Online Application

Easy Online Application For Quick & Easy Enrollment
Affordable Plans with Exclusive Benefits
4 Out 5 People Get $10 or less Premiums Without Any Hassle

Easy Online Application For Quick & Easy Enrollment
Affordable Plans with Exclusive Benefits
4 Out 5 People Get $10 or less Premiums Without Any Hassle

Register for INSTANT ACCESS to the TFRA Webinar

First Name *

Last Name *

City *

State *

Email *

Phone *

Date of birth *

Captcha

I agree to terms & conditions and privacy policy provided by the company. By providing my phone number, I agree to receive text messages from the business.

**Obtain Affordable Health Insurance through the**

Subsidized Marketplace in Tennessee today!

Complete the Tennessee survey for personalized insurance options and be sure to check your email (including spam) for important updates from us!

Let's Start with Basic Info

First Name *

Last Name *

Gender *

Male
Female
No elements found. Consider changing the search query.
List is empty.

Date of birth *

Email *

Phone *

Address (NO PO BOX's)*

City *

Postal code *

Marital Stauts *

Single
Married
Widowed
Separated
Divorced
No elements found. Consider changing the search query.
List is empty.

Spouse's Name *

Spouse's DOB *

Spouse's Employment *

Employed
Unemployed
Social Security Benefits
No elements found. Consider changing the search query.
List is empty.

Spouse's Estimated Annual Income - If any *

Spouse's Employer Name *

Do you want your Spouse covered on this policy? *

Yes

Spouse's Social Security Number *

Your current employment status? *

Employed

Unemployed

Receiving Social Security

Medicaid Health

Employer Name *

Approximate Annual Income *

Can you please provide an ESTIMATE of your annual income? *

$0 - $22K

$23 - $25K

$26 - $30K

$31 - $36K

Monthly Social Security Income *

Are you enrolled in any of these plans? *

Medicare

Medicaid

None

Do you have children you claim on your taxes? *

Yes

First child's first and last name *

Child's DOB *

Do you have a second child? *

Yes

Second child's first and last name *

Second child's DOB *

Do you have a third Child? *

Yes

Third child's first and last name *

Third child's DOB *

Do you have a fourth Child? *

Yes

Fourth child's first and last name *

Fourth child's DOB *

Do you have a primary care doctor you see regularly? *

Yes

Please list any Doctors' that you want to keep and the location you see them. *

Do you take any medications currently? *

Yes

Please list all medications and dosages that you are currently talking. *

Are you a smoker? *

Yes

Do you also need a dental plan? *

Yes

What type of work do you need your dental plan to cover? *

Need Work Done
Just Preventative Cleanings
No elements found. Consider changing the search query.
List is empty.

Do you need a Vision Plan? *

Yes

How often do you need new glasses/contacts? *

Every Year
Every 2 Year
Not At All
No elements found. Consider changing the search query.
List is empty.

Social Security Number (9 Digits) *

A Full 9 Digit Social is Required to Qualify

Attestations

By clicking on this box, I agree to the following:

I agree to have my personal identifying information (PII) used and retrieved from third-party data sources for this application. If there are multiple parties to be covered under my policy, I have consent for their PII to be used and retrieved for third-party data sources as well.
I agree that Charles P. Taylor may use my PII to compare health insurance plans based on costs, benefits and other important features; to determine eligibility for health coverage and cost-sharing reductions; to choose a plan; and to enroll me in coverage.
I attest that I am not currently enrolled in any other health insurance, whether private or goverment sponsored.
I attest that I am not currently incarcerated, nor is anyone else applying for coverage under this application currently incarcerated.
I understand not all policies will come with a healthy reward card, this depends on several factors; such as location, income, program availability, and what you might already be enrolled into.
Charles P. Taylor will choose the best policy that Health Sherpa tells us with the information you have provided.
I agree that Charles P. Taylor and its licensed agents will be my agent of record (AOR). As AOR, Charles P. Taylor
Has the authority to use my PII to enroll me in affordable health care through the Marketplace. This Consent of Aurthorization will remain in full force and effect unless expressly rescinded in writing to [email protected].
I attest that I will file a federal tax return in the year 2024 for the tax year 2023, and the same in perpetuity to keep my benefits with the Affordable Care Act.
I understand that the Internal Revenue Service (IRS) will compare the income I provided on my application with the income I claim on my federal tax return. If the income on my tax return is lower than the income in my application, I may be eligible to get an additional tax credit amount. If the income on my tax return is higher than the income in my application, I may owe additional federal income tax.
I understand that my application information may be disclosed to other federal agencies so that my eligibility for affordable health insurance through the Marketplace can be determined.
I attest that if any information listed on my original application changes it is my responsibility to update the information either directly through the federal Marketplace or through Charles P. Taylor. Charles P. Taylor will then update my application through the Marketplace on my behalf. I can also make changes by accessing my online Marketplace account or by calling 1-800-318-2596. Further, if any information changes from my original application, I understand that this may affect eligibility for members of my household.
I understand that Charles P. Taylor communications may contain links to other websites that are not operated by Charles P. Taylor. The company has no control over and assumes no responsibility for the content, privacy policies or practices of any third-party sites or services.
I attest that all information provided in this application is true and accurate to the best of my knowledge.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Your signature *

Clear

Obtain Affordable Health Insurance through the Subsidized Marketplace in Tennessee today!

Complete the Tennessee survey for personalized insurance options and be sure to check your email (including spam) for important updates from us!

