Note for service fee: according the ACA law, our services for people to get ACA (Obamacare) tax credit must be free. If you apply for Short-Term Health Insurance, our services are also free. However, the insurance company may require $20 fee to process your application and finalize their insurance paper works. Also, we are hiring: see details.


Fact Find please fill this online application (below)
Which way can I go? Government Free Care, ACA (Obamacare), or Normal Healthcare ?
Click here to find out

- Input your data in each box below, one by one, and then click Submit Fact Find at bottom.
Don't hit Enter-key, use mouse/Tab-key move to next. Input can't be saved, must submit; or, you do it again.

 

 

Health Insurance Fact Find
- By submit this form, you choose Henry Hu as your exclusive agent to
buy health insurance  and to apply for financial aid - ACA Tax Credit.

   Please fill your family data into the online table below. If applying financial aid, please provide your income data and documents (see how to apply "Step by Step"). Also, you can download Application Fact Find.

Note: If you do not have required documents listed below, we may help you to work out, because they are substitutable. Please call (503) 693-2423.


Home address     ( 家庭住址,    Dirección de la casa )

Phone number      ( 電話號碼,    número de teléfono ) 

Email address     ( 電子郵件,    Email Dirección )  


Name

Birthday (mm-dd-yyyy)

Relation

Gender (M/F)

US Citizen Greencard Others

Social Security Number

 Driver License #, State

Anyone smoking?

姓名(全家每個人)

生日

關係

性別

公民/綠卡

工卡號碼

駕駛證號碼

是否吸煙？

nombre

Cumpleaños

relación

género

EE.UU. / tarjeta verde

Número de Seguro Social

licencia de conducir

Yes / No

Self

   Please add your note into notebox below:
 
   After finished, click Submit (at bottom) to send. We will email you a quote within 24 hours and maybe call you for the quote.

Family Income: If you apply for financial aid for health insurance, we need your family income data. Please fill your family income Last Month (2020 or 2021) total $, and projected year 2021 total $. For verification, we need copy of last month payroll pay-stubs, 2019 or 2020 W-2 and tax return Form1040 (first two pages).

Additional requests:

1.)  If someone is a college student, please provide costs of annual total tuition and fees (Form 1098-T); if someone pays back a student loan, also provide annual interest payment of the loan.

2.)  If your family has other incomes besides of wages and self-employed incomes, please list net profit for each of them with category name.

3.)  If anyone in your family already has a current health insurance, please make copy of the insurance card with carrier name, address, phone number, and policy number.

4.)  Please list each employer name, address, and phone number for each family member.

5.)  If anyone has a "greencard", Please make copy of each greencard for both front and back sides.

6.)  If a US citizen who was not born in the US, please list the person name with the original greencard number and the certificate number of naturalization.

Attachments, There are helpful sample documents (click a link below) when applying special offers of health insurance: 

The government required document list of 1.) immigration status; 2.) family income; 3.) lower income for OHP (government free care).

Tips: Use your cell phone to take pictures of documents and email the pictures to us: hwu475@gmail.com. Also, for your data safety (not to send online), you may use your cell phone to take a 'screen shot', after filled in all your family data, and then email the picture to us.


Agreement: I am (print name). I agree to provide my family personal data (birthday, SSN, income, etc.) for Henry Hu Agency to assist me to apply for benefits of health insurance. I know the data will be forwarded to US government and I agree to take full responsibility for the data I provided. Henry Hu Agency will keep the data confidential for applying insurance only and protect privacy of all applicants.

Get Confirmation:  In order to make sure that we have received your application (the Fact Find) after you click the button “Submit Fact Find”, please call our cell phone (503) 475-4705 to get a confirmation number. Thanks for your cooperation.