I give my permission to Simple Health Insurance, agent Zhipeng Zhu to serve as the health insurance agent or broker to help us understand insurance plans for myself and my entire household if applicable.
I understand this is NOT an agreement to purchase health insurance and there will NOT be any service fee charged by the agent. Whether I purchase the health insurance plan through agent or I go to Marketplace website, the premium of insurance will be the same.
By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by telephone only for the purposes of one or more of the following:
Searching for an existing Marketplace application;
Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums;
Providing ongoing account maintenance and enrollment assistance, as necessary; or
Responding to inquiries from the Marketplace regarding my Marketplace application.
I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII is kept private and safe when collecting, storing, and using my PII for the stated purposes above.
I confirm that the information I provide for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge.
I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by calling Simple Health Insurance at 832-460-5669
