Mere Benefits is a DBA of Health Wealth Simplified LLC, managed by Kate Spilsbury, Licensed Insurance Agent #9527400.

Health Insurance Quote Request

Ready to explore health plans? Complete this form so we can match you with the best options. No application or commitment—just info to get started.

First Name *

Last Name *

Phone *

Email *

I consent to receive communications from Health Wealth Simplified, LLC DBA Mere and Mere Benefits, including but not limited to text messages (SMS/MMS), emails, phone calls, and ringless voicemails. These communications may include information about health insurance plans, policy updates, educational events, and promotional offers. Some communications may be automated or sent using AI tools. Message frequency may vary. Message and data rates may apply.
I understand that I may withdraw my consent at any time by replying STOP to a text or using the unsubscribe link in an email. I also understand that withdrawing consent means Mere will no longer be able to service my insurance needs, as electronic communication is required for our client relationship. Consent is required for us to provide services, but is not required to purchase insurance from any carrier. We will not send marketing messages outside of legally permitted hours. See our Privacy Policy at https://www.merebenefits.com/privacy-policy for details.

Virtual Meeting Disclosure:
I acknowledge that some virtual meetings may be recorded and transcribed using Fathom AI Notetaker, a HIPAA-compliant tool used by Mere to support accurate documentation. This platform operates under a Business Associate Agreement and stores data securely. Meeting summaries or transcripts may be retained and used only for service-related purposes.

What is your total projected household income for the year you’re applying for coverage (e.g., if applying for 2025 coverage, estimate your 2025 income)?

Please include all sources of income for each person in your tax household. Your tax household includes everyone you claim as a dependent on your tax return, even if they have separate insurance. Income that should be counted includes:

Wages and salaries before taxes (include tips and bonuses)
Self-employment income (after business deductions)
Unemployment benefits
Social Security benefits
Rental or investment income

For guidance, you can refer to your most recent tax return. This amount will generally be similar to Line 11 on Form 1040 if your income is expected to be close to that amount. If you’re unsure about specific income details, please consult a CPA for assistance.

TOTAL projected household income this year *

Who referred you? (If no one please ignore this form field)

Who Would You Like to Work With? *

Consent

I authorize Kate Spilsbury to be my health insurance agent for myself and my household. This allows Kate Spilsbury to enroll me, or my family, in a Qualified Health Plan on the Federally Facilitated Marketplace. By agreeing to this, I give permission for Kate Spilsbury to use my confidential information for the following purposes:

Search for an existing Marketplace application.
Complete applications for eligibility and enrollment in a Marketplace plan or other government insurance programs.
Provide ongoing account maintenance and enrollment assistance.
Respond to inquiries from the Marketplace regarding my application. The Agent will keep my personal information private and secure, using it only for the purposes listed above. I confirm that the information I provide on my application will be accurate to the best of my knowledge. I understand that I am not obligated to share additional personal information beyond what is required for the application. I can revoke or modify my consent at any time by emailing [email protected]
I authorize you to enroll me in the best available plan. I grant you access to my healthcare.gov account for submitting necessary information. By signing below, I confirm my understanding and agreement to the terms outlined in this attestation.

Agent of Record: Kate Spilsbury

NPN: 9527400

Phone Number: (904) 654-5450

Email Address: [email protected]

By signing below I have read and agree to the text above. I also agree to the privacy policy that is linked above *

Clear

Consent

I authorize Worley Richards to be my health insurance agent for myself and my household. This allows Worley Richards to enroll me, or my family, in a Qualified Health Plan on the Federally Facilitated Marketplace. By agreeing to this, I give permission for Worley Richards to use my confidential information for the following purposes:

Search for an existing Marketplace application.
Complete applications for eligibility and enrollment in a Marketplace plan or other government insurance programs.
Provide ongoing account maintenance and enrollment assistance.
Respond to inquiries from the Marketplace regarding my application. The Agent will keep my personal information private and secure, using it only for the purposes listed above. I confirm that the information I provide on my application will be accurate to the best of my knowledge. I understand that I am not obligated to share additional personal information beyond what is required for the application. I can revoke or modify my consent at any time by emailing [email protected]
I authorize you to enroll me in the best available plan. I grant you access to my healthcare.gov account for submitting necessary information. By signing below, I confirm my understanding and agreement to the terms outlined in this attestation.

Agent of Record: Worley Richards

NPN: 7918700

Phone Number: (602) 606-7785

Email Address: [email protected]

By signing below I have read and agree to the text above. I also agree to the privacy policy that is linked above *

Clear

Thank you!

Step 1 COMPLETED. Proceed to Step 2