Compliance & Regulatory Disclosures

1. State Insurance Department Licensing & Authority

Prime Health Global is an independent health insurance brokerage agency duly organized and licensed to conduct insurance business under the authority of state insurance departments, including the Florida Department of Financial Services (FDFS) and reciprocal state insurance commissioners.

Our designated advisors maintain active individual agent and agency licenses in good standing across Health, Life, and Variable lines of authority. Consumers may independently verify our licensure through state insurance regulatory registries, including the Florida Office of Insurance Regulation (OIR) and state license verification databases. We operate physical advisory locations in Miami and Tampa, Florida.

2. CMS Federal Marketplace Certification & Standards

Prime Health Global adheres to the rigorous operational, privacy, and consumer consent standards mandated by CMS (Federal Health Insurance Marketplace) under federal regulation 45 CFR § 155.220 for Federally Facilitated Marketplace (FFM) and state-based exchange agents.

Our CMS compliance framework ensures:

• Annual completion of CMS marketplace registration, training, and identity verification.
• Documented consumer consent prior to searching for marketplace applications or processing plan enrollments.
• Accurate eligibility determination support for Advance Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR).
• Strict safeguarding of Personally Identifiable Information (PII) processed across exchange integration channels.

3. Federal ACA Protections & The 10 Essential Health Benefits

All individual, family, and small group major medical plans presented by Prime Health Global are Qualified Health Plans (QHPs) that strictly comply with federal statutory mandates established by the Affordable Care Act (ACA):

Every major medical ACA policy covers the 10 Essential Health Benefit categories: (1) Ambulatory patient services; (2) Emergency services; (3) Hospitalization; (4) Maternity and newborn care; (5) Mental health and substance use disorder services; (6) Prescription drugs; (7) Rehabilitative and habilitative services; (8) Laboratory services; (9) Preventive and wellness services; and (10) Pediatric services, including oral and vision care.

5. Federal Subsidy (APTC & CSR) Governance

Advance Premium Tax Credits (APTC) and Cost-Sharing Reductions (CSR) are federal financial subsidies provided under Internal Revenue Code § 36B to reduce monthly premiums and out-of-pocket costs for qualifying households:

• Income Thresholds: Eligibility is determined by household Modified Adjusted Gross Income (MAGI) relative to the federal poverty level (FPL). Under extended federal legislation, households earning between 100% and 400%+ of the FPL may qualify for subsidized health plans.
• Silver Plan CSR Enhancements: Cost-Sharing Reductions that lower deductibles, copayments, and out-of-pocket maximums are exclusively available when enrolling in a Silver-tier Marketplace plan.
• Mandatory IRS Reconciliation: Consumers receiving APTC subsidies must file a federal income tax return using IRS Form 8962 to reconcile advance subsidies against final reported household income.
• Duty to Report Life Changes: Consumers must notify our agency or HealthCare.gov within 30 days of significant life events (e.g., changes in income, marriage, divorce, birth, or relocation) to adjust subsidy amounts and prevent year-end tax adjustments.

6. Special Enrollment Period (SEP) Verification Protocols

Outside the annual Open Enrollment Period (November 1 through January 15 in most states), individuals may only enroll in or change major medical health plans upon experiencing a Qualifying Life Event (QLE) that triggers a 60-day Special Enrollment Period:

• Loss of Minimum Essential Coverage (MEC) through employer job loss, aging off a parent’s policy at age 26, or expiration of COBRA.
• Household changes including marriage, birth of a child, adoption, or foster care placement.
• Permanent relocation to a new rating area or county that makes new health plan options available.
• Changes in eligibility for federal marketplace subsidies.

In accordance with CMS regulations, applicants during a Special Enrollment Period must provide verifiable supporting documentation (e.g., certificate of creditable coverage, birth certificate, marriage license) to confirm SEP eligibility before policy issuance.

8. Carrier Appointments & Broker Independence

Prime Health Global is an independent agency and maintains active carrier appointments across top-rated regional and national health insurers, including:

Because we operate independently, our advisors owe their fiduciary duty of honesty and transparency to you, the consumer. We compare plans objectively to match your specific prescription drug formularies, preferred physicians, and household budget without institutional bias toward any single carrier.

9. HIPAA Data Safeguards & Anti-Robocall Pledge

Prime Health Global adheres to administrative, physical, and technical safeguards modeled upon the Health Insurance Portability and Accountability Act (HIPAA) Security and Privacy Rules (45 CFR Part 164) and federal marketplace security guidelines:

• All electronic communications and web intake forms operate over 256-bit SSL/TLS encrypted connections.
• Customer records are protected with multi-factor authentication and role-based access restrictions.
• Zero Lead Selling Pledge: We never sell consumer inquiry leads to third-party marketing aggregators, insurance lead exchanges, or unsolicited robocall centers. Your information is used exclusively by our in-house licensed advisory desk.

10. Fraud, Waste, and Abuse (FWA) Policies

Prime Health Global maintains a zero-tolerance policy regarding insurance fraud, waste, and abuse. In accordance with federal guidelines and state insurance codes:

• All advisors receive mandatory annual training on detecting and preventing fraudulent marketplace applications.
• Intentional misrepresentation of income, tax household size, residency, or qualifying life events on insurance applications constitutes a federal and state criminal offense.
• Suspicious activity is subject to mandatory reporting to the Florida Division of Insurance Fraud (DIF) and the CMS Center for Program Integrity (CPI).

11. Regulatory Governance Contact & Public Inquiries

For regulatory inquiries, compliance audits, consumer advocacy matters, or licensing verification requests, please contact our designated compliance division: