Authorization:
I, the undersigned, hereby authorize Cornerstone Care Agency, with Aaron Scott as the agent of record, to act on behalf of me and my household in the following matters related to our insurance needs:
1. Medicare Insurance:
a. Assist with enrollment and plan selection.
b. Provide guidance on benefits and coverage options.
2. Marketplace Insurance:
a. Assist with enrollment in Marketplace plans.
b. Provide guidance on premium tax credits and coverage options.
3. Commercial Insurance for Individuals:
a. Assist with enrollment and plan selection.
b. Provide guidance on benefits and coverage options.
Scope of Authorization:
This authorization allows Cornerstone Care Agency to obtain and share information related to our insurance needs,including but not limited to:
● Personal health information.
● Insurance eligibility and coverage details.
● Communication with insurance providers on our behalf.
Duration of Authorization:
This authorization is effective immediately and shall remain in effect until revoked in writing by me.
Acknowledgment:
By signing below, I acknowledge that I have read and understand this authorization form. I confirm that I am the person named above and that I am authorized to make this request.