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.