Estoy de acuerdo en notificar a Your Health Advisor, LLC tan pronto como tenga conocimiento de cualquier cambio en el ingreso anual estimado que he proporcionado anteriormente. Reconozco que cualquier omisión por mi parte de notificar a Your Health Advisor sobre cualquier cambio en ese ingreso anual estimado puede afectar mi elegibilidad.

I acknowledge that in some cases it may be necessary for Your Health Advisor, LLC to verify my income. I acknowledge that if income verification is required in order for Your Health Advisor, LLC to complete my enrollment, I hereby authorize Your Health Advisor, LLC and/or its authorized agents to submit an Income Attestation Letter on my behalf with the information that I have provided above.

I hereby provide Your Health Advisor, LLC, and its owners, members, principals, agents, and employees (collectively, "YHA") with consent and authorization to enroll me (and my spouse / partner or dependents if I have elected above) in a health insurance plan through the ACA Marketplace (“Consent”). In the event that I am already enrolled in a plan, I hereby designate YHA and its authorized agents as my Agent of Record, and I authorize YHA and its authorized agents to enroll me in a new insurance plan, if a plan is available that YHA and/or its authorized agents determine, at their sole discretion, better meets my needs and/or the needs of my spouse / partner or dependents. I acknowledge that this Consent shall remain in effect unless and until I rescind the Consent, in writing, by notifying YHA at WeCare@yourhealthadvisor.info of my revocation of the Consent.