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Privacy and the use of your information

Important Marketplace Emails: If the Marketplace has your email address, they’ll automatically send you important information, updates, and reminders about Marketplace enrollment. You can opt out of these communications at any time. To do this, click on the "unsubscribe" link in the footer of any Marketplace email.

Privacy and the use of your information: The Marketplace will keep your information private as required by law. Your answers on this form will only be used to determine eligibility for health coverage or help paying for coverage. The Marketplace will check your answers using the information in their databases and the databases of other federal agencies. If the information doesn't match, the Marketplace may ask you to send them proof. The Marketplace won't ask any questions about your medical history. Household members who don't want coverage won't be asked questions about citizenship or immigration status.

As part of the application process, the Marketplace may need to retrieve your information from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security (DHS), and/or a consumer reporting agency. They need this information to check your eligibility for coverage and help paying for coverage if you want it and to give you the best service possible. The Marketplace may also check your information at a later time to make sure your information is up to date. The Marketplace will notify you if they find something has changed.

Learn more about your data, or view the Privacy Act Statement.

By continuing, you (the consumer) grant HealthSherpa permission to access your Marketplace application.

To continue, please review the following statements and then enter your name, the name of your Authorized Representative (if applicable), and the date to signify that you understand and agree:

• I, or my Authorized Representative acting on my behalf, hereby provide my consent for Latonya Meriwether (collectively, the "Agent") to provide me with information about my health insurance choices for the purpose of helping me apply for and enroll in health coverage through the Marketplace.
• I give permission to the Agent to access my Personally Identifiable Information (PII) that is necessary to determine eligibility for health insurance and to enroll into a health plan, including but not limited to my name, home address, email address, phone number, date of birth, social security number, financial information, and employment information.
• I also give permission for the Agent to access the PII of all persons I list on my application for the same purpose and confirm that I have the authority to consent on their behalf.
• I understand that I'm required to provide true answers and that I may be asked to provide additional information, including proof of my eligibility for a Special Enrollment Period if I qualify. If I don't, I may face penalties, including the risk of losing my eligibility for coverage.

To continue, you must agree and check each of the following statements:

I agree to have my information used and retrieved from data sources for this application. I have consent for all people I’ll list on the application for their information to be retrieved and used from data sources.