The forms below are to help you establish an account once you are when ready to enroll in the marketplace.
- BeWellnm Confidentality Statement
- BeWellnm Consent Fillable Form
- beWellnm Fillable Consent (Spanish)
- Marketplace Account Information
- YesNM Account Information
How to file an Appeal
Depending on the situation, consumers may have four options for obtaining relief:
- Request for Casework: for help with a complex case, access to certain special enrollment periods or Form 1095-A that cannot be resolved through other resources;
- Appeal to Marketplace: for help with problems related to a a final Marketplace eligibility determination;
- Appeal to Insurer: for help with problems related to a decision by an insurer or participating provider in a health plan; and
- Complaint to Department of Insurance (OSI): for help with problems related to an insurer’s decision, discrimination by an insurer, or fraudulent selling of insurance
- To learn more.
ACA update and Important Tax Information
Have questions about how the ACA impacts the IRS click on this link to learn more: www.irs.gov/affordable-care-act/individuals-and-families
Have you received your 1095-A, B, and C form in the mail yet? It’s your Health Insurance Marketplace Statement. Like the W-2 you get from your employer, if you enrolled and received coverage through the Marketplace than you should receive a 1095-A in the mail. If you have not received it in the mail when you are ready to file your taxes then you can get an electronic copy by logging into your Marketplace account on HealthCare.gov.
The links below allow you to download and printout the Health Coverage Forms for 2020 Health Coverage Statements: