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Estaba harto de tratar con las compañías de seguros por teléfono. Decidí que era tiempo para reunirme con alguien en persona . Nos encontramos con Joe Martin. Pasó 25 minutos y nos ayudo a escoger el plan de seguro perfecto para nosotros. Yo recomendaría a Joe Martin y 1st Choice para cualquiera que quiere hablar con una persona real. Fue una experiencia tan fácil. Después de la reunión , los llamamos con preguntas y fueron rápidos para ayudarnos. no podría haber pedido mejor servicio. Gracias.
Privacy & use of your information
We’ll keep your information private as required by law. Your answers on this form will only be used to determine eligibility for health coverage or help paying for coverage. We’ll check your answers using the information in our electronic databases and the databases of other federal agencies. If the information doesn’t match, we may ask you to send us proof.
We won’t ask any questions about your medical history. Household members who don’t want coverage won’t be asked questions about citizenship or immigration status.
Important: As part of the application process, we may need to retrieve your information from the Internal Revenue Service (IRS), Social Security, the Department of Homeland Security (DHS), and/or a consumer reporting agency. We need this information to check your eligibility for coverage and help paying for coverage if you want it and to give you the best service possible. We may also check your information at a later time to make sure your information is up to date. We’ll notify you if we find something has changed. I agree to have my information used and retrieved from data sources for this application. I have consent for all people I’ll list on the application for their information to be retrieved and used from data sources.
Read these statements, and select whether you agree or disagree.
- No one applying for health coverage on this application is incarcerated (detained or jailed)
- To make it easier to determine my eligibility for help paying for health coverage in future years, I agree to allow the Marketplace to use income data, including information from tax returns, for the next 5 years (the maximum number of years allowed). The Marketplace will send me a notice, let me make any changes, and I can opt out at any time.
- I know that I must tell the program I’ll be enrolled in if information I listed on this application changes. I know I can make changes in my Marketplace account or by calling 786-766-1247. I understand that a change in my information could affect my eligibility for member(s) of my household.
- I’m signing this application under penalty of perjury, which means I’ve provided true answers to all of the questions to the best of my knowledge. I know that I may be subject to penalties under federal law if I intentionally provide false or untrue information.
- I understand that because the premium tax credit will be paid on my behalf to reduce the cost of health coverage for myself and/or my dependents:
- I must file a federal income tax return in 2019 for the tax year 2018.
- If I’m married at the end of 2018, I must file a joint income tax return with my spouse.
- I also expect that:
- No one else will be able to claim me as a dependent on their 2018 federal income tax return.
- I’ll claim a personal exemption deduction on my 2018 federal income tax return for any individual listed on this application as a dependent who is enrolled in coverage through this Marketplace and whose premium for coverage is paid in whole or in part by advance payments.
- If any of the above changes, I understand that it may impact my ability to get the premium tax credit. I also understand that when I file my 2018 federal income tax return, the Internal Revenue Service (IRS) will compare the income on my tax return with the income on my application. I understand that if the income on my tax return is lower than the amount of income on my application, I may be eligible to get an additional amount. On the other hand, if the income on my tax return is higher than the amount of income on my application, I may owe additional federal income tax.
- By entering my name below I am indicating my intent to and agree to permit 1st Choice Health Quote Inc. or its agents to sign forms electronically on my behalf and warrant that all of the information I have provided is accurate, complete and true to the best of my knowledge.
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