Methods of Contact

In a medical emergency, call 911. For coverage questions for a service or medication, call the number on the back of your insurance card. Prime Choice Insurance operates between 8AM and 5PM Central, Monday-Friday, and may have extended hours at their discretion. Outside of standard operating hours, please contact the number on the back of your insurance card. Otherwise, please call us and/or email us with general questions.

Rescission

You may rescind consent by providing written notice of rescission. The request shall be effective 60 days from the date of receipt of such notice. The request shall be delivered in writing and sent via certified mail, or emailed to customerservice@primechoiceins.com.

Onboarding / Enrollment

Agency Responsibilities

• Maintain all licenses and certifications as required by the Federal Government, States, and Carriers

• Provide initial consultation and personalized recommendations, based on the needs of the household

• Consider all applicable plans in a geographic area to address needs of customers.

• Facilitate application for Advanced Premium Tax Credits (APTCs) and/or Cost Sharing Reductions (CSRs)

• Facilitate enrollment in client requested insurance plan(s)

• Send confirmation of enrollment

Household Responsibilities

• Ensure accurate and detailed information about the household’s coverage needs, composition, health, and income information

• Request in writing (mail/email) to be enrolled in coverage at least 3 business days before the deadline that is required to have your coverage start on your preferred effective date

• Review the application carefully for accuracy and completeness before submission

• Read carefully, and agree to, all Attestations in the Attestation Summaries section below.

• Create an individual account on the carrier portal

• As requested, submit verification documentation to the exchange, caseworker, and/or insurance carrier

Household Maintenance

Agency Responsibilities

• Process household updates

• Provide ongoing instruction for any questions related to coverage

Household Responsibilities

• Notify your agent if any of the following changes: address, tax household composition, tax filing status, tax household income, insured household members, eligibility for other health insurance coverage

• Make timely premium payments and submit any updates to bank information to your insurance carrier

Renewal / Open Enrollment

Agency Responsibilities

• Conduct market research to be informed of the plan landscape for the following plan year

• Review renewal rates and make plan recommendations

Household Responsibilities

• Review renewal recommendations and confirm household’s coverage needs

• Prior to plan selection, inform Prime Choice Insurance if any of the following has changed: address, tax household composition, tax filing status, tax household income, insured household members, eligibility for other health insurance coverage

• Read carefully, and agree to, all Attestations in the Attestation Summaries section below.

• Assist in timely return of renewal letter with plan selection

Plan Termination

Agency Responsibilities

• Provide termination instructions per insurance carrier guidelines

• When applicable, process termination requests

Household Responsibilities

• Notify your agent to terminate coverage

• When applicable, and if so instructed by your agent, notify your insurance carrier directly to terminate coverage

Renewal of Coverage Attestation

To determine my eligibility for help paying for coverage in future years, I agree to allow the Marketplace use my income data, including information from tax returns, for the next five years. If automatically renewing my coverage, the Marketplace will send me a renewal notice, let me make changes, and I can opt out at any time.

Tax Attestation

I understand that I’m not eligible for a premium tax credit if I am found eligible for other qualifying health coverage such as Medicaid, Children’s Health Insurance Program (CHIP), or a job-based health plan. If I become eligible for other qualifying health coverage, I must contact the Marketplace to end my Marketplace coverage and premium tax credit. If I don’t, the person who files taxes in my household may need to pay back my premium tax credit.

Because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents:

• I must file a federal income tax return for the coverage year

• If I’m married at the end of the coverage year, I must file a joint income tax return with my spouse.

I expect that:

• No one else will be able to claim me as a dependent on their federal income tax return for the coverage year

• I’ll claim a personal exemption deduction on my federal income tax return for the coverage year for any individual listed on the application as my dependent who is enrolled in coverage through the Marketplace, and whose premium for coverage is paid in whole or in part by advance payments of the premium tax credit.

If any of the above changes:

• It may impact my ability to get the premium tax credit

• When I file my federal income tax return for the coverage year, the Internal Revenue Service (IRS) will compare the income on my tax return with the income on my application. I understand that if the income on my tax return is lower than the amount of income on my application, I may be eligible to get an additional premium tax credit amount. If the income on my tax return is higher than the amount of income on my application, I may owe additional federal income tax.

Final Submission Attestation

I know that I must tell the program I’ll be enrolled in if information listed on my application changes. I know I can make changes in my Marketplace account or by calling the Marketplace Call Center. I know a change in my information could affect eligibility for member(s) of my household.

If anyone on my application is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (e.g. Medicare, Medicaid, or Children’s Health Insurance Program), the Marketplace will automatically end their Marketplace plan coverage. This will help make sure that anyone who’s found to have other qualifying health coverage won’t stay enrolled in Marketplace coverage and have to pay full cost.

I’m signing this application under penalty of perjury, which means I’ve provided true answers to all of the questions to the best of my knowledge. I know I may be subject to penalties under federal law if I intentionally provide false information.