You can use this application to: â–« Apply for free or low-cost insurance from Medicaid or Nevada Check-Up. If you cannot provide the requested documents, you may submit this "letter of explanation.How to fill out the Application for Health Insurance in Nevada? Download and print the health plan form you need. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. Before you submit a Non-Plan Provider Claim. Form to us, find out if it is necessary to do so. Here you can find plan information and use the waiver form during the waiver periods to waive out of UNLV's insurance plan with comparable coverage. Com to find coverage in your area. The information shown on Form 1095A helps you complete your federal individual income tax return.