Please fill out this questionaire to determine if you are eligible for a health insurance subsidy.
New Clients Only
If more than, pls put in additional information.
The exception is if the LOWEST COST job insurance offered to the You ONLY is MORE THAN 9.5% of the HOUSEHOLD income, then you can apply for ACA.
Please include a copy of your id.
By signing this this form, you agree to allow Chi Ching Financial to use this information to assist you in enrolling in a health insurance and/or dental insurance plan.
Enter the correct verification code.