Healthcare Reform Quick Forms

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Forms for Groups

EXCHANGE NOTICE-FOR EMPLOYERS OFFERING COVERAGE

All employers are required to notify new employees about the new health insurance “exchanges” or marketplaces and current employees annually thereafter. This sample form will make this task easier for you.

EXCHANGE NOTICE-FOR EMPLOYERS NOT OFFERING COVERAGE
All employers are required to notify current and new employees about the new health insurance “exchanges” or marketplaces annually . This sample form will make this task easier for you. This form is specifically worded for employers who will no longer, or currently do not, offer employer paid coverage.

ACA Compliant Company Census Form

Use this form to give us your employee information. This is an updated form for the 2014 ACA compliant plans. Please note that under the ACA we must collect dependent data such as date of birth and also tobacco user status of all members. The more accurate the information is, the more accurate your quotes will be! This can also be faxed to us at our secure fax (888)287-3186.

Mini-COBRA Model Notice Template  Click to download a model notice for Mini-COBRA

 

Forms for Individuals

Getting enrolled Total Benefit Solutions Inc has designed a custom form for our clients to use. Using this form and submitting it to Total Benefit Solutions Inc  will enable our Marketplace trained and certified licensed independent brokers to assist you in the enrollment process from  the registration right through the enrollment! Remember as your independent broker we always work in your best interests,  not an insurance company. We represent you, our client and not an insurer or government agency.

Click the link below to open the form and get started!  When completed, just click the link to attach it to an email, or print and fax it to our toll free secure fax at 1 (888)287-3186. It couldn’t get any easier!

Get the form and get started!

Assigning a Broker
Want to do it yourself? When enrolling on the Marketplace at healthcare.gov you must assign an authorized representative to help you during registration. This form is a quick and easy instruction sheet on how to complete that step of the registration process.


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