1095-A Form look up

1095-A HELP

1095-A FORM:

* Indicates required field

Please notify your client that we may call him/her for verification and permission to access information with the healthcare exchange. In order to stay compliant with current federal (HIPAA) laws, please certify that your client is in full agreement or he/she is filing out this form on themselves. *

Tax client's Info:

Name *

First

Last

Date of Birth 01/01/2001 *

Phone Number *

What insurance did you have in 2022 *

Terms of agreement *

I (tax client) understand that by entering my name below, I am certifying and agreeing to the terms. *

Name (I understand and agree) *

First

Last

return email *

I Agree

Contact: Georgia Health Advisor 912-323-8808
Email: georgiahealthinsurance@aol.com

For full disclosure:

I agree to allow an agent with "All-Health" access to my healthcare.gov account, in order to retrieve and make available, my 1095-a info. I know and understand that this will effectively make said agent my agent of record. And I can, in the future rely on said agent for information and updates about my healthcare.gov account.