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Quote Request for Private Health Insurance
Quote Request for Private Health Insurance
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Are you, or anyone listed on this form, offered health insurance from their employer?
Income Information
You may be eligible for a subsidy/premium tax credit to help pay your healthcare premium. To determine if you are eligible please provide us with your estimated total household income for 2022.
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I have read the
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and I hereby authorize KHI Solutions to collect and use my PII to the extent reasonably necessary to assist in comparing health insurance plans, obtaining determinations of eligibility for coverage, enrolling in QHP's through the Marketplace, and/or applying for Federal subsidies, and any other health related plan.
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