By submitting this form, you authorize Tom Mueller (NPN 19878991), a licensed agent with TruShield Health, to help you apply for Marketplace (ACA) coverage, assist with updates and renewals, discuss your case with the Marketplace Call Center, and receive information related to your application. You understand: • You are responsible for the accuracy of all information provided. • You must review and confirm all details before Tom submits anything. • This consent is valid for 12 months unless you revoke it. • You may revoke your consent at any time by contacting Tom Mueller.