County Health Dept. ListView a list of all the County Health Dept contact phone numbers for Program Eligibility.Program Ins. Enrollment: 1-844-441-4422Call for help with enrollment in Insurance for the Program.Eligibility: 1-844-381-2327Call for help with Program Eligibility.
** Important Changes ** Before completing the form, please READ before enrolling.
I need an Insurance Policy

I have NOT enrolled in a Marketplace/ACA Plan for 2025 and have (or had) a 2024 policy.

Pre-Open Enrollment Easy Renewal: October 1, 2024 - October 31, 2024.
Help maintain your existing insurance plan or to enroll in a new one for 2025.

Do not complete this form if you have already completed an enrollment in a Marketplace / ACA Health Insurance Plan for 2025 through either:

  • The Marketplace / ACA.
  • An Agent/Broker.

Only complete this form if you need assistance with Marketplace / ACA enrollment from BRHPC/American Exchange. American Exchange is a CMS Certified Federally Facilitated Marketplace Agent/Broker in the State of Florida and will act as your Agent of Record upon completing this form.

Before continuing, please ensure you have the required information to enroll:

  • Tax Household Information (for all individuals in your Tax Household):
    • Legal Name (include hyphens, spaces, etc)
    • Date of Birth
    • Social Security Number
    • Income
  • Household size
  • Citizenship or Proof of legal residency (Immigration status indicating lawful presence)
  • Address and preferred contact information

*If you live in Miami-Dade County, go to Miami-Dade Form
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