-Updated for American Rescue Act 2021-
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Affordable Care Act 2021 Checklist 

    Thank you for the opportunity to help with your health insurance for 2021.  Completing this form will provide us with an estimate of your premium discount tax credit so we can help you select the most effective plan. 
    Please tell us about your current coverage so we may "Compare and Save."  If you don't have insurance now, please select that option under "Current Insurance Co."  dropdown menu.
    Important -  Many New 2021 plans have limited networks of Doctors, Specialists and Hospitals.  List your information below. Please let us know who will be getting coverage.  If you have more than 3 children–please provide additional info for them in the "Comments" box.
    Premium Discount Tax Credits (Subsidy) Information
    https://www.kff.org/interactive/subsidy-calculator/
     Completing this will allow us to estimate your Premium Discount. You may also get an estimate HERE
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    HEALTH INSURANCE MARKETPLACE CALCULATOR
    ​Have you reconciled your Advance Premium Tax Credit or Prior years tax returns for:
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    ​Thank you for completing this form.  For 20 years we have worked hard to live up to our motto of "More Value for Your Insurance Dollar$"  We appreciate the opportunity to work with you.
Disclaimer: We verify your doctor's status by the insurance companies “in network provider list” as published on their website. It is advisable to check with your doctors as to their arrangements with the insurance companies.
We are bound under federal regulations to protect your personal information. (PII)