Skip to main content
FreeHealthPlan.org

Terms & Conditions


By completing and submitting an application for health insurance, you are giving permission to Douglas Curl, NPN 9893707, to serve as the health insurance broker for yourself and your entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally Facilitated Marketplace. By consenting to this agreement, you authorize the above-mentioned Broker to view and use the confidential information provided by you in writing, electronically, or by telephone only for the purposes of one or more of the following:


1. Searching for an existing Marketplace application

2. Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or other government insurance           affordability programs, such as Medicaid and CHIP or advance tax credits to help pay for Marketplace premiums

3. Providing ongoing account maintenance and enrollment assistance, as necessary

4. Responding to inquires from the Marketplace regarding my Marketplace application


You understand that the Broker will not use or share your personally identifiable information (PII) for any purposes other than those listed above. The Broker will ensure that your PII is kept private and safe when collecting, storing, and using your PII for the stated purposes above. By providing your telephone number, you consent to receive text messages. You are agreeing to receive marketing or one-on-one messages from FreeHealthPlan.org. Message frequency may vary. Standard message and data rates may apply. Reply STOP to opt out. Reply Help for help. FreeHealthPlan.org agents only communicate on behalf of FreeHealthPlan.org. Any additional companies, carriers, or providers would need to get a separate opt-in to communicate with customers.

You confirm that the information you provided for entry on your Marketplace eligibility and enrollment application will be true to the best of your knowledge. You understand that you do not have to share additional personal information about yourself or your health with your Broker beyond what is required on the application for eligibility and enrollment purposes. You understand that your consent remains in effect until you revoke it, and you may revoke or modify your consent at any time by phone or email.

    • Name of Primary Writing Broker: Douglas Curl
    • Broker National Producer Number: 9893707
    • Name of Agency: Curl Insurance Services, DBA: Free Health Plan.org, LLC
    • Agency National Producer Number: 20769053
    • Phone Number: (833) 205 3320
    • Email Address: support@freehealthplan.org

You understand that failure to adhere to all of the information below may result in loss or repayment of any or all tax credits to the IRS. By completing and signing this form, you are confirming receipt and understanding of all of the following:


You understand the 2025 Adjusted Gross Income and household information you provided qualifies you for Premium Tax Credits.


You understand that if you underestimate your 2025 Adjusted Gross Income, the difference must be paid when federal income tax returns are filed.


You understand that if you overestimate your 2025 Adjusted Gross Income, the difference will be issued as a refundable credit when federal income tax returns are filed.


You are aware that you must file your 2025 taxes and reconcile your premium tax credit. 1095A forms will be mailed to members in January 2026.


You have provided information for all dependents and understand that if you are legally married, you are required to file taxes jointly.


You understand that if you qualify for health insurance through your employer, a spouse's employer, a parent's employer, Medicaid, TRICARE, VA Coverage, etc., you may not be eligible for the premium tax credit. To be eligible for the premium tax credit, your share of of the monthly premium in the lowest-cost plan offered to you must be higher than 9.12% of your household income.


You understand you may be denied coverage if you did not disclose the use of tobacco products more than 4 times per week in the past 6 months in any form (cigarettes, cigars, oral tobacco, pipe, etc), during the application process.