(Might need one or more.)

• Permanent Resident Card, “Green Card” (I-551)
• Reentry Permit (I-327)
• Refugee Travel Document (I-571)
• Employment Authorization Document (I-766)
• Machine Readable Immigrant Visa (with temporary I-551 language)
• Temporary I-551 Stamp (on passport or I-94/I-94A)
• Arrival/Departure Record (I-94/I-94A)
• Arrival/Departure Record in foreign passport (I-94)
• Foreign Passport
• Certificate of Eligibility for Nonimmigrant Student Status (I-20)
• Certificate of Eligibility for Exchange Visitor Status (DS-2019)
• Notice of Action (I-797)
• Document showing membership in a federally recognized Indian tribe or American Indian born in Canada
• Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
• Document saying withholding of removal
• Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
• Alien number (also called alien registration number or USCIS number) or I-94 number
• USCIS Acknowledgement of Receipt (I-797C)

Note: Undocumented immigrants cannot get Marketplace Health coverage. They may apply for coverage on behalf of documented individuals.

• Lawful Permanent Resident (LPR/Green Card holder)
• Asylee
• Refugee
• Cuban/Haitian Entrant
• Paroled into the U.S.
• Conditional Entrant Granted before 1980
• Battered Spouse, Child, and Parent
• Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
• Temporary Protected Status (TPS)
• Deferred Enforced Departure (DED)
• Lawful Temporary Resident
• Member of a federally recognized Indian tribe or American Indian born in Canada
• Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
• Individual with Non-immigrant Status, includes worker visas (such as H1, H-2A, H-2B), student visas, U-visa, T-visa, and other visas, and citizens of Micronesia, the Marshall Islands, and Palau
• Deferred Action Status (Exception: Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
• Administrative order staying removal issued by the Department of Homeland Security

• Open enrollment starts November 1^st
• Open enrollment ends on January 15^th, and the last day to enroll for coverage starting on February 1^st is January 15^th.
• After January 15^th, you can only get a health plan if you qualify for a Special Enrollment Period (SEP’s). [View them here.]
• You can apply for Medicaid or the Children’s Health Insurance Program (CHIP) at any time of the year.

• Typically, any income changes ~$5,000 should be updated in Health Sherpa to prevent issues when filing taxes
• You can report these changes to the Marketplace online, by phone, or in person. You can also reach out to your agent, and they can update it for you.

Use this link and sign in to upload documents here.

If you are submitting by mail:

• Send photocopies only
• Include your printed bar code page. This can be found on the last page of your eligibility notice. If you do not have a bar code, include the client’s printed name and application ID.
• Mail the document to:

Health Insurance Marketplace

Attn: Supporting Document

465 industrial Blvd.

London, KY 40750-001

Get ahold of your agent to have them help you through the process and explain what the best options are.

If you would like, you can keep your marketplace coverage plan too. Once your Medicare Part A (Hospital Insurance) coverage starts, you will no longer be eligible for any premium tax credits or other cost savings you may be getting for your Marketplace plan. You will pay full price for the Marketplace plan.

The best practice to check if your client’s policy is effectuated is to check the correlating carrier’s agent portal that you signed them up on. For example, if you signed them up with Allstate, you would check Allstate’s agent portal.

You can also check if your client’s policy is effectuated by calling the carrier as well.

The modified adjusted gross income is the total of the following for each member of your household who must file a tax return:

• The adjusted gross income (AGI) on the federal tax income
• Exclude foreign income
• Nontaxable social security benefits (including tier one railroad retirement benefits)
• Tax-exempt interest
• Modified adjusted gross income (MAGI) does not include supplemental security income (SSI)

You will include your gross income if you have a W-2. Marketplace savings are based on your expected household income for the year you want coverage, not last year’s income. You can view this link on how to estimate your expected income for the year you want coverage

• Count income & household size

If you are sixty-five and older, but have not reached forty quarters of employment, you can buy insurance in the Marketplace and get lower costs on monthly premiums and out-of-pocket costs based on your household size and income.

