I give my permission to John Parambil (NPN: 21178567) to serve as the health insurance agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by telephone only for the purposes of one or more of the following: Searching for an existing Marketplace application; Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums; Providing ongoing account maintenance and enrollment assistance, as necessary; or Responding to inquiries from the Marketplace regarding my Marketplace application. I also give consent to the agent mentioned above, to submit any required documentation on my behalf for enrollment purposes. I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII is kept private and safe when collecting, storing, and using my PII for the stated purposes above. 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 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 emailing John@wellshieldservices.com. I, John Parambil, a licensed and experienced health insurance agent, hereby provide this attestation to acknowledge your agreement to the contents outlined below. By affixing your signature below, you respectfully request me or my agency affiliates to enroll both yourself and/or your family in the most suitable zero premium ACA plan available. Please note that if there are no zero premium health plans available in your area based on the provided information, we will inform you of the available plans and seek your consent before proceeding with enrollment. In addition to enrolling you in the optimal ACA plan, you authorize me or my agency to access your healthcare.gov account and submit the necessary information as required, in accordance with the details provided. Upon signing & submitting this document I am confirming I do not currently have Medicare, Medicaid, Group, federally recognized tribes, or ANCASA shareholder insurance coverage, and that I will adhere to all goverment regulations such as tax codes, etc. We cannot take any actions that jeopardize these types of coverages. SMS Consent: By providing your mobile number, you consent to receive SMS communications from John Parambil. As your sales agent, I and/or my agency will receive compensation from UnitedHealthcare per member per month for the plan you are enrolled in. I or my agency could be eligible for additional compensation based on our sales performance. I or my agency could earn up to $18.75 per member per month if we enroll more than 500 members in Individual & Family Plan coverage during plan year 2024. I may also be eligible for a trip valued at approximately $4,080 if I’m one of the top Individual & Family Plan agents nationwide. This compensation is paid based on your enrollment in a UnitedHealthcare Individual & Family plan. You will not be billed for this compensation. You are only responsible for your monthly premiums and any copayments or cost share amounts that may be due when you seek care. You are being given this information as required by federal law, so that you are aware of the compensation I receive from UnitedHealthcare as a result of your enrollment in the plan.