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 info@easyhealthfl.com.