Ohio Individual Marketplace Privacy Notice Statement 

                                                                                               Privacy Notice Statement

I understand that by providing my personally identifiable information (PII), I am consenting to the use and disclosure of my information as described in this Privacy Notice Statement.

The information I provide will be used by Rola Khwais/ Khwais Financial LLC, acting as my agent/broker, to assist with my application for health insurance coverage through the Federally Facilitated Marketplace (HealthCare.gov). This information may include, but is not limited to, name, address, date of birth, Social Security Number, income, and immigration status.

My information will be used only for the purposes of determining eligibility for health coverage and financial assistance, enrolling me in a health plan, and ongoing administration of my coverage. My information will not be shared with unauthorized third parties.

I understand that I must provide accurate information, and I will have the opportunity to review and confirm the accuracy of my application information before it is submitted.

I give my consent for Rola Khwais/ Khwais Financial LLC to collect, use, and retain my PII for these purposes.