ADDITIONAL AGREEMENTS: Please read the attestations below and sign if you agree. Use of Personal Information: I consent to the use and disclosure by All Care Insure, LLC of (a) the personal information I have provided about myself and others in the questionnaire above, and (b) any other personal information about myself or the other individuals listed above which may be obtained by All Care Insure, LLC from government data sources, for purposes of applying for health insurance coverage through the Federally Facilitated Exchange (the “Marketplace”) and for any other purposes disclosed in All Care Insure, LLC’s Privacy Policy. If you have questions about our Privacy Policy, please contact us at customerservice@allcareinsured.com. Eligibility: I understand that I’m required to provide true and complete answers to the questions posed above and that I may be asked to provide additional information, including proof of my eligibility for a Special Enrollment Period if I qualify. If the information provided by me is not true and complete I may face penalties, including the risk of losing my eligibility for coverage. I know that I must inform All Care Insure, LLC if information I have provided changes. I understand that I can update my information in my Marketplace account or by contacting All Care Insure, LLC at customerservice@allcareinsured.com. I know a change in my information could affect eligibility for member(s) of my household. I understand that if anyone I identified above as needing coverage is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (like Medicare, Medicaid, or CHIP), the Marketplace will automatically end their Marketplace plan coverage. This will help make sure that anyone who’s found to have other qualifying coverage won’t stay enrolled in Marketplace coverage and have to pay full cost. Renewal of Coverage: To make it easier to determine my eligibility for help paying for coverage in future years, I agree to allow the Marketplace to use my income data, including information from tax returns, for the next 5 years. The Marketplace will send me a notice, let me make any changes, and I can opt out at any time. Tax Attestation: I understand that I’m not eligible for a premium tax credit if I’m found eligible for other qualifying health coverage, like Medicaid, the Children’s Health Insurance Program (CHIP), or a job-based health plan. I also understand that if I become eligible for other qualifying health coverage, I must contact the Marketplace to end my Marketplace coverage and premium tax credit. If I don’t, the person who files taxes in my household may need to pay back my premium tax credit. I understand that because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents: I must file a federal income tax return for the 2024 tax year. If I’m married at the end of 2024, I must file a joint income tax return with my spouse. I also expect that: No one else will be able to claim me as a dependent on their 2024 federal income tax return. I’ll claim a personal exemption deduction on my 2024 federal income tax return for any individual listed on this application as my dependent who is enrolled in coverage through this Marketplace, and whose premium for coverage is paid in whole or in part by advance payments of the premium tax credit. IF ANY OF THE ABOVE CHANGES I understand that it may impact my ability to get the premium tax credit. I also understand that when I file my 2024 federal income tax return, the Internal Revenue Service (IRS) will compare the income on my tax return with the income on my application. I understand that if the income on my tax return is lower than the amount of income on my application, I may be eligible to get an additional premium tax credit amount. On the other hand, if the income on my tax return is higher than the amount of income on my application, I may owe additional federal income tax. I understand the foregoing does not constitute tax advice provided by All Care Insure, LLC to me, and that should I have any questions regarding any tax credits for which I may be eligible, my tax returns, or any other related tax matters I should consult a qualified tax advisor prior to enrolling in health insurance coverage provided via the Marketplace. Electronic Signatures and Communications: I consent to the use of an electronic signature to sign all forms presented to me by All Care Insure, LLC during the health insurance enrollment process, including, without limitation, to sign this form, unless and until I withdraw my consent to the use of electronic signatures by providing notice to the address below. I agree that this consent is effective on the date that I affix my signature. By signing, I agree to be legally bound as if I had signed this form and other documents with a handwritten signature, and I acknowledge that I have reviewed and agree to the above terms and conditions. By signing I am providing my express written consent to receive emails, telephone calls, text messages, and artificial or pre-recorded messages from All Care Insure, LLC regarding this form and any health insurance coverage applied for on my behalf by All Care Insure, LLC. (2) I understand that at this time I have not yet applied for Federally Facilitated Exchange health insurance, and that All Care Insure, LLC. will be using the information and consents I provide herein to fill out, sign on my behalf, and submit the Federally Facilitated Exchange application. If you have any questions, please contact All Care Insure, LLC. at customerservice@allcareinsured.com. This form is used to help to find insurance for you and your family. The information provided must be accurate for the subsidies to be accurate. Failure to provide the correct information could result in claims being invalidated or the termination of your insurance policy. By submitting an application, you confirm that the information is accurate to the best of your knowledge. Anyone on this online application who may or may not qualify for Medicaid grants us authorization to submit their details to the state's Medicaid agency for consideration. Also allowing us to automatically deny any applicant for Medicaid, or to trigger any SEP as stated by Healthcare.gov in order to have the applicant's plan start ASAP. By submitting this application you give us permission to access any application submitted using your information to use for more accuracy and information to choose the right plan for you. By submitting this application you express full consent to allow us to do any verification method or code sending to ourselves so that we can take care of the entire enrollment process. By selecting “No” to the question “Do you have insurance through your Employer, Medicare, Medicaid, VA, or ACA?” you consent to not knowing you currently have any insurance, and give us full authority to enroll you into any health insurance plan, this is to assure you at least have some health insurance. By submitting this application, you authorize us to communicate with you through various channels, including but not limited to phone, text, email, or mail, regarding any insurance products that may be available at the time. Additionally, you grant us permission to initiate contact using any of the aforementioned methods in connection with the form you have provided to us. By acknowledging this agreement, you provide consent for us to utilize the information provided and enroll you into an alternative Health Care Program, potentially replacing the “Affordable Care Act” (ACA) or "Obamacare," as required by potential industry shifts and changes.