L&H Smart Family Services
Consent Form · Plan Year 2027
Federal rules (CMS) require health insurance agents to have your consent before helping you apply for financial help or enroll in a Marketplace plan.
For new and existing clients: whether you are applying for a new policy or renewing your plan for 2027, please sign this form.
I give permission to the agent(s) listed above, of L&H Smart Family Services, to act as health insurance agent for me and my household and to use the personal information I provide (in writing, electronically, or by phone) only to: search for my Marketplace application; complete my application and enrollment, including financial help, Medicaid or CHIP; maintain my account during the year; and respond to Marketplace requests about my application. My information will not be used for any other purpose and will be kept private.
This consent is valid through December 31, 2027, unless I cancel it sooner by calling or texting 561-444-8209 or 786-337-1160, or emailing [email protected].
Before we can submit your application, the Marketplace may send you a one-time code or link by text, email or automated call so you can approve L&H Smart Family Services as your agent. The code or link expires in 15 minutes, so please stay near your phone when we work on your application. If you are a new applicant, your plan costs $30 or less a month after the tax credit, or you are switching from another agent, you may also need to verify your identity first. Please use your own phone number and email; we are not allowed to use ours. This step is in addition to signing this consent form. It is a federal rule (CMS) to protect you from fraud.