Enroll in No-Cost $0 Health Insurance Today + Subsidies

If your family income is in the BLUE RANGE , you qualify for a $0 or low cost health plan with subsidies. Apply now!

You may qualify for a $500 Rewards card that can help you pay for utilities and rent.

HOW IT WORKS

1.FILL UP THE FORM

2.EVALUATION

3.GET FREE HEALTH INSURANCE

First Name *

Last Name *

Phone *

Email *

City *

Address *

State *

Postal code *

Gender *

Date of birth *

What is your employment status? *

Are you currently on Medicare or Medicaid? *

How much was your household income last year? *

What is your projected annual household income for this upcoming year? *

Do you currently have health insurance? *

Do you have a Primary Care Physician (Doctor) that you want to keep? *

Physician Full Name *

Name of Physician's Practice *

Physician's Practice Address *

Please select your Marital Status *

Please enter your Spouse's First Name *

Please enter your Spouse's Last Name *

Please select your Spouse's Gender *

Please select your Spouse's Income *

Do you wish to enroll your Spouse? *

Do you have tax dependents (typically children)? *

Number of Tax Dependents *

Enter Tax Dependent's information below

First Name *

Last Name *

Date of Birth *

Do you wish to enroll this dependent as well? *

Enter Tax Dependent's Information Below

First Name *

Last Name *

Date of Birth *

Do you wish to enroll this dependent as well? *

Enter Tax Dependent's Information Below

First Name *

Last Name *

Date of Birth *

Do you wish to enroll this dependent as well? *

Enter Tax Dependent's Information Below

First Name *

Last Name *

Date of Birth *

Do you wish to enroll this dependent as well? *

Enter Tax Dependents Information Below

First Name *

Last Name *

Date of Birth *

Do you wish to enroll this dependent as well? *

Consent

I give my permission to Keisha Nevers to serve as the health insurance agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by telephone only for the purposes of one or more of the following:

1. Searching for an existing Marketplace application;

2. Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums;

3. Providing ongoing account maintenance and enrollment assistance, as necessary; or

4. Responding to inquiries from the Marketplace regarding my Marketplace application. I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII is kept private and safe when collecting, storing, and using my PII for the stated purposes above.

I confirm that the information I provide for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge. I understand that I do not have to share additional personal information about myself or my health with my Agent beyond what is required on the application for eligibility and enrollment purposes.

I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by emailing Obeliskinsurance@gmail.com

I, Keisha Nevers, a licensed and experienced health insurance agent, hereby provide this attestation to acknowledge your agreement to the contents outlined below. By affixing your signature below, you respectfully request me or my agency affiliates to enroll both yourself and/or your family in the most suitable zero premium ACA plan available.

Please note that if there are no zero premium health plans available in your area based on the provided information, we will inform you of the available plans and seek your consent before proceeding with enrollment.

In addition to enrolling you in the optimal ACA plan, you authorize me or my agency to access your healthcare.gov account and submit the necessary information as required, in accordance with the details provided.

By signing below, you acknowledge the following:

You agree to the terms and conditions outlined in this attestation.

You respectfully request my expertise or that of my agency affiliates to enroll you and/or your family in the most suitable zero premium ACA plan available.

In the event that no zero premium health plan is available in your area, you understand that we will disclose the available plans and seek your consent before proceeding with enrollment.

You authorize me or my agency to access your healthcare.gov account and submit the necessary information as required.

Keisha Nevers, NPN: 18161208, 561-556-6892, Obeliskinsurance@gmail.com

Enrollment Agreement *

Our Enrollment Process Takes Less than 5 Minutes to Complete

Terms of Service

By using our services, you agree to the following terms:

Representation

You grant Obelisk Insurance Agency Group the authority to act on your behalf concerning health insurance matters, including enrollment, renewals, and related decisions.

Accuracy

You confirm that all information provided to Obelisk Insurance Agency Group is true and accurate. False or misleading information can lead to the termination of services.

Revocation

Your consent remains in effect until you revoke it. You may revoke or modify your consent at any time by contacting Obelisk Insurance Agency Group.

Limitation of Liability

Obelisk Insurance Agency Group and associated entities are not liable for any errors or omissions in the services provided or for any damages, including indirect or consequential damages.

Privacy Policy

Data Collection

We collect Personally Identifiable Information (PII) solely for the purposes mentioned in our Comprehensive Attestation Agreement.

Data Protection

We are committed to ensuring the privacy and safety of your PII. Your data will not be shared for any purposes other than those explicitly stated in our agreement.

Income Attestation

We use your income information solely to determine eligibility for health insurance programs and potential subsidies.

Contact

For any concerns regarding your data, please contact Obelisk Insurance Agency Group.

TCPA Disclaimer

By providing your phone number, you expressly consent to receive auto-dialed and/or pre-recorded telemarketing calls, text messages, and/or emails from or on behalf of Obelisk Insurance Agency Group at the phone number and email address you provided, including for marketing purposes. You understand that consent is not a condition of purchase. Message and data rates may apply.

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