In order to research what the best options are for you or your family I need the following information in order to get Health Insurance Quotes. Due to the changes in the Health Insurance industry over the last several years I do charge an up front Agent Fee of $200 to research all of the options in your area and to provide quotes, plan information, and application instructions.
Open Enrollment generally is between November 1st and December 15th for policies that start January 1st.
Outside of Open Enrollment you generally must select a qualifying event from the Special Enrollment Box below. However there is a COVID-19 special enrollment from 2/15/21 – 8/15/21 so if sending your form during that window there is no reason to select a qualifying event.
I do not charge if you an instant quote? Click here: Marketplace Quotes
If after reviewing the quotes you want my assistance in selecting the best plan for you or your family then please return to this page and complete the remainder of this form.
If you are requesting enrollment outside of the Annual Enrollment Period, then you must qualify for one or more of the following events in the past 60 days (check all that apply):