Direct Enrollment Partner Informational Display Form

Direct Enrollment (DE) entities – including issuers and web-brokers – may provide CMS with information on their direct enrollment pathways that can be shared with consumers who may wish to use the DE entities’ services. By providing this information, the DE entity agrees to have this information displayed on publicly-accessible, government-owned and controlled websites, including HealthCare.gov. If you wish your information to be displayed, please submit all information described below in the specified format.
All fields are required unless indicated.
CMS may contact you if there are compliance problems with your submission. This will not be displayed publicly on HealthCare.gov.
CMS may contact you if there are compliance problems with your submission. This will not be displayed publicly on HealthCare.gov.
Please enter your entity Marketing name, as you wish to have it displayed to consumers. Note: this page is only for web-brokers and issuers participating in Direct Enrollment (DE) or Enhanced Direct Enrollment (EDE), with consumer-facing webpages, who have a web-broker or Qualified Health Plan (QHP) issuer agreement with CMS. Agents and brokers who work with issuers and web-brokers may participate in Help On Demand.
Organization Type
This is for CMS’s records only. It will not be displayed publicly. Note: the Partner ID is distinct from the HIOS Issuer ID. The Partner ID is assigned by the CMS Data Services Hub (DSH) support team and must be used in EDE and DE application program interface (API) transactions when EDE applications/enrollments originate from entities through DE or EDE. Upstream entities using EDE must have a unique partner ID and must coordinate with the entity providing their EDE pathway to request this ID.
New or Update
If this is the first time your organization has completed this form for displaying information on HealthCare.gov, select “New”. Select “Update” if you have an existing submission.
Direct Enrollment Pathway
Which direct enrollment pathway is your company implementing for the current plan year?
Enrollment Timeframe

Can consumers enroll through your direct enrollment pathway outside of the annual Open Enrollment Period?
The website URL must take consumers directly to the beginning of the QHP shopping experience on the DE entity’s website.
In which state[s] will consumers be able to enroll in a QHP through your DE pathway?
Clear search
I certify that there are not disclaimers or trademark icons associated with the logo I have submitted that would prevent CMS from sharing or publishing the logo on publicly available sources, such as HealthCare.gov
I certify that I am authorized to provide this information on behalf of my organization, the information I provided is accurate, and CMS is authorized to share the information provided through publicly-available sources, such as HealthCare.gov