WWWW.MARKETPLACEENROLL.COM
HEALTH INSURANCE: MARKETPLACE OR OBAMACARE
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OFFICE
QUOTE/CUOTA
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HEALTHCARE.GOV
MARKETPLACE FORMS AND APPLICATIONS
CONSENT
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tO FACILITATE ELECTRONIC ENROLLMENT & ASSISTANCE YOU MUST GIVE US CONSENT
.
This will expedite your approval of any subsidy or premium tax credit to help you pay for your health insurance plan.
Get a Quote
PLEASE CONSENT FOR US TO CALL YOU BACK.
*
Indicates required field
Name
*
First
Last
Phone Number
*
(123)456-7890 10 Digits Total
Email
*
As Licensed Agents, do you give us your permission to conduct an online person search? ( Nos da consentimiento para hacer una busqueda en Healthcare.gov, ya que estamos Certificados?) *
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Yes
Do you give us permission, to assist you with completing a Marketplace application? ( Nos da su permiso, para asistirlo en completar una aplicacion del Mercado de Salud o Healthcare.gov?) *
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Yes
Do you give us permission to assist you make a plan selection and enrollment? ( Nos da permiso de ayudarle a seleccionar un plan y ingresarlo?)
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Yes
Do you give us permission to assist you with ongoing account/enrollment Maintenance. (Example upload documents required by Healthcare.gov or make life changes to your account) ( Nos da permiso de seguir ayudandolo con la cuenta del gobierno: por ejemplo bajar los documentos a traves del sitio Healthcare.gov o ayudarle reportar/cambiar cambios en su cuenta?) *
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Yes
You agree to contact the Marketplace to authorize us on your account by calling the Marketplace Call Center - 24/7 (800) 318-2596 ** (Esta de acuerdo en hablar al Mercado de Salud hablando al (800) 318-2596 - 24/7 para autorizarnos en su cuenta) *
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Yes
If you are applying yourself using HealthCare.gov, don't forget to enter Agent or Broker Professional help information under the "Application help" "Navigator/Agent" tab. ( Si se va inscribir directamente esta de acuerdo en ingresar nuestro codigo de agente bajo la pestaña " Application Help" "Navigator/Agent)? *
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Yes
I agree to receiving marketing and promotional materials
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Submit
Home
OFFICE
QUOTE/CUOTA
Contact
HEALTHCARE.GOV
MARKETPLACE FORMS AND APPLICATIONS
CONSENT
About
WWW.MARKETPLACEENROLL.COM