American Rescue Plan Act (APRA)
ARPA Second Election and Assistance Eligible Individual Attestation
ARPA Second Election and Assistance Eligible Individual Attestation
By completing the below electronic Form, you are certifying that the information included is true and accurate.
If you fail to notify Vita of a change in your Assistance Eligible Individual status, you may be subject to a penalty of $250 (or if the failure is fraudulent, the greater of $250 or 110% of the premium assistance provided after termination of eligibility).
Once the form is completed, your request will be processed and visible on the Vita Member Portal in 3—5 business days.
If you fail to notify Vita of a change in your Assistance Eligible Individual status, you may be subject to a penalty of $250 (or if the failure is fraudulent, the greater of $250 or 110% of the premium assistance provided after termination of eligibility).
Once the form is completed, your request will be processed and visible on the Vita Member Portal in 3—5 business days.
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