Open Enrollment Update Form – 2026

By checking this box, you consent to the following: I, the primary household contact, give my permission to CFM Health, LLC, as my health insurance agent/broker, to assist me and, if applicable, my entire household for purposes of enrollment/re-enrollment in a Qualified Health Plan (QHP) offered through the Federally Facilitated Marketplace (“Marketplace”). By consenting to this agreement, I acknowledge and authorize the following: Scope of Authorization I permit CFM Health, LLC and its designated licensed agents to: Search for, access, and update an existing Marketplace application; Complete an application for eligibility and enrollment in a Marketplace QHP or other government insurance affordability programs, such as Medicaid, CHIP, or advance premium tax credits (APTCs); Provide ongoing account maintenance and enrollment assistance as needed; update my policy as the agent may see fit in order to receive the best benefit possible, Respond to inquiries from the Marketplace regarding my application. Use of Personally Identifiable Information (PII) I understand that my agent will collect, use, and disclose my PII only for the purposes listed above. I consent my agent to submit the necessary documents in my behalf in order to qualify for a subsidy. I consent CFM Health LLC to contact me through email, SMS or phone call for marketing/customer service purposes. My agent must adhere to federal privacy and security standards to keep my PII safe. My agent will not use or share my PII for any other purpose without my explicit consent. Truthfulness of Information I confirm that all information I provide for my Marketplace application is true to the best of my knowledge. I understand that providing false or inaccurate information may affect my eligibility for coverage or financial assistance. Disclosure of Limitations I understand that my agent cannot offer legal, tax, or financial advice. I am not required to provide any health or personal information beyond what is necessary for completing the Marketplace application. Compensation Disclosure I acknowledge that my agent/broker may receive a commission or payment from the insurance carrier for my enrollment into a health plan. I understand that I do not pay my agent directly for enrollment services. Consent Duration & Revocation This consent remains in effect for five years or until I revoke it. I may revoke or modify my consent at any time by contacting CFM Health, LLC at info@cfm-health.org subject: “Consent Revocation”.