I authorize Stephen Marker, a licensed health insurance agent doing business as Marker Coverage Advisors, to assist me and my household, if applicable, with evaluating, enrolling in, and maintaining health insurance coverage, including:

• Qualified Health Plans offered through the Federally Facilitated Marketplace

• Qualified Health Plans offered through State-Based Exchanges

• ACA-compliant health insurance plans purchased directly from insurance carriers (off-exchange)

Agent Role Disclosure

I understand that Stephen Marker (Marker Coverage Advisors) is an independent licensed insurance agent and is not the Health Insurance Marketplace, a government agency, or an insurance company. The agent provides enrollment assistance but does not determine eligibility for financial assistance or make final coverage decisions. Eligibility determinations are made by the Marketplace or insurance carrier.

Compensation Disclosure

I understand the agent may receive compensation from insurance companies if I enroll in coverage. Compensation may include commissions and other incentives. This compensation does not increase my premium or the cost of the plan.

Authorization to Assist

By agreeing, I authorize the agent to:

• Access my Marketplace or carrier account information as permitted

• Search for existing applications

• Complete and submit applications for coverage

• Provide enrollment support, account maintenance, and carrier communication

• Respond to Marketplace or carrier inquiries regarding my coverage

Agent of Record

I designate Stephen Marker as my Agent of Record (AOR) for health insurance matters.

Privacy Authorization

I authorize the collection and use of my personal information for the purposes described above and understand my information will be kept private and secure.

Communication Consent

I consent to receiving calls, texts, and emails related to my coverage and enrollment. Message and data rates may apply. I may opt out of texts at any time.

Special Enrollment Attestation

If enrolling outside Open Enrollment, I attest that any qualifying life event information I provide is true and accurate.

Scope

This authorization applies for the current and future plan years unless revoked.

Revocation

I may revoke this authorization at any time by contacting 952-522-3838.

Plan Selection Authorization

I understand that my health plan options have been explained to me, including plan type, coverage level, provider network considerations, and estimated costs. I acknowledge that the final plan selection is my decision.

I authorize Stephen Marker, licensed health insurance agent, to enroll me in the plan I select or verbally confirm during our communication. If I am unable to complete the selection directly, I authorize the agent to complete the enrollment based on the plan option I have indicated and approved.