• IMPORTANT NOTE: Requests for release with carriers in partnership with Senior Market Advisors must have Reciprocal Release Form attached in order to process.  Requests made without the appropriate form cannot be processed.

  • Release Request

    BEFORE CONTINUING, you will need to print and complete the Reciprocal Release Request (CLICK HERE To View & Print) and upload it below.

  • Release Request

    BEFORE CONTINUING, you will need to print and complete the Reciprocal Release Request (CLICK HERE To View & Print) and upload it below if you are requesting a release for our carriers in partnership with Senior Market Advisors listed below:

    Carriers in Partnership with Senior Market Advisors: Aetna / Coventry, Anthem BCBS / Amerigroup, BCBS of IL, NM, OK, TN, TX (Regional), Centene / Allwell / Wellcare, Cigna Healthspring, Clover Health, Devoted, Freedom/Optimum, Gateway Health Plan, Humana, Lasso, Molina, Scan, United Health Care, Vantage Health Plan

     

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  • Format: (000) 000-0000.

  • It looks like you have selected Aetna and/or Cigna as a carrier you need a release for. 

  • Aetna Release Requirement: Please download and complete #1 and #2 of the "Transfer Release Option" section on the following form and upload it with your Reciprocal release: Aetna Release Form

  • Cigna Release Requirement: Please download and complete the "Release From Topline" section on the following form and upload it with your Reciprocal release: Cigna Release Form

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  • Effective August 1st, 2023, the release process is closed.  New release requests can be submitted on January 1st, 2024.

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