You may choose someone to act on your behalf. You may choose a relative, friend, sponsor, lawyer or a doctor. A court may also appoint someone. You and the person you choose must sign, date, and complete a representative statement.
Zing Health does not require a specific form for appointments. Zing Health can provide the CMS Appointment of Representative Form - CMS-1696 which you may use for appointment of representative
You may also use an equivalent written notice. An equivalent written notice includes the following:
A representative form is valid for one year from the date it has signatures for both you and the appointee, unless revoked. For example, if the enrollee signs the form on January 1, 2020 and the representative signs on January 3, 2020 (or vice versa), the form is effective for one year starting on January 3, 2020.
If the you would like the same individual to continue serving as a representative after one year, you must reappoint that person by submitting a new representative form.