Let's Start with Basic Info

First Name *

Last Name *

Gender *

Male
Female
No elements found. Consider changing the search query.
List is empty.

Date of birth *

Email *

Phone *

Address (NO PO BOX's)*

City *

Postal code *

Marital Stauts *

Single
Married
Widowed
Separated
Divorced
No elements found. Consider changing the search query.
List is empty.

Spouse's Name *

Spouse's DOB *

Spouse's Employment *

Employed
Unemployed
Social Security Benefits
No elements found. Consider changing the search query.
List is empty.

Spouse's Estimated Annual Income - If any *

Spouse's Employer Name *

Do you want your Spouse covered on this policy? *

Yes

Spouse's Social Security Number *

Your current employment status? *

Employed

Unemployed

Receiving Social Security

Medicaid Health

Employer Name *

Approximate Annual Income *

Can you please provide an ESTIMATE of your annual income? *

$0 - $22K

$23 - $25K

$26 - $30K

$31 - $36K

Monthly Social Security Income *

Are you enrolled in any of these plans? *

Medicare

Medicaid

None

Do you have children you claim on your taxes? *

Yes

First child's first and last name *

Child's DOB *

Do you have a second child? *

Yes

Second child's first and last name *

Second child's DOB *

Do you have a third Child? *

Yes

Third child's first and last name *

Third child's DOB *

Do you have a fourth Child? *

Yes

Fourth child's first and last name *

Fourth child's DOB *

Do you have a primary care doctor you see regularly? *

Yes

Please list any Doctors' that you want to keep and the location you see them. *

Do you take any medications currently? *

Yes

Please list all medications and dosages that you are currently talking. *

Are you a smoker? *

Yes

Do you also need a dental plan? *

Yes

What type of work do you need your dental plan to cover? *

Need Work Done
Just Preventative Cleanings
No elements found. Consider changing the search query.
List is empty.

Do you need a Vision Plan? *

Yes

How often do you need new glasses/contacts? *

Every Year
Every 2 Year
Not At All
No elements found. Consider changing the search query.
List is empty.

Social Security Number (9 Digits) *

A Full 9 Digit Social is Required to Qualify

Attestations

By clicking on this box, I agree to the following:

I agree to have my personal identifying information (PII) used and retrieved from third-party data sources for this application. If there are multiple parties to be covered under my policy, I have consent for their PII to be used and retrieved for third-party data sources as well.
I agree that Charles P. Taylor may use my PII to compare health insurance plans based on costs, benefits and other important features; to determine eligibility for health coverage and cost-sharing reductions; to choose a plan; and to enroll me in coverage.
I attest that I am not currently enrolled in any other health insurance, whether private or goverment sponsored.
I attest that I am not currently incarcerated, nor is anyone else applying for coverage under this application currently incarcerated.
I understand not all policies will come with a healthy reward card, this depends on several factors; such as location, income, program availability, and what you might already be enrolled into.
Charles P. Taylor will choose the best policy that Health Sherpa tells us with the information you have provided.
I agree that Charles P. Taylor and its licensed agents will be my agent of record (AOR). As AOR, Charles P. Taylor
Has the authority to use my PII to enroll me in affordable health care through the Marketplace. This Consent of Aurthorization will remain in full force and effect unless expressly rescinded in writing to [email protected].
I attest that I will file a federal tax return in the year 2024 for the tax year 2023, and the same in perpetuity to keep my benefits with the Affordable Care Act.
I understand that the Internal Revenue Service (IRS) will compare the income I provided on my application with the income I claim on my federal tax return. If the income on my tax return is lower than the income in my application, I may be eligible to get an additional tax credit amount. If the income on my tax return is higher than the income in my application, I may owe additional federal income tax.
I understand that my application information may be disclosed to other federal agencies so that my eligibility for affordable health insurance through the Marketplace can be determined.
I attest that if any information listed on my original application changes it is my responsibility to update the information either directly through the federal Marketplace or through Charles P. Taylor. Charles P. Taylor will then update my application through the Marketplace on my behalf. I can also make changes by accessing my online Marketplace account or by calling 1-800-318-2596. Further, if any information changes from my original application, I understand that this may affect eligibility for members of my household.
I understand that Charles P. Taylor communications may contain links to other websites that are not operated by Charles P. Taylor. The company has no control over and assumes no responsibility for the content, privacy policies or practices of any third-party sites or services.
I attest that all information provided in this application is true and accurate to the best of my knowledge.

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Your signature *

Clear

No calls, no hassle—just chat with our Agents.

Each application needs to be filled out completely and double verified after you choose your plan. A licensed agent will then communicate with you about any additional information they need. The day the plan is written and approved you will receive a text message with a copy of the plan, link to look up additional Doctors and Drugs, and a link to that carrier’s rewards program.

This will be followed up by an email from www.healthcare.gov as well as receiving all information and appropriate cards in the mail in 3-4 weeks. You are all set.

How it works

No calls, no hassle—just chat with our Agents.

Each application needs to be filled out completely and double verified after you choose your plan. A licensed agent will then communicate with you about any additional information they need. The day the plan is written and approved you will receive a text message with a copy of the plan, link to look up additional Doctors and Drugs, and a link to that carrier’s rewards program.

This will be followed up by an email from www.healthcare.gov as well as receiving all information and appropriate cards in the mail in 3-4 weeks. You are all set.

Our motive is to make enrollment process easy. And enroll you in $10 or less premium which is depend on your annual household income & state of residence. 4 out of 5 people qualify for $10 or less Premium

Let's start your enrollment Process Now.