To speak with a licensed agent, call 844-YOUNG65 (968-6465)

2025 ACA Renewal Scope
2025 ACA Renewal Scope

BrighterDay Renewal Form Update Request for 2025

Please answer the below questions so we can get a jump start on evaluating your needs for the upcoming plan renewal season so we can make sure you have the proper coverage for 2025. There are many changes this year so we must re-evaluate your current coverage. If you are receiving this then you are a current client of BrighterDay Insurance for your Health Insurance needs. If you have any questions, feel free to reach us at 844-YOUNG65 (968-6465)

By signing below, I am confirming that my 2025 projected total annual household income is: For W2 employees its gross income before deductions. For 1099 Self-Employed its Adjusted Gross Income after Business deductions.

YES! I give BrighterDay Insurance Services and their Independant & Captive Agents and All Employees permission to access my healthcare.gov application and submit it for a health insurance policy for 2025!

YES! I give permission to look up my application and apply for health insurance!

AGREEMENTS, please read the attestations below and sign if you agree.

I agree to have my information used and retrieved from government data sources for this application. I have consent for all people I’ll list on the application for their information to be retrieved and used from government data sources.

I understand that I’m required to provide true answers and that I may be asked to provide additional information, including proof of my eligibility for a Special Enrollment Period if I qualify. If I don’t, I may face penalties, including the risk of losing my eligibility for coverage.

Renewal of coverage to make it easier to determine my eligibility for help paying for coverage in future years, I agree to allow the Marketplace to use my income data, including information from tax returns, for the next 5 years. The Marketplace will send me a notice, let me make any changes, and I can opt out at any time.

TAX ATTESTATION

I understand that I’m not eligible for a premium tax credit if I’m found eligible for other qualifying health coverage, like Medicaid, the Children’s Health Insurance Program (CHIP), or a job-based health plan. I also understand that if I become eligible for other qualifying health coverage, I must contact the Marketplace to end my Marketplace coverage and premium tax credit. If I don’t, the person who files taxes in my household may need to pay back my premium tax credit.

I understand that because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents: I MUST FILE A FEDERAL INCOME RETURN FOR THE 2025 TAX YEAR. If I’m married at the end of 2025, I must file a joint income tax return with my spouse. I also expect that: No one else will be able to claim me as a dependent on their 2025 federal income tax return. I’ll claim a personal exemption deduction on my 2025 federal income tax return for any individual listed on this application as my dependent who is enrolled in coverage through this Marketplace, and who's premium for coverage is paid in whole or in part by advance payments of the premium tax credit. IF ANY OF THE ABOVE CHANGES I understand that it may impact my ability to get the premium tax credit. I also understand that when I file my 2025 federal income tax return, the Internal Revenue Service (IRS) will compare the income on my tax return with the income on my application. I understand that if the income on my tax return is lower than the amount of income on my application, I may be eligible to get an additional premium tax credit amount. On the other hand, if the income on my tax return is higher than the amount of income on my application, I may owe additional federal income tax.

PLEASE READ ATTESTATIONS BELOW BEFORE YOU SIGN AND SUBMIT YOUR APPLICATION: I know that I must tell the program I’ll be enrolled in if information I listed on this application changes. I know I can make changes in my Marketplace account or emailing BrighterDay Insurance Services at rferchert@brighterdayinsurance.com I know a change in my information could affect eligibility for member(s) of my household. If
anyone on your application is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (like Medicare, Medicaid, or CHIP), the Marketplace will automatically end their Marketplace plan coverage. This will help make sure that anyone who’s found to have other qualifying coverage won’t stay enrolled in Marketplace coverage and have to pay full cost. I’m signing this application under penalty of perjury, which means I’ve provided true answers to all of the questions to the best of my knowledge.

By signing below, I give permission to BrighterDay Insurance Services and their Independant & Captive Agents and All Employees to:

  • Search for an existing Marketplace application.
  • Complete enrollment which includes submitting a 2025 application to the marketplace.
  • Provide ongoing account maintenance and enrollment assistance, as necessary; or
  • Respond to inquiries from the Marketplace regarding my application.

Consent to Receive SMS Notifications, Alerts, Calls, Emails, Ringless Voicemails & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. You can
reply STOP to unsubscribe at any time.

This permission is granted for me, my spouse or any other household member listed on the application in the plan that we have applied for.

I have read and agree to the terms above SIGN IN BOX TO SUBMIT APPLICATION

Sign Here

BrighterDay Insurance Services

Agency Owner: Ranae Ferchert
rferchert@brighterdayinsurance.com