You can view all the SEP’s here

• To prove eligibility during a SEP, you may need to provide specific documents or information. Here ae some common scenarios and the corresponding documentation:

1. Qualifying Life Events (QLEs):

• Marriage: marriage certificate.
• Birth or Adoption: Birth certificate or adoption papers.
• Loss of Other Coverage: Letter or notice from your previous health insurance provider indicating the end of coverage.

Change in Household Income: Pay stubs, tax returns, or other income verification documents.

• Change in residence: proof of address change

1. Unexpected situations:

• Medical Emergency: Medical records, hospital discharge summary, or doctors note.
• Natural Disasters: Proof of residence in an affected area (FEMA letter)

2. Enrollment or Plan Errors:

• Misinformation or Misrepresentation: Any relevant communication or evidence of the error.
• Technical Errors: Screenshots or descriptions of the issue met during enrollment.

3. Newly eligible for Savings:

• Income change: Pay Stubs, tax returns, or other income verification documents.
• Moving from a Non-Expansion State: Proof of new address and income.

4. Dependent Due to Court Order:

• Child support or Custody order: Court order or legal documentation.

Remember that the specific documents needed may vary based on your circumstances and the reason for your SEP. It is best to consult with the Health Insurance Marketplace or a certified Navigator for personalized guidance.

COBRA insurance coverage is a federal program which stands for Consolidated Omnibus Budget Reconciliation Act. It provides eligible individuals with the choice to continue their existing group health insurance coverage under certain circumstances. Here are some key takeaways:

• Eligibility: If you lose your job, reduced work hours, transition between jobs, experience death or divorce, or encounter other life events, you may qualify for COBRA coverage.
• Continuation of health benefits: COBRA allows you to extend your existing group health benefits provided by your employer. This continuation usually lasts for at least 18 months and up to 36 months in some cases.
• Costs: Qualified individuals must pay the entire premium for coverage, which can be up to 102% of the plan’s cost. Additionally, there may be admin fees.
• Notice & Election: Employers and plans must provide notice about COBRA rights, and eligible individuals can elect continuation coverage.
• Coverage Transition: COBRA makes it easier to keep your existing doctors and pharmacists, even if they are out of network when you switch plans.

The “family glitch” refers to a situation where family members of employees are unable to receive health insurance premium subsidies because the employee’s self-only health insurance is considered affordable, even if the cost of obtaining family coverage makes it unaffordable to the household.

Some states do not offer PPO plans, Texas being a big one.

• Exclusive Provider Organization (EPO): A managed health care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in the case of an emergency).
• Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contact with the HMO. It generally will not cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
• Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor to see a specialist.
• Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network, you can use doctors, hospitals, and providers outside of the network without a referral for an added cost.

Catastrophic health insurance plans have low monthly premiums and remarkably high deductibles. They may be an affordable way to protect yourself from worst-case scenarios, like getting seriously sick or injured. On the other side, you pay most routine medical expenses yourself.

• Mainly people under 30 years old.
• People aged 30 or older with a hardship exemption or affordability exemption (based on Marketplace or job-based insurance being unaffordable).
• Link for more info

Yes, dental coverage is available through the Marketplace in two ways:

1. Health plans with dental coverage: Some health plans include dental coverage. When you compare plans, you can see which ones offer dental benefits. If a health plan includes dental coverage, the premium covers both health and dental services.
2. Separate dental plans: In some cases, separate dental plans are offered. You can find these plans when you shop for options in the Marketplace. If you choose a separate dental plan, you will pay a separate premium in addition to the premium for your health plan.

Keep in mind that dental insurance is treated differently for adults and children:

• Children (18 and under): Dental coverage is an essential health benefit for kids. If you are getting health coverage for someone 18 or younger, dental coverage must be available either as part of a health plan or as a separate dental plan. You do not have to buy it.
• Adults: Dental coverage is not an essential health benefit for adults, so health plans do not have to offer adult dental coverage.
• 3^rd party dental plans are recommended (i.e., Allstate, Healthy America, Humana).

