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Consent to enroll (APTC/CSR)
In accordance with the Notice of Benefit and Payment Parameters, beginning June 18, 2023: Agents, brokers and web-brokers must obtain documentation that the consumer consents to work with that agent, broker or web-broker when enrolling in advance payments of the premium tax credit (APTC) and cost-sharing reduction (CSR) payments. By dating and signing below, the undersigned gives consent to be enrolled in a federally facilitated exchange insurance policy by The Hummingbird Agency, LLC (hereafter The Agency) and its designated agents. This consent shall last for the duration of the policy and its renewals, so that licensed and appointed agents of The Agency may service the policy at the request of the policyholder. Such services may include but are not limited to: updating household information or size, updating income, updating significant life events, manually renewing at end-of-year when necessary, quoting plans, or changing the type of policy, at the policyholder's request. Consent may be rescinded by emailing The Agency at hello@hummingbirdins.com with a request to remove consent.

Your typed name, today's date, and this device's internet address are saved with your consent. You can remove consent anytime by emailing jesse@hummingbirdins.com.

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