a generalized format. Maryland Health Connection may collect information it has about users and their usage of Maryland Health Connection accounts to determine trends and make decisions regarding system design and future application updates. Any information collected for this purpose will not be personally identifiable.
Maryland Health Connection is a registered trade name of the Maryland Health Benefit Exchange, an independent State of Maryland agency.
###Application Agreement###
I know that if Medicaid pays for a medical expense, any money I get from other health insurance or legal settlements will go to Medicaid in an amount equal to what Medicaid pays for the expense.
I know I'll be asked to cooperate with the agency that collects medical support from an absent parent. If I think that cooperating to collect medical support will harm me or my children, I can tell the agency and I won't have to cooperate.
I know that I must tell the Maryland Health Connection if anything changes from what I included on this application. I can contact the Call Center at 1-855-642-8572 or visit MarylandHealthConnection.gov to report any changes.
I know that any change that I report may alter mine or my household's eligibility status. If the change results in me and my household becoming ineligible for help paying for health coverage, I and my household may no longer receive help paying for coverage.
I’m signing this application under penalty of perjury. This means I’ve provided true answers to all the questions including incarceration status on this form, to the best of my knowledge. I understand that the Maryland Health Connection will use data from other State and Federal sources to determine eligibility. I know that if I’m not truthful, there may be a penalty.
I understand that Maryland Health Connection will use data from my tax return during the renewal process to determine yearly eligibility for help paying for health insurance for the next 5 years. I understand that if I check this box I can change my answer later, and if I don’t check the box I can select less than 5 years.