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The 5 Minute AJ Health and Wealth Health Insurance Application

We have helped families with their Marketplace applications since 2013. We have created this form to assist you through the enrollment process. We will never call you. Only a text or email if there is an issue with your new health insurance.

You can call us at any time at (850) 316-4378.

This form is to be used to help you insure you and your family. The information provided must be accurate for the subsidies to be accurate. Our job is impossible with incorrect information. Submitting this form tells us that to the best of your knowledge all of the above information is accurate. You will not receive any phone calls from AJ Health and Wealth. We will however text or email you if the Marketplace requests anything from you. You will also receive everything in the mail. Let us know if you need any further assistance.