I give, Pilar Montes Lumpkin NPN 17031598 & Accurate Health Plans - Agency NPN 18614900 and it's agents, permission to serve as the health insurance agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by telephone only for the purposes of one or more of the following:

1. Searching for an existing Marketplace application.
2. Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums.
3. Providing ongoing account maintenance and enrollment assistance, as necessary.
4. Responding to inquiries from the Marketplace regarding my Marketplace application.