ACA Marketplace Forms

3 forms available. Fill online with BeneFill. Auto-fill from your profile and download completed PDFs.

Income Verification / Data Matching Response

Marketplace-specific · Marketplace

moderate

Documentation resolving income discrepancies between application and IRS data. Failure to respond may result in APTC adjustment or loss of coverage.

67% auto-fill22 min saved15 fieldsSubmission guide included

Special Enrollment Period (SEP) Verification

Marketplace-specific · Marketplace

easy

Documentation of qualifying life event (job loss, marriage, birth, move) for enrollment outside open enrollment. Must enroll within 60 days of qualifying event.

70% auto-fill14 min saved20 fieldsSubmission guide included

State-Based Marketplace Application

State-specific (CA, NY, CO, etc.) · State-based marketplaces

moderate

State-specific marketplace application in states operating their own exchanges (17 states + DC).

63% auto-fill33 min saved60 fieldsSubmission guide included