top of page


The following limited power of attorney authorizes Your Health Advisor LLC, its principal, and authorized representatives to make decisions concerning your health insurance only. This limited power of attorney does not authorize Your Health Advisor or any other person to make decisions about your medical care.  The following limited power of attorney shall be effective immediately as of the date you sign below. If Your Health Advisor becomes unable or unwilling to act for you after you sign the limited power of attorney, we will notify you in writing at the email address you provided, and this power of attorney will terminate on the date of that notice.  Please review the limited power of attorney carefully. If you have questions about the limited power of attorney or the authority you grant to Your Health Advisor LLC you should seek legal advice before signing this form. Nothing in these disclosures regarding limited power of attorney constitutes legal advice or legal opinion.



 I grant Your Health Advisor limited authority to take any and all actions to select, procure, and maintain health insurance for myself, spouse and/or any of my dependents though the Federally-Facilitated Marketplace ("FFM"), including, but not limited to the following actions:  Search the Marketplace for existing applications, or create a new application on my (and/or my Spouse, Partner, & Dependents) behalf. Select a health plan for me;     Apply for and enroll me (and my dependents) in the selected health plan;     Add or remove coverage;     Create or change a beneficiary or dependent designation;     Update contact information for me, spouse and/or any dependents or beneficiaries;     Update information relevant to eligibility for subsidies for the health insurance;     Submit supplemental materials to a health insurance marketplace or exchange, including, but not limited to, proof of income and social security numbers, or any other required information or document;     Change my health plan and those of my dependents; if Your Health Advisor, it's principal or any authorized representative  determines that another plan that is available is more affordable, better meets my needs, or I state that It is my preference and/or that of my dependents ; and  Take any other action with regard to such health insurance as permitted by law.  The authority granted to Your Health Advisor hereunder extending 365 days from the date signed will renew automatically yearly. The authority granted to Your Health Advisor hereunder will cease immediately  upon my death or incapacity, or if I revoke the limited power of attorney, via email, via call or via text message, to Your Health Advisor.  Any person, including, without limitation, Your Health Advisor, any web-broker through which Your Health Advisor may submit an application for insurance on my behalf, and the FFM, may rely upon the validity of this limited power of attorney or a copy of it unless that person knows it has been terminated.  



Please read the attestations below and sign if you agree.   Use of Personal Information:   I consent to the use and disclosure by Your Health Advisor, LLC of (a)  the personal information I have provided about myself and others in the questionnaire above, and (b) any  other personal information about myself or the other individuals listed above which may be obtained by Your Health Advisor, LLC from government data sources, for purposes of applying for health insurance coverage through the Federally Facilitated Exchange (the “Marketplace”) and for any other purposes disclosed in Your Health Advisor, LLC’s Privacy Policy.   I agree to this website’s Privacy Policy ( and Terms of Use  (   If you have questions about our Privacy Policy, please contact us at Each request is subject to verification. California and Nevada residents exercising the right to opt out of the sale of their data should access our Do Not Sell My Info form here. For more information regarding these privacy matters, please refer to our Privacy Policy.    


 Eligibility:   I understand that I’m required to provide true and complete answers to the questions posed above and that I may be asked to provide additional information, including proof of my eligibility for a Special Enrollment Period if I qualify. If the information provided by me is not true and complete, I may face penalties, including the risk of losing my eligibility for coverage.   I know that I must inform [Your Health Advisor, LLC] if information I have provided changes. I understand that I can update my information in my Marketplace account or by contacting Your Health Advisor, LLC at 915-777-3515. I know a change in my information could affect eligibility for member(s) of my household. I understand that if anyone I identified above as needing coverage  is enrolled in Marketplace coverage and is later found to have other qualifying health coverage (like Medicare, Medicaid, or CHIP), the Marketplace will automatically end their Marketplace plan coverage. This will help make sure that anyone who’s found to have other qualifying coverage won’t stay enrolled in Marketplace coverage and have to pay full cost.    


 Renewal of Coverage:   To make it easier to determine my eligibility for help paying for coverage in future years, I agree to allow the Marketplace to use my income data, including information from tax returns, for the next 5 years. The Marketplace will send me a notice, let me make any changes, and I can opt out at any time.  



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 2024 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 premium tax credit 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.   I understand the foregoing does not constitute tax advice provided by Your Health Advisor, LLC to me, and that should I have any questions regarding any tax credits for which I may be eligible, my tax returns, or any other related tax matters I should consult a qualified tax advisor prior to enrolling in health insurance coverage provided via the Marketplace.    Electronic Signatures and Communications:   I consent to the use of an electronic signature to sign all forms presented to me by Your Health Advisor, LLC during the health insurance enrollment process, including, without limitation, to sign this form   below,  unless and until I withdraw my consent to the use of electronic signatures by providing notice to the address below.  I agree that this consent is effective on the date that I affix my signature below.   By signing below, I agree to be legally bound as if I had signed this form and other documents with a handwritten signature, and I acknowledge that I have reviewed and agree to the above terms and conditions.    


By signing below I am providing my express written consent to receive emails, telephone calls, text messages, and artificial or pre-recorded messages from You Health Advisor, LLC regarding this form and any health insurance coverage applied for on my behalf by You Health Advisor, LLC.    (2) I understand that at this time I have not yet applied for Federally Facilitated Exchange health insurance, and that Your Health Advisor, LLC. will be using the information and consents I provide herein to fill out, sign on my behalf, and submit the Federally Facilitated Exchange application.  If you have any questions, please contact Your Health Advisor, LLC. at    This form is used to help to find insurance for you and your family. The information provided must be accurate for the subsidies to be accurate. Failure to provide the correct information could result in claims being invalidated or the termination of your insurance policy. By submitting an application, you confirm that the information is accurate to the best of your knowledge." 

bottom of page