Open / Special Enrollment Form
OPEN ENROLLMENT 2026
Open Enrollment runs from November 1 through January 15 and is open to everyone.
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Enrollments completed by December 15 will take effect on January 1.
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Enrollments completed between December 16 - January 15 will take effect on February 1.
Consultations will be available from November 6 through January 14, with limited evening and weekend appointments.
SPECIAL ENROLLMENT 2025-2026
If you need coverage outside the Open Enrollment period, you must qualify for a Special Enrollment Period (SEP) due to a life event such as:
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Loss of other creditable coverage (e.g., employer plan)
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Marriage or divorce
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Birth or adoption of a child
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Moving out of your current coverage area
Note: You must enroll within 60 days of your qualifying event.
Some events (such as the birth of a child) allow retroactive coverage, while others take effect on the first of the month after you apply.
SCHEDULING AND PAYMENT POLICY
Once your questionnaire and consultation payment have been submitted, we will contact you within 2 business days to schedule your appointment.
If mailing a check, your appointment will be scheduled once the check is received. (Checks will not be cashed until the appointment is confirmed.)
If we are unable to offer a satisfactory appointment time, a full refund will be issued.
Due to the short Open Enrollment window and limited appointment availability:
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Cancellations or no-shows will receive a refund minus a $25 cancellation fee.
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Rescheduling requests require at least 24 hours’ notice; otherwise, a $25 rescheduling fee will apply and will be collected at the time of consultation.
IMPORTANT: We MUST have information for all family members to be covered.
IMPORTANT: You must click the Pay Online button to finish payment and then come back to this form and hit the green submit button at the bottom to complete your submission.
Broker Disclosure and Transparency:
Carriers represented may or may not provide commissions to brokers for the placement of business. If applicable, commissions are built in to the premiums quoted. Premiums do not change if the client utilizes the services of a broker or enrolls in a plan directly through the Marketplace Exchange. This broker charges a consultation fee and will also accept any commissions payable by a carrier. Client has the right to request copies of carrier’s commission at any time. Broker will provide such information within 10 business days of request. Client can view the Denny & Associates, Inc. Notice of Privacy Practices on our website at www.dtdinsurance.com. Broker will provide a paper copy immediately upon request.
THANK YOU
Denny & Associates Inc