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 for 2024 ** Before completing the form, please READ before enrolling.
I need an Insurance Policy

I have NOT enrolled in a Marketplace/ACA Plan for 2024

Do not complete this form if you have already completed an enrollment in a Marketplace / ACA Health Insurance Plan for 2024 through either:

  • The Marketplace / ACA.
  • An Agent/Broker.
*If you already have an Insurance Policy,
then select insurance type
.

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

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