AGENT: BYRON J PATTERSON
AGENT NPN: 8827726
AGENT EMAIL: [email protected]
.
1. Personal and Income Information Accuracy: I hereby confirm that all personal and income-related information I have provided is accurate and true to the best of my knowledge. This information will be used to determine my eligibility for health insurance and any potential subsidies.
2. Agent of Record Consent: I hereby appoint Byron J Patterson as my agent of record for all matters related to health insurance. This includes, but is not limited to, assisting with enrollment, policy changes, and claims. I understand that I have the right to revoke or modify this consent at any given time.
3. Scope of Appointment: I understand that this appointment is valid for up to 10 years unless I specify a different duration or choose to revoke it earlier.
4. Special Enrollment Period (SEP) Acknowledgment: I acknowledge that certain life events, such as loss of coverage or significant life changes, may qualify me for a Special Enrollment Period (SEP).
5. Communication Consent: I hereby give consent to Byron J Patterson to communicate with me regarding health insurance options, benefits, and related matters. This may include phone calls, emails, or other forms of communication.
6. No Guarantees: I understand that while Byron J Patterson will strive to provide the best possible benefits and subsidies based on my circumstances, there are no guarantees regarding specific outcomes.
7. Data Protection and Privacy: I understand that my personal and income-related data will be treated with the utmost privacy and will be used in compliance with all relevant data protection regulations.
8. Advertisements and Misleading Information: I confirm that I have not been influenced by any misleading advertisements or promises. I understand that Byron J Patterson is committed to providing accurate and transparent information during the enrollment process.
9. CMS Requirements Acknowledgment: I am aware of the CMS's requirements to document and maintain records indicating that a consumer or their authorized representative has provided consent prior to assisting with applying for or enrolling in Marketplace coverage. I also confirm that I have reviewed and verified the accuracy of my eligibility application information before its submission to the Marketplace.
10. Right to Modify or Revoke Consent: I understand that I have the right to modify or revoke any consent given at any point in time. By signing below, I acknowledge and agree to the terms and conditions stated above.
