Application Policies: Rights and Responsibilities

This document talks about your rights and responsibilities as a HealthSource RI customer.

Application Policies: eSignature

The document below shows what the page looks like when you provide an electronic signature or "eSignature" to complete your application. When you sign this page you:

• confirm the information you entered in your application is correct;
• give HealthSource RI permission to share information about you and your income; and
• pledge that you filed taxes last year

Application Policies: Payment

These agreements describe your rights and responsibilities when you make a one-time or recurring payment to HealthSource RI.

Application Policies: Consent for Identity Proofing

This consent form gives HealthSource RI permission to access personal information about you to verify your identity.

Application Policies: Data Sharing

This agreement gives HealthSource RI permission to use and share information about you to see if you qualify for health insurance or other programs.

Application Policies: Consent for Use of Income Data

This consent form lets HealthSource RI use information about your income to see if you qualify for financial help to buy health insurance.

Application Policies: User Acceptance Agreement

This agreement explains how HealthSource RI protects your privacy and personal information.