ACA Authorization Form | Trimble Health

ACA Authorization

Confirm your details.

This form authorizes Trimble Health to act as your agent/broker on HealthCare.gov.

Don’t fill this out:

First Name

Last Name

Phone Number

Date of Birth

Social Security Number Used only to verify your identity on HealthCare.gov.

Zip Code

I authorize Trimble Health to act as my authorized representative on the Health Insurance Marketplace and to assist me with my enrollment and coverage questions.

Authorization received!

We’ll confirm your broker-of-record status on HealthCare.gov and follow up by email.

Why we ask

What this authorization does.

Being listed as your agent/broker of record lets us view your marketplace application, help you compare plans, and fix enrollment issues on your behalf. You’re never locked in and can revoke it anytime.

No cost

Authorization never changes your premium

Revocable

Remove us as your broker anytime

Secure

Sent over an encrypted connection

Authorize Trimble Health as your agent.

Confirm your details.

Authorization received!

What this authorization does.