For all Adults – here

For Women – here

For Children – here

Chiropractic Care:

• Coverage Varies: Chiropractic care is often covered by health insurance, but the extent of coverage varies. Here are some key points:
• Big Insurance Companies: Approximately 91% of major insurance companies cover prescribed chiropractic care.
• Limitations: Coverage typically includes 15 to 25 prescribed visits with a $20 to $30 copay.
• Partial Coverage: Partial insurance coverage is more common than complete coverage.
• Out-of-Pocket Costs: Patients may still need to pay out-of-pocket for some services.

Acupuncture:

• Partial Coverage: About 32% of big insurance firms cover acupuncture.
• Annual Limit: Coverage is usually limited to approximately 20 visits per year.
• Check Your Plan: Verify with your specific insurance plan to understand the details of acupuncture coverage.

Massage Therapy:

• Limited Coverage: Roughly 17% of large insurance firms cover massage therapy.
• Criteria: Coverage is typically considered if physical therapy and medication have not provided sufficient relief.
• Individual Plans: Check your individual health plan to figure out if massage therapy is covered.

Alternative Payment Options:

• Health Savings Accounts (HSAs): Consider using an HSA to cover costs for treatments not fully covered by insurance. HSAs allow you to set aside pretax dollars for qualified medical expenses, including alternative therapies.

Contact Your Insurance Provider:

• Before seeking alternative treatments, reach out to your insurance company’s member services representative or review your plan documents.

HSA plan, also known as a High Deductible Health Plan (HDHP) It is a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.

If you enroll in an HSA-eligible plan, you may pay a lower monthly premium but have a higher deductible.

If you combine your HSA-eligible plan with HSA, you can pay that deductible, plus other qualified medical expenses. i.e., copayments, coinsurance, and more.

So, if you have an HSA-eligible plan and do not need many health care items and services, you may receive help from the lower monthly premium.

If you need more care, you will save by using the tax-free money in your HSA plan to pay for it.

Your HSA balance rolls over year to year, so you can build up reserves to pay health care items and services you need later.

Under the tax law, HSA-eligible plans must set a minimum deductible and a limit, or maximum, on out-of-pocket costs for both individuals and families.

• The minimum deductible is the amount you pay for health care items and services per year before your plan starts to pay.
• The maximum out-of-pocket costs are the most you will have to pay per year if you need more health care items and services.

If your school offers a student health plan, it can be an easy and affordable way to get basic insurance coverage.

• If you are enrolled in a student health plan, in most cases it counts as qualifying health coverage.
• This means you are considered covered under the health care law and will not have to pay the penalty for not having insurance. Be sure to check with the plan to be sure.

If you are a dependent under 26:

• If you are living in the same state as your parents, you can be included in your parents’ application. Your parents can add you during Open Enrollment (or during a Special Enrollment Period if they qualify). Losing a student health plan may qualify you for a Special Enrollment Period. This way they can add you to their plan outside Open Enrollment. (Voluntarily dropping a student plan does not qualify you for a Special Enrollment Period.)

Living in a different state from your parents: You have two options:

1. Apply for coverage with your parents or stay on their plan. Before you enroll or decide to stay on a parent’s plan, be sure to read the plan’s coverage documents and review the provider network carefully so you know how the plan covers care delivered in the state you go to school.
2. Apply yourself in the state you go to school. You may want to do this to enroll in a plan that better meets your needs in the state you go to school. When you fill out your application, please note:

• You will still be included in your parent’s tax household, even though you are applying separately. They will fill out or update their application and state that you do not need health coverage. Your income will still be counted because Marketplace savings are based on expected income for all tax household members, not just the ones who need insurance.
• You will do the same: When you fill out your own separate application, state that your parents and the other members of their tax household do not need health coverage. But you will include their income on your application.
• The cost of both your plan and your parent’s plan may be reduced with a premium tax credit and extra savings based on the whole household’s income, not just yours.
• When you move to or from the place you live and go to school, you may be eligible for a Special Enrollment Period allowing you to enroll outside the yearly Open Enrollment Period.

