This notice explains how your agent may collect, use and share your information. Please read it carefully and contact Piedmont Insurance & Business Group if you have any questions.

We are legally required to give you this notice by applicable law and our agreement with the federal government. We respect your personal information and want you to fully understand how we may use and share your information.

What information will you ask me to give you?

We must collect certain information about you, called Personally Identifiable Information (“PII”) in order to help you complete your application for health insurance. PII is information that can be used to identify you or trace your identity. These are a few examples of PII. This is not a complete list.

• name, address, date of birth, telephone number
• social security number
• household income, marital status
• race or ethnicity
• credit or debit card numbers

Will you keep my information safe?

We have developed privacy and security policies that we must follow to ensure that we protect your PII.

How will you use my information?

We will use only the information that we need to help you obtain health insurance through the Federally Facilitated Exchange (“FFE”) or State-based Marketplaces (SBMs) and to provide Authorized Functions approved by the FFE/SBMs, or other services as permitted under applicable law. These are a few of the authorized functions that we may conduct. This is not a complete list:

• Searching for a Marketplace application
• Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance affordability programs, such as Med- icaid and CHIP or advance tax credits to help pay for Marketplace premiums
• Answering questions about your eligibility
• Respond to inquiries from the Marketplace regarding your application
• Helping with filing appeals of eligibility determinations
• Correcting errors in your application
• Assisting with ongoing account enrollment/maintenance

Will you share my information with anyone?

We may only share your information as described in this notice. We may share your information with certain Federal or State agencies, the health insurance issuer that you select, corporate partners, and/or subcontractors that help us to provide services to you. We must get your permission to share your information for any other pur- pose that is not described in this notice.

What happens if I don’t share my information with you?

If you do not want to share your information, you may not be able to enroll in a health insurance plan or receive assistance with your health insurance through our agency. By accepting this Privacy Policy and Consumer Consent for Assistance, you give our agency ongoing permission to work on your (and your family’s) behalf, including to add, remove, access, and modify your health insurance coverages and account via HealthSherpa or Marketplace. You may revoke this consent by sending a written notice to your agent and with your agent’s written confirmation of receipt. If this consent is revoked, you may not be able to receive assistance with your health insurance through our agency until a new consent form has been signed.

Last updated October 20, 2023.