Broward Regional Health Planning Council
County Health Dept. List
View a list of all the County Health Dept contact phone numbers for Program Eligibility.
Program Ins. Enrollment:
1-844-441-4422
Call for help with enrollment in
Insurance
for the Program.
Eligibility:
1-844-381-2327
Call for help with Program Eligibility.
Medinova
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Renewed Program Eligibility / Re-Enrollment
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Help
County Health Dept. List
Participating Pharmacies
Tutorials
Glossary of Terms
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Read an Insurance ID Card
Health Insurance Bills
Medicare and Enrollment
Educational Materials
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Client Complaint Procedure
Contact
** Important Changes ** Before completing the form, please
READ
before enrolling.
I have recently renewed my program eligibility
Premium Assistance Re-enrollment
*If are already enrolled in Premium Assistance and you renewed your program eligibility after your eligibility expired or your account was suspended, you are required to complete this form to request Re-enrollment.
You will be asked to verify any changes to the following:
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
Premium Assistance Re-Enrollment
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