IMPORTANT! Read this before proceeding

Please complete the following screens carefully as the text you enter here will merge into the client's contract.  Once you have submitted this form a contract will be processed by a member of the Assured Answers team and will be sent directly to the client from our RightSignature software. The broker team CSR will be copied on this communication. It is imperative that you communicate to your client that we are following an electronic process for all steps of the ACA 1094/1095 filing. Materials you can share with your client have been distributed to all AP Broker/Service teams. This information is also available on

Common Errors:
Incorrect Contract Signer Provided
Misspelling of Client Legal Name
Misspelling of Names & Email Addresses
Failure to Complete Full Year Data for Medical Coverage Information