Access to the FFEs and SBE-FPs. Any Web-broker; its Downstream and Delegated Entities, including downstream Agents/Brokers; and its assignees or subcontractors, including, employees, developers, agents, representatives, or contractors, cannot remotely connect or transmit data to the FFE, SBE-FP or its testing environments, nor remotely connect or transmit data to a Web-broker’s systems that maintain connections to the FFE, SBE-FP or its testing environments, from locations outside of the United States of America or its territories, embassies, or military installations. This includes any such connection through virtual private networks (“VPNs”). This “Agreement Between Web-Broker and the Centers for Medicare & Medicaid Services for the Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform” has been signed and executed by: TO BE FILLED OUT BY WEB-BROKER The undersigned is an authorized official of Web-broker who is authorized to represent and bind Web-broker for purposes of this Agreement. Signature of Authorized Official of Web-broker Date Printed Name and Title of Authorized Official of Web-broker Web-broker Name Signature of Privacy Officer Attesting Compliance that Web-broker Systems Comply with Appendices A and B of this Agreement and the Non-Exchange Entity System Security and Privacy Plan Printed Name and Title of Privacy Officer Attesting Compliance that Web-broker Systems Comply with Appendices A and B of this Agreement and the Non-Exchange Entity System Security and Privacy Plan Web-broker Partner ID Web-broker Address Web-broker Contact Number Web-broker must indicate in the below checkbox whether Web-broker will assist Qualified Employees and/or Qualified Employers in applying for or enrolling in SHOP coverage for the benefit year as defined in Section VI.a of this Agreement: ☐ Web-broker will assist Qualified Employees and/or Qualified Employers in the benefit year as defined in this Agreement ☐ Web-broker will not assist Qualified Employees and/or Qualified Employers in the benefit year as defined in this Agreement FOR CMS The undersigned are officials of CMS who are authorized to represent and bind CMS for purposes of this Agreement.
Access to the FFEs and SBE-FPs. Any Web-broker and its assignees or subcontractors—including, employees, developers, agents, representatives, or contractors—cannot remotely connect or transmit data to the FFE, SBE-FP or its testing environments, nor remotely connect or transmit data to a Web-broker’s systems that maintain connections to the FFE, SBE-FP or its testing environments, from locations outside of the United States of America or its territories, embassies, or military installations. This includes any such connection through virtual private networks (“VPNs”). This “Agreement Between Web-Broker and the Centers for Medicare & Medicaid Services for the Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform” has been signed and executed by:
Access to the FFEs and SBE-FPs. EDE Entity; its Downstream and Delegated Entities, including downstream Agents/Brokers; and its assignees or subcontractors— including, employees, developers, agents, representatives, or contractors—cannot remotely connect or transmit data to the FFE, SBE-FP or its testing environments, nor remotely connect or transmit data to EDE Entity’s systems that maintain connections to the FFE, SBE-FP or its testing environments, from locations outside of the United States of America or its territories, embassies, or military installations. This includes any such connection through virtual private networks (VPNs). This “Agreement between EDE Entity and the Centers for Medicare & Medicaid Services for the Individual Market Federally-facilitated Exchanges and State-based Exchanges on the Federal Platform” has been signed and executed by: TO BE FILLED OUT BY XXX ENTITY The undersigned is an authorized official of EDE Entity who is authorized to represent and bind EDE Entity for purposes of this Agreement. The undersigned attests to the accuracy and completeness of all information provided in this Agreement. Signature of Authorized Official of EDE Entity Date Printed Name and Title of Authorized Official of EDE Entity EDE Entity Name EDE Entity Partner IDs Signature of Privacy Officer Printed Name and Title of Privacy Officer EDE Entity Address EDE Entity Contact Number FOR CMS The undersigned are officials of CMS who are authorized to represent and bind CMS for purposes of this Agreement.
