BROKER NAME: MOSES ADEDIPE
BROKER NPN: 14991254
AGENCY: MERCYLAND INSURANCE DEPOT
AUTHORIZATION TO COLLECT PERSONAL INFORMATION
By contacting Mercyland Insurance Depot for assistance in obtaining health insurance you agree that we may create, collect, disclose, access, maintain, use, and store Personally Identifiable Information (PII), and PII for you or anyone else who is included on your application, to perform the following duties:
Inform you or your authorized representative about the full range of Marketplace health coverage options and insurance affordability programs for which you are eligible.
Mercyland Insurance Depot will:
- Assist you in completing your application for health coverage in a Qualified Health Plan (QHP) through the Marketplace and for insurance affordability programs.
- Help you enroll in a QHP or in an insurance affordability program.
You may revoke this authorization at any time and agree to notify us in writing if you choose to revoke this authorization.
Please note that Swanson-Phillips & Associates will be compensated by the insurance carrier if you choose to purchase coverage.
You are responsible for the selection of the insurance carrier that best meets your needs.
We will follow privacy and information security standards when creating, collecting, disclosing accessing, maintaining, storing, or using your PII. Information about these standards is available at www.mercylandinsurance.com We are not expected or required to maintain or store any of your PII, but if we do maintain or store your PII, we will follow these privacy and information security standards.
You are under no obligation to provide any information to us, but we cannot provide coverage or services without the information we request.