SECTION 2: REVIEW, CONFIRMATION OF APPLICATION ACCURACY, AND INCOME DATA USAGE
2.1 Reporting Changes: I will report any changes in my circumstances different from my original application within 30 days to avoid impacting my coverage or eligibility.
2.2 Income Data Usage: I agree to allow the Marketplace to use income data, including information from tax returns, for the necessary duration as required by the application process and subsequent procedures.
2.3 Avoiding Coverage Overlap: If anyone in my application has other qualifying health coverage, I understand their Marketplace coverage will be terminated to prevent overlapping coverages.
2.4 Accuracy of Information: I confirm that all details in my eligibility application, including contact and income information, are accurate. I am aware that discrepancies or false information may affect my eligibility and have legal consequences.
2.5 Declaration under Penalty of Perjury: I declare under penalty of perjury that the information provided is true and accurate, and I understand the penalties for providing false information under federal law.
SECTION 3: PRIVACY AND INFORMATION USAGE
I acknowledge that Uworld Insurance Group will access and use my personal information for application and enrollment purposes and commit to keeping my information private and secure.
SECTION 4: RESPONSIBILITY FOR COSTS
I agree to be responsible for the payment of any premiums or costs associated with the health insurance coverage obtained through this agreement.
SECTION 5: AGREEMENT TERM AND MODIFICATION
This agreement remains effective until modified or terminated by either party with written notice.
CONSENT AND SIGNATURE
By signing below, I agree to the terms outlined in this document and provide my consent for Uworld Insurance Group and its agents to act as my Agents of Record.
