I, the undersigned, hereby authorize the team of agents at Valley Insurance Professionals (“VIP”), the insurance broker for the Oregon Homecare Workers Supplemental Trust (“Trust”), to act as my “Agent of Record” relating to any health insurance plan in which I enroll, whether I apply directly or through the applicable federal or state Marketplace. I understand that VIP has a team of licensed insurance agents assigned to assist care providers and their families.
Click here to see VIP's Notice of Privacy Practices.
The following section pertains to my Marketplace application for health insurance, whether via website enrollment, direct enrollment, phone enrollment, or on paper. The term “eligibility,” when used below, shall be in reference to Marketplace eligibility and not Carewell SEIU 503 benefits:
If you have questions about this form, you can call the Carewell SEIU 503 Benefits Team at 1-844-503-7348.