Attn: Health Insurance Marketplace Www.//Healthcare.gov
This is to certify that effective the
Is my only authorized representative for the purpose of arranging Health Insurance on my behalf.
I understand that this is a requirement of your company to have, as a matter of record, one agent/broker representing my interest in the marketplace.
FURTHER, That, by my signing this letter, I am terminating the ability of any other agent/broker to obtain my information OR change anything. pertaining to my coverage, or my family, ( if applicable This letter of authorization will remain valid until formally rescinded in writing by me.