Consent

ACA Marketplace consent

The Health Insurance Marketplace requires your written permission before an agent can help with your application. Reading and signing this takes about a minute.

Why this consent is needed

Federal rules require an agent or broker to have your documented permission before helping with a Health Insurance Marketplace application. Your consent lets us look at your existing application, compare plans with you, submit or update an application on your behalf, and follow up with the Marketplace when something needs fixing.

Consent is free, it never obligates you to enroll in anything, and you can withdraw it at any time by calling or emailing our office. We keep a copy of your signed consent on file, and you receive a copy by email as soon as you submit.

What we do not ask for here

This form never asks for a Social Security number, a Medicare number, tax or income documents, or any bank or card details. If anything is needed later for your application, we collect it with you directly through a secure channel.

Sign your consent

Fill in your details, check each statement, and type your name as your signature.

First name

Last name

Phone

Date of birth (optional)

Helps us match you to the right Marketplace record.

State (optional)

What you are agreeing to

I give Bleu Sky's Insurance Solutions permission to act as my agent to review, compare, complete, submit, and update a Health Insurance Marketplace (ACA) application on my behalf.

I understand the agency may discuss my application, plan options, and eligibility results with the Marketplace and with the insurance companies involved.

I understand this consent stays in effect until I withdraw it, that I may withdraw it at any time by calling or emailing the agency, and that giving consent does not obligate me to enroll in any plan.

Type your full name as your signature

Dated September 15, 2026.

Your information is used only to respond to your request. We never sell your information. Please do not include Social Security numbers, Medicare numbers, medical records, or banking details.