Maine United HealthLicensed Maine health insurance broker · Lewiston
New client

Sign the consent form from your phone

Maine and federal rules require your written consent before a broker can look at your CoverME.gov account or quote you. It takes two minutes, nothing is printed, and your reply email is the record.

Open the consent form (PDF)
  1. 1Open the PDF on your phone with the button above, or from the email we sent you.
  2. 2Fill in your name, date of birth, address and contact details. Household members too, if they are applying. Tap the checkboxes to say what you consent to. Do not type a Social Security number anywhere on it.
  3. 3Sign by typing your name in the signature box and adding today's date.
  4. 4Reply to our email with the PDF attached, or send it to christopheryork@maineunitedhealth.com. Your reply from your own email address is your electronic signature under Maine and federal law.
  5. 5We confirm by email and book your appointment. The consent lasts until you cancel it, which you can do any time by email or phone.

What the consent allows

  • Searching for your existing CoverME.gov application
  • Completing an application with you and submitting it after you approve
  • Looking at your plan and bills to help you all year
  • Nothing else: we never log in as you, change your bank details or enroll you without your approval

Rather do it in the office? Bring a photo ID and we will do it on paper in five minutes.

Already signed?

Tell us what you need and we will call you

Do not include Social Security numbers, dates of birth or income in this form. We take those by phone or in person.

Dec 15 deadline for Jan 1 coverageCallTextFree quote