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  • Complete Agency Form
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About this form

Please use this form ONLY to submit your 2014 benefit year annual enrollment count and remit the contribution amount owed for the ACA Transitional Reinsurance Program.... ACH Company ID = 7505008015 and Company Name = USDEPTHHSCMS. Please use the Current Year ACA Transitional Reinsurance Program Annual Enrollment Contributions form to submit your Current Year contributions.

Accepted Payment Methods:

  • Bank account (ACH)

By creating an account you can:

  • See the payments you made since you created an account.
  • Store payment information, such as credit card numbers, so that you do not have to reenter it each time you make a payment.
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  • Set up automatic recurring payments (from a bank account, debit card, or credit card).

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Contact: Transitional Reinsurance Contributions
Email: Click to email
Phone: 000-000-0000 Hrs: 8-10(M-St) ET
Website: Click to visit site

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