Open Enrollment November 1 - December 15, 2019

Health Care Marketplace Applications

These are SAMPLE forms below. To get official rates for you and your family or to speak to a representative simply start here.

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Beginning October 1, 2013, you will need to complete this application and submit it to the Health and Human Services (HHS). These new applications are considerably shorter than traditional health insurance applications and should only take you about 7 mins to complete. The online application will be the fastest way to apply and find out instantly what financial assistance you may qualify to receive, but the HHS will also provide in-person and phone applications with counselors for those that need assistance.

[button size=”large” url=”https://s3.amazonaws.com/hcmpfiles/uploads/2013/06/marketplace-app-short-form.pdf” text=”Application for Individuals”]

[button size=”large” url=”https://s3.amazonaws.com/hcmpfiles/uploads/2013/06/marketplace-app-family.pdf” text=”Application for Families”]

[button size=”large” url=”https://s3.amazonaws.com/hcmpfiles/uploads/2013/06/marketplace-app-no-financial-assistance.pdf” text=”Application for Individuals without Family Assistance “]

About

This website is privately owned and all information and advertisements are independent and are not associated with any state exchange or the federal marketplace. Additionally, this website is not associated with, sanctioned by or managed by the federal government, the Centers for Medicare & Medicaid, healthcare.gov or the Department of Health and Human Services.

About

This website is privately owned and all information and advertisements are independent and are not associated with any state exchange or the federal marketplace. Additionally, this website is not associated with, sanctioned by or managed by the federal government, the Centers for Medicare & Medicaid, healthcare.gov or the Department of Health and Human Services.

Need Help?

Call to speak with a representative M-F 8am-7pm EST

1-800-219-7214

Health Network Group, LLC
301 Clematis Street
STE 3000
West Palm Beach, FL 33401
844-519-5533