• Obtain E&O insurance (either self-coverage, or reach out to Empower to get coverage for contracts exclusively with Empower)
• Fill out the join Empower Brokerage Form
• To begin the process, watch the getting started video on the contracting page via our website. Click here to view it.

You can view all the carriers that you can get contracted with for each state here

Existing and current agents can request more contracts here.

You can also reach out to our contracting team with any contracting questions as well.

P: (817)-410-5888

E: contracting@empowerbrokerage.com

To locate the correct contractor for the specific Individual Medical, Senior products, Ancillary products, and Life/ Financial carrier, please see the full carrier portfolio at the bottom of the contracting page here.

Yes, you need to be both licensed and contracted in every state that you do business in

The hierarchy needs to be licensed and contracted in every state the downline agents do business in as well.

For ACA, the commission is typically paid as earned on a per-customer/per-month basis.

• For any other commission questions, contact our staff.
• E: commissions@empowerbrokerage.com
• P: (817)-410-8186

You can view our production qualifications here, to get invited to this amazing vacation! To get invited, check out the production qualifications here.

Enjoy this video touching on the amazing opportunity here

You can view the FPL chart here

Most Lead Programs provided by Empower come at no cost to the Agent

You will need to be contracted with 3 competitive ACA carriers for the states you are requesting ACA leads for.

• LeadServ
• LeadServ is our proprietary, ultramodern lead distribution system, which can be accessed via the internet and on the go (via the Apple and Android App Store). This is the tool that Empower uses to distribute all our generated leads to agents efficiently.
• The Agent will receive all leads from Empower through LeadServ and can easily disposition these leads on the go.
• When an agent consistently dispositions their leads, it lets us know that the agents are actively working on these leads and encourages us to send them more leads in the future.

• Lead Maximizer
  • This is our data mining engine that allows an agent to search for any life and health insurance market that they would like to target based on search criteria that they select.
  • Once an agent has been contracted with 3-4 carriers through Empower, they can gain access to this tool. We start out with 2000 credits where each credit can be used to generate different names as well as contact information. Productive agents will continue to receive more credits from Empower as needed.
• Social Media Leads
  • We post many consumer-facing advertisements on various social media sites to generate these leads at no cost to the agent. Once a prospective client interacts with our advertisement and provides some contact information, we then get to work distributing these leads to our agents.
• Retail Opportunities
  • We also offer opportunities for agents to work shifts in a retail setting with their own booth. These retail opportunities may include Albertsons, CVS, Kroger, Walgreens, Goodwill, and local grocery stores.

You can find more details here.

If you are interested in expanding your client base and increase your production with our lead programs, please go to the lead page here and fill out the sign-up instructions, select opportunities you are interested in, and acknowledge and submit the form at the bottom of the page.

If you suspect that your client was fraudulently stolen from you or the agent of record (AOR) changes without you knowing, visit this page to see what the proper steps are to get this issue reprimanded.

As an agent, you can set up a PIN security code for you and your clients as well.

As well as referring to the fraudulent agent page and following those steps, you and your client should also report it to the Federal Trade Commission here.

Yes! CMS requires that consumer consent be obtained by the agent or broker prior to aid.

CMS does not prescribe the way agents and brokers must document consent. Instead, there are different formats that may be acceptable for agents and brokers to use to document consumer consent, it can be a recorded phone call, text message, email, electronic document with digital signatures, physical document with wet signatures, and more.

Below are the two documents and call script needed to confirm client consent

• Personally identifiable information (P.I.I.) consumer consent form
• ACA consumer consent call script
• Eligibility application confirmation form
• Personally identifiable information consumer consent for (Spanish)
• ACA consumer consent call script (Spanish)
• Eligibility application confirmation form (Spanish)

• If the client is under Empower, you can retrieve this document under the client page in Health Sherpa
• View this link for more information here