In order for us to process your enrollment thru the Health Insurance Marketplace, please sign the authorization form below.
Information Needed for Quote and/or Enrollment
- Immigration documentation (i.e. residence card)
- Social Security numbers & Birth dates for all household members
- To qualify for financial assistance(tax credits) we need income, expenses, and deductions of everyone in your household, even those not applying for coverage.
- Employer and household income information (i.e. tax return)
- Anyone you include on your tax return as a dependent, even if they don’t live with you.