Your assigned ACA Agent is Mr. Dennis White. Dennis is a certified ACA Agent and specializes in helping Florida residents obtain healthcare though the federal marketplace, commonly referred to as Obamacare. Dennis’ National Producer Number (NPN) is 18897149.

This self-enrollment service works for individuals and families that may qualify for completely FREE coverage. If based on your entries below it’s determined that you qualify for less than 100 percent government-assisted coverage, Dennis will contact you to discuss your options prior to enrollment.

If you're single and unemployed click here for an abbreviated form.

Families should enter each household member that is reported on your annual tax return. Person2 is reserved for the spouse if married. Person3-8 is used to report dependants (typically children).

Each person' entry should contain the following elements. Gender, Full Name, DOB and SSN. If you don’t want ACA coverage for a listed member, add "NC" after their SSN to indicate "No Coverage" needed. Seperate each element with a comma as shown in this example:
M,John J Doe,06-07-1988,123-45-6789

The household income entry is your best forecast of the total income for this year that will be reported to the IRS next April. This income is used to determine your eligibility and funding.


Person1
Person2
Person3
Person4
Person5
Person6
Person7
Person8
Phone
Email
Address
Zip code
County
Household Income	household income explained income limits table

Is person1 or person2 offered group health insurance at their work?

Does Person1 or Person2 smoke or use any tobacco products?

Does any person require specific doctors to be in-network for offered coverage?

Enter medications by all persons - this is needed to select the best provider that covers these medications.

In the last 60-days, has person1 or person2 have any of the following events: Got married, divorced or have a new baby? Lose your job or start a new job? Have a death in the family? Move to another state or lost your health insurance? Are you losing your medicare or CHIP coverage?

Do you grant permission for your assigned agent, Mr. Dennis White, to become your agent of record as it relates to Obamacare/ACA and to have Mr. Dennis White enroll you into suitable FREE healthcare coverage? Type your initials below to confirm your permission: If for any reason you do not qualify for FREE coverage, Dennis will contact you to discuss your options.