DISCLAIMER!

By signing you have given me all the information above and it is correct to the best of your knowledge, you agree to contact your agent when there are any changes to your income or family status as it could change your subsidy amount or eligibility. You understand that if you miss a payment and your healthcare is cancelled you will have to wait until the next open enrollment to re-enroll and may still be subject to penalties. You agree that you are responsible for assuring the doctors you want are in the network you chose. Your First and Last name below is considered your digital signature.

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