By siging this agreement I am giving the privilege to Chance Luna Ins Agency of my consent to open online accounts with healthcare.gov and other websites in order to enroll in health coverage . I also am aware that if request information in regards to account details I may contact CLIA to obtain. I understand that if my income changes or I have a lifestyle change I am to contact the Marketplace AND Chance Luna Ins Agency to update
my account AND if I ever choose to cancel my coverage that I must do so in writing and I must contact Chance Luna Ins Agency 214.675.0999 or 972.613.4911.
By signing, you allow this person to sign your application, get offical information about this application, and act for you on all future matters related to this application and other health insurance policy plan and account needs.