For Affordable Care Act/Obamacare enrollments:
I certify that the information provided is true and accurate
I attest that no one applying for health coverage on this application is incarcerated.
I attest that no member on the enrollment application has group coverage offered to them.
I give permission to the marketplace to access my . returns for up to 5 years to verify my income for subsidy purposes. This permission can be revoked at any time. However, if I revoke permission, I understand that I will be required to complete a federal application every year to confirm my income and subsidy eligibility. I understand that should the information listed on this application for enrollment change, it is my responsibility to update the information with the federal marketplace. I understand that I can make changes by accessing my marketplace account online or by calling 1-800-318-2596. I further understand that a change in my information could affect eligibility for members of my household.
I agree to allow HealthSherpa to submit my healthcare.gov financial assistance and health insurance application on my behalf.
I understand that changes may occur to my premium based on my subsidy eligibility results. Further, I authorize HealthSherpa and BP Marketing Agents to submit the application for enrollment and notify me of these changes via the email I provided on the application.
I acknowledge Brandon ACA Health Insurance or its Agency affiliates, as my agent of record and authorize them to submit and sign this application on my behalf. I understand that because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents:
• I must file a federal income tax return in 2024 for the tax year of 2023.
• If I’m married at the end of 2023, I must file a joint income tax return with my spouse.
I also expect that:
• No one else will be able to claim me as a dependent on their 2023 federal income tax return.
• I’ll claim a personal exemption deduction on my 2023 federal income . return for any individual listed on this application as a dependent who is enrolled in coverage through this marketplace and whose premium for coverage is paid in whole or in part by advance payments.
• If any of the above changes, I understand that it may impact my ability to get a premium tax credit.
I also understand that:
• When I file my 2023 federal income tax return, the Internal Revenue Service (IRS) will compare the income on tax return with the income on my application.
• If the income on my tax return is lower than the amount of income on my application, I may be eligible to get an additional premium tax credit amount.
• If the income on my tax return is higher than the amount of income on my application, I may owe additional federal income tax.
By signing the document, I am affirming that I agree to all the above statements.
We reserve the right to change this policy at any time, and if we do so, we will post changes and updates to this page. Please refer to this policy periodically to inform yourself if changes have been made.
Information we may collect
We collect the following Personally Identifiable Information from users who buy our products and services: name, email address, telephone number, address, and credit card number.
Additional information from or about you may also be collected in other ways, including responses to customer surveys and any communications with our customer service team.
We use “cookies” so that our Website can remember you and provide you with the information you’re most likely to need. For instance, when you return to the Website, cookies identify you and prompt the site to provide your username (not your password), so you can sign in more quickly. Cookies also allow our Website to remind you of your past usage and to suggest similar products and services. Finally, we use information gained through cookies to compile statistical information about use of our Website, such as the time users spend at the site and the pages they visit most often. Those statistics do not include PII.
Our Use of Personally Identifiable Information
We use your Personally Identifiable Information to create your account, to communicate with you about products and services you’ve purchased, to offer additional products and services, and to bill you. We also use this information to the extent necessary to enforce our Website terms of service and to prevent imminent harm to persons or property.
When you use the Service, including accepting a payment, contacting customer service or requesting technical support, in addition to many other interactions with Affordable Healthcare Advisors, we will apply the information that we have collected. Knowing this information allows us to verify your identity, communicate with you and enforce our agreements with you, as well as secure the best possible experience for all Affordable Healthcare Advisors customers by ensuring compliance with applicable US state and federal laws and our own policies. We may also use this information to improve and enhance our offerings to you.
Affordable Healthcare Advisors may use certain information about you without identifying you as an individual to third parties. We do this for purposes such as analyzing how the Service is used, diagnosing service or technical problems, maintaining security, and personalizing content.
Protecting Personal information
Information that can be used to identify a person is “Personally Identifiable Information”. This does not include information that has been aggregated or made anonymous. All information is securely stored on our servers in the United States. We employ the highest in industry standards to protect Personally Identifiable Information, as well as any information provided relating to your invoiced customers.
Third-party client and customer information, provided to Affordable Healthcare Advisors by users, shall be considered confidential and shall not be disclosed to any third party, unless required to do so by law or subpoena or if we believe that such action is necessary to conform to the law, or comply with legal process served on us. Such information shall be utilized only for the purpose for which Affordable Healthcare Advisors was created, which is to facilitate the billing and collection process for electronic billing of customers and clients.
Although Affordable Healthcare Advisors utilizes the highest reasonable levels of data security in the industry, we cannon guarantee the security of PII or other information provided to us. By using our Website, you acknowledge and agree that we make no such guarantee, and that you use our Website at your own risk.
Sharing Personal information
As we develop our business, we may buy or sell assets or business offerings. Customer, transaction, email, and visitor information is generally one of the transferred business assets in these types of transactions. We may also transfer such information in the course of corporate divestitures, bankruptcy, mergers, or dissolution.
Compromise of Personal Information
Affordable Healthcare Advisors shall not be liable for the transfer of any personal identification information resulting from loss or distribution of data, the delineation or corruption of storage media, power failures, natural phenomena, riots, acts of vandalism, sabotage, terrorism or any other event beyond Affordable Healthcare Advisors’s control.
Your Choices About Your Information
You may, of course, decline to submit personally identifiable information through the Service, in which case Affordable Healthcare Advisors may not be able to provide certain services to you. You may update or correct your account information at any time by logging in to your account. You can review and correct the information about you that Affordable Healthcare Advisors keeps on file by contacting us as described below.
Information relating to minors
Affordable Healthcare Advisors does not knowingly collect or solicit personal information from anyone under the age of 18 or knowingly allow such persons to register with our Service. If you are under 18, please do not send any information about yourself to us, including your name, address, telephone number, or email address. No one under age 18 is allowed to provide any personal information to or on Affordable Healthcare Advisors. In the event that we learn that we have collected personal information from a minor under age 18 without verification of parental consent, we will delete that information as quickly as possible. If you believe that we might have any information from or about a child under 18, please contact us as described below.
It is our policy to provide notifications, whether such notifications are required by law or are for marketing or other business related purposes, to you via email notice, written or hard copy notice, or through conspicuous posting of such notice on our website, as determined by Affordable Healthcare Advisors in its sole discretion. We reserve the right to determine the form and means of providing notifications to you.
Please contact us through out contact page with any questions or concerns regarding our policy.