This application can be used to apply for Medicaid, the. Family Planning Benefit Program, or for assistance paying your health insurance premiums.VA's free Agent Orange Registry health exam for eligible Veterans who were exposed to Agent Orange during their military service. The application for life insurance benefits consists of the forms included in this packet, as well as the additional information noted under item 1 below. You MUST sign the Certification below only if you are a United States citizen, Native American or national of the. These pages contain the Benefits Administration Letters (BALs) used for program administration. Many health plans require you to renew your plan each year in order to keep your health coverage and we're here to help you every step of the way. These sample letters can be used in various circumstances you may encounter that require you to communicate with insurance companies. Contact us if you do not understand a notice, or if you cannot do what we ask in the time allowed. Program (NJ FamilyCare).