Get ready to apply
Michigan Department of Health and Human Services
CSHCS Insurance Premium Payment
What you get
Cost-effective premium assistance may help you keep private health coverage; separate review and documentation apply. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- Fax to 517-335-9491
- Your time
- About 15 minutes
- Last checked
- Aug 27, 2026
Before you start, check you fit
- If applicable, include your COBRA election form and a pharmacy cost report.
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open the application PDF ↗ Checked Aug 27, 2026Fax it to 517-335-9491.
What the form asks for
Reason resources are insufficientDescribe the reason for the lack of resources that is impacting the ability to pay for insuranceHave ready
- Completed MSA-0725 premium-payment application.
- Insurance-carrier billing statement or employer statement verifying premium cost.
- Private-insurance or Medicare Explanation of Benefits statements or expenditure summaries.
- Completed COBRA election form when coverage will be maintained under COBRA.
- Pharmacy report showing prescription cost and insurer or Medicare payment when the coverage includes a prescription benefit.
After you send
For questions or status, call the CSHCS Family Phone Line at 800-359-3722. If you have not heard back in two weeks, write and ask whether it arrived.