Health Application

Templates

Health Application

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Insurance

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Datapoint

Description

This is some text inside of a div block.

Applicant Name

Captures the full legal name of the individual applying for health insurance coverage.

Mailing Address

Includes the applicant's street address, city, state, and ZIP code.

Date of Birth

Required to determine eligibility and age-based rating.

Social Security Number (SSN)

Used for identity verification and reporting purposes.

Phone Number

Primary contact number for the applicant.

Email Address

Used for policy communications and documentation.

Marital Status

Required for determining family plan eligibility and tax credits.

Requested Coverage Start Date

Indicates the date the applicant wishes the health insurance coverage to begin.

Dependent Name(s)

Captures the name of each individual to be covered under the application in addition to the primary applicant.

Relationship to Applicant

Indicates whether each dependent is a spouse, child, or other eligible individual.

Dependent Date of Birth

Used for age-based premium calculation.

Dependent SSN

Required for all dependents (if available) for identification and IRS reporting.

Estimated Household Income

Highlights estimated household income to determine eligibility for subsidies or cost-sharing reductions under ACA or similar programs.

Alcohol Use

Returns whether the applicant or dependents use alcohol products, which may impact premium rates.

Tobacco Use

Indicates whether the applicant or dependents use tobacco products, which may impact premium rates.

Eligibility for Other Coverage

Discloses whether the applicant has access to other coverage (e.g., through employer, Medicare, Medicaid).

A health insurance application gathers key information needed to determine eligibility, calculate premiums, and enroll individuals and their dependents in coverage. Feathery’s AI automatically extracts structured data including applicant identifiers, contact details, and requested coverage start date, as well as dependent information such as names, relationships, dates of birth, and Social Security Numbers. It also captures financial and lifestyle details like estimated household income, alcohol and tobacco use, and eligibility for alternative coverage options.

By automating data capture and validation, Feathery reduces manual entry, improves accuracy, and accelerates the enrollment process. This enables insurers and brokers to efficiently calculate age-based rates, apply subsidies or cost-sharing reductions, and deliver faster, more reliable onboarding for applicants and their families.

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