Marketplace Privacy Notice Statement:  We (as Agent) are authorized to collect personally identifiable information (PII) from you by Marketplace Federal Requirement.  Any PII we collect is used to process your Marketplace Application and assistance with enrollments as expressed within this consent.  If you choose to give us PII, we may share this information with Marketplace (Healthcare.gov) and individual insurance company on consumer’s behalf to process consumer’s application and maintenance of business for consumer.  In order for Agent to process Marketplace application for consumer, release of PII to Agent is mandatory.  If you choose not to provide us with the PII requested, or not to respond to certain questions, your application may be denied until further PII is obtained as per required for application completion/maintenance.

Consumer understands that the Agent will not use or share their personally identifiable information (PII) for any purposes other than those listed within their consent.  The Agent will ensure that my PII is kept private and safe when collecting, storing and using my PII for the stated purposes within this consent listed below.  All PII will be provided to CMS (Federal Agency) and be maintained within Federal systems’ records.  Consent to use PII is in effect until consumer revokes by contacting Agent.  Consent may be revoked at any time by consumer contacting the Agent at 918-277-9148 or 539-233-5202 or johnsongalvin@yahoo.com or Galvin@TriumphFinancialLLC.net

·     Assist with application, eligibility, plan selection, enrollment, renewal, and disenrollment activities.

·     Assist consumers with applying for APTC and CSR eligibility determinations.

·     Educate consumers on Insurance Affordability Programs, Medicaid, the Children’s Health Insurance Program (CHIP), if applicable.

·     Meet legal responsibilities and conduct quality assurance.

·     Respond to inquiries from the Marketplace regarding your Marketplace Application.