New applicants use the Idaho Individual Application & Cover Sheet for their region. To choose the correct application, please refer to the region by county list below. The QHP Change Form is used to change an existing member's off-exchange QHP plan. To choose the correct form, please refer to the region by county list below.
North Region - For residents of the following counties: Adams, Benewah, Bonner, Boundary, Clearwater, Idaho, Kootenai, Latah, Lewis, Nez Perce and Shoshone counties
Southwest Region - For residents of the following counties: Ada, Adams, Blaine, Boise, Camas, Canyon, Cassia, Custer, Elmore, Gem, Gooding, Jerome, Lincoln, Minidoka, Owyhee, Payette, Twin Falls, Valley and Washington counties
East/Southeast Idaho Region - For residents of the following counties: Bannock, Bear Lake, Bingham, Bonneville, Butte, Caribou, Cassia, Clark, Custer, Franklin, Fremont, Jefferson, Lemhi, Madison, Minidoka, Oneida, Power and Teton counties
2020 Application Forms
2019 Application Forms
East/Southeast Idaho Region