Signed in as:
filler@godaddy.com
Signed in as:
filler@godaddy.com
AS REQUIRED UNDER THE 2023 CMS-9899-F AMENDMENT OF 45 CFR § 155.220.
I have reviewed and confirm the accuracy of my Marketplace enrollment as being complete and accurate and give permission for the enrollment to be submitted
I understand that Matt Miles and/or their staff will not share my personally identifiable information (PII) and they will ensure that my PII is kept private and safe when collecting, storing, and using my information for the stated purposes above.
I confirm that the information I provide for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge.
I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time. I understand that requests must be made in writing, either by sending the request via certified mail to the address below or via email to matt@hsa1.net.
Matt Miles | (903) 246-9760 | matt@hsa1.net | NPN: 2085297