Licenses

The Healthcare.gov Authorization - Please review before you enroll:

You agree that InsuranceBird, LLC will complete an application on your behalf through healthcare.gov and will manage your email communications in connection with your healthcare.gov account, including but not limited to opting out of or filtering marketing communications about the exchange on your behalf.

You acknowledge and agree that InsuranceBird, LLC should appoint itself as your broker in connection with this process and that you've had the chance to review the further information about brokers here in connection with this appointment.

You agree to have your information used and retrieved from data sources for this application by healthcare.gov, and represent and warrant that you have consent for all people you've listed on your application for their information to be retrieved and used from data sources.

You represent and warrant that any information about yourself or your family submitted to HealthBird and InsuranceBird is true and correct to the best of your knowledge. You agree to allow the Marketplace to use your income data, including information from tax returns, for the next 5 years and that the Marketplace will send you a notice, let you make any changes, and allow you to opt out at any time.

You agree to be bound by the HealthBird Terms and Privacy Policy and the healthcare.gov Terms and Privacy Policy. For more about Heathcare.gov's use of your data, click here. For the healthcare.gov Privacy Act Statement, click here.

In addition, you agree to the following statements as required by Healthcare.gov:

"I know I must tell the program I'll be enrolled in if the information I listed on this application changes. I can make changes in my Marketplace account online or by calling 1-800-318-2596. TTY users should call 1-855-889-4325. I know a change in my information could affect eligibility for member(s) of my household.”

"If members of my household are found to be enrolled in other qualifying coverage (including Medicaid, CHIP and Medicare), I understand that the Marketplace may terminate their Marketplace coverage.”

"I'm signing this application under penalty of perjury, which means I've provided true answers to all of the questions to the best of my knowledge. I know I may be subject to penalties under federal law if I intentionally provide false information."