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Special Enrollment Form


If you need to enroll in the Marketplace throughout the year, you must experience a qualifying event that will allow for a Special Enrollment Period (SEP).  Some common SEPs include, but are not limited to, a loss of other creditable coverage, such as from an employer plan; Marriage; Divorce; Birth of a Child; Moving out of your current enrollment area, etc.

Open Enrollment, which is open to everyone, runs from November 1 - January 15.  Enrollments completed by December 15th will take effect on January 1st. Enrollments completed from December 16th - January 15th will take effect on February 1st. We will offer our consultations from November 3rd through January 12th with limited evening and weekend appointment times.


Once your information has been submitted, you will be contacted by the end of the following business day to schedule an appointment. Your credit card payment will not be processed until your appointment has been scheduled.  If mailing a check, we will contact you to schedule an appointment once the check is received.  We will not cash the check until the appointment has been made.  

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  Broker will provide a paper copy immediately upon request.


Denny & Associates Inc

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