I understand that:
1. I do not have to provide Mary Reynolds, Rhonda Lynn or Heather Khan with any information that I do not want to provide. However, the help I receive is based only on the information I provide, and if the information I give is inaccurate or incomplete, the agent/s may not be able to offer all the help that is available for my situation.
2. Mary Reynolds, Rhonda Lynn and/or Heather Khan should ask me to provide only the minimum amount of my Personally Identifiable Information (PII) that is necessary to help me.
3. Mary Reynolds, Rhonda Lynn and/or Heather Khan must make sure that my PII is kept private and secure when creating, collecting, disclosing, accessing, maintaining, storing, and/or using my PII. The agent/s must follow the privacy and information security standards that apply to them.
4. If I give my contact information when signing this form, my general consent includes permission for Mary Reynolds, Rhonda Lynn and/or Heather Khan to follow up with me about applying for or enrolling into coverage after my fist meeting with them.
5. Once I have signed this authorization form I can expect Mary Reynolds, Rhonda Lynn and/or Heather Khan to help me without asking me to sign another authorization form, unless I make changes to my application data in the future.
Exceptions or Limitations to Consent
I understand that this authorization will be valid for 10 years, unless I make changes to my application data in the future, in which case I will need to sign a new authorization form. I also understant that I can revoke, limit, or otherwise change the consents I provide through this form at any time. If I don't make any limitations, exceptions, or changes to my consent now, I can still do so at any time in the future by notifying Mary Reynolds, Rhonda Lynn and/or Heather Khan by phone call or email.