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 confirm that I have reviewed my completed application and that all information is accurate. I understand that I do not have to share additional personal information about myself or my health with my Agent beyond what is required on the application for eligibility and enrollment purposes. I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by contacting my Agent.
