Marketplace Consent & Application Review

I give my permission to my agent named above and Build Better Benefits, Inc. to serve as my health insurance agent and agency — for myself and my household, if applicable — for enrollment in a Qualified Health Plan on the Federally-facilitated Marketplace.

I authorize them to view and use my personal information, including personally identifiable information (PII), provided in writing, electronically, or by phone, only to:

1. Search for an existing Marketplace application;
2. Complete an application for a Marketplace Qualified Health Plan, or for programs such as Medicaid, CHIP, or advance payments of the premium tax credit;
3. Provide ongoing account maintenance and enrollment assistance; and
4. Respond to Marketplace inquiries about my application.

They will not use or share my PII for any other purpose and will keep it protected. My consent stays in effect until I revoke it; I may revoke or change it at any time by emailing admin@thebenefitsboss.com.

To verify this electronic signature, submission details — including the date and time, IP address, and device and browser information — are recorded with this consent.

I confirm that I have reviewed my Marketplace eligibility application — including my projected household income, household size, and the information for each person applying — and that it is accurate and complete to the best of my knowledge.

My agent explained the attestations at the end of the application before it was submitted, and I had the chance to ask questions.