WA HealthPlanFinder Consent Form
This notice must be provided and we must receive your consent before we can assist you in completing the eligibility application, comparing and selecting qualified health plans (QHPs), enrolling in coverage through the Exchange (WaHealthPlanFinder.org), and providing ongoing account/enrollment maintenance.
When you apply to WaHealthPlanFinder.org, the information that you provide will be maintained in a federal system of records.
Your confidential personal and financial information is used for Exchange business purposes only and is only disclosed to individuals who are authorized to receive or view it.
We must keep a record of providing this notice and receiving consent from you to assist you in applying for and enrolling in coverage in the Exchange.
Your signature is not required.
Please complete the form to the right.