Consumer Forms, Appeal Process and Tax Information

Consumer Forms, Appeal Process and IRS Information

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 Form

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 morewww.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 2017 Health Coverage Statements:

Learn more now

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