Verify Insurance or Speak With Admissions

I acknowledge that my Agent has reviewed my eligibility notice for health insurance and that I understand my eligibility and the expectations thereof. I acknowledge that all the information that I have provided to my Agent is correct and true to the best of my knowledge. I agree that my Agent is held harmless and not liable for any incorrect information that may be reported on my applications. I agree that all potential tax liability in relation to my qualified health plan application and enrollment is my own. I agree that I have an understanding of advance premium tax credits, how they work and how they may impact the filing of my taxes each year. I understand that any differences in expected tax credits and actual tax credits received are my own responsibility. I acknowledge that my Agent is never liable for any misunderstanding in conjunction with advanced premium tax credits, my eligibility, or my tax liability. I acknowledge that my Agent has answered my questions adequately and has provided all the information necessary to understand my policy and how it works. I acknowledge that my Agent has informed me about hospital and doctor networks, the potential or expected cost of my prescription drugs and the basic language of my insurance and what costs I may expect (deductibles, co-pays, co-insurance, etc). I acknowledge that my Agent has, in the best of their ability, helped me to find a plan that I can afford and that will work for my current needs. I acknowledge that it is my responsibility to report any changes that may occur during each year that may affect my health insurance premiums like changes in income, residence, gain/loss of coverage, gain/loss of employment, change in household size, and any other change relative to my insurance plan or advance premium tax credit.