• Join Our Team!

    Join Our Team!

    Agent Contracting Request Form

  • Thanks for your interest in contracting with PPI.  Complete the information in the form below, and our team will reach out to you with contracting instructions.

    Questions?  Call us at 864.228.2635

    NOTE: This form is NOT a contract.  This form will indicate your interest in appointing through PPI, and then additional contracting links/paperwork and certifications (if applicable) will be required before you begin marketing/selling any carrier products listed on this form.  After completing this form, our team will reach out to you with additional instructions for new appointments and transfers.

  • Have you completed your FFM (CMS) Certification?
  • Are you licensed in and plan to market ACA in any of the following states? These states operate their own State-based Exchanges: AR, CA, CO, GA, KY, MD, ME, NV, NJ, NM, NY, PA, VA, WA
  • If yes, have you completed the State-Based Exchange certification(s) for the state(s) above that you will market ACA plans in?

  • Note: All agents marketing ACA health plans are required to complete the CMS (FFM) Certification and/or State-Based Exchange Certifications (if appliable). 

    If you have not completed your FFM (CMS) Certification and/or the State Based Exchange certification(s) yet (if applicable), then you must complete those required certifications before proceeding with ACA carrier contracting.  

    Click here for more information and instructions for completing the FFM (CMS) Certification.

    Click here for more information and instructions for completing the State-Based Exchange Certifications.

    Once you have completed your FFM and/or State-Based Certifications, please return to this form to complete your contract requests.

    Questions? Call our Agent Care Team at 877-612-7317

  • Status*
  • Mailing Address Type*

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Are you requesting to appoint as an individual or an agency?*
  • Are you the principal agent for this agency?
  • Select the Lines of Insurance that you sell
  • Interested in Senior Lead Program?
  • Rows
  • Interested in the 12 month Health Sales & Lead Program?

  • Health Agent Experience

  • How frequently would you like 15 health leads?

  • CONTRACT REQUESTS 

    Click the blue bars below to see all carriers available in that segment. 

    Then, select the carriers you would like to request appointment with, and our contracting team will send you instructions for new appointments & transfers.

    NOTE: Selecting carriers below indicates intent to contract; you will not be fully contracted until you complete all required paperwork/links for each carrier.

    • ➤ Under 65 - Individual 

    • Click here to see which ACA & Non-ACA carriers are available by state.

    • ACA Carriers:

    • Alliant - (TS)
    • Select the states that you're requesting to appoint with Alliant:
    • Ambetter - (KR)
    • Select the states that you're requesting to appoint with Ambetter:
    • Do you plan to sell off-exchange and/or ICHRA with Ambetter?

    • Ambetter transfers will close September 1st - April 15th

    • Ambetter onboarding and adding states is closed until February 2026.

    • AmeriHealth - only available in New Jersey - (KR)
    • AmeriHealth Caritas - (KA)
    • Select the state(s) that you are requesting to be appointed to sell AmeriHealth Caritas:
    • Anthem - (KA)
    • Select the states that you're requesting to be appointed to sell Anthem:
    • Anthem/Wellpoint - (KA)
    • Select the state(s) that you're requesting to be appointed to sell Anthem/Wellpoint:
    • Antidote - (KW)
    • Select the state(s) that you're requesting to be appointed to sell Antidote:

    • AvMed - Onboarding is Closed until further notice. Please check back in August 2026

    • BCBS of Arizona - (KA)

    • BCBS AZ - New Appointments & Transfers Closed - 11/1 - 2/1

    • BCBS of Michigan - (KR)
    • BCBS of Nebraska (KW)
    • BCBS of North Carolina - (DB)

    • BCBS NC New Appointments & Transfers Currently Closed

    • BCBS of South Carolina (ACA) - (TB)
    • I would like to also contract with Blue Choice (U65 plans):
    • BCBS of Tennessee - (KR)
    • I am currently set up as a
    • Care Source (ACA) - (KR)
    • Select the states you are requesting to be appointed to sell Care Source ACA:

    • CareSource Transfers closed Sept 1-Dec 31st. 

    • Cigna (ACA) - (KA)
    • Select the states you are requesting to be appointed to sell Cigna ACA:
    • I am currently set up with Cigna as a

    • Cigna New Appointments & Transfers Closed - 11/1 - 2/1

    • Christus - TX, LA only - (DB)
    • Select the states you are requesting to be appointed to sell Christus:
    • HealthFirst - Florida only - (KA) - pending
    • HealthFirst is requiring a minimum of 10 members enrolled within the first 60 days of appointment.  If you do not meet this requirement, HealthFirst may terminate your appointment.  I commit to enrolling a minimum of 10 members within the first 60 days of appointment.
    • Highmark (BCBS) - (KA)
    • Select the states you are requesting to be appointed to sell Highmark:
    • Horizon Blue - only available in New Jersey - (KR)
    • Imperial Health Plans - (KR)
    • Select the state(s) you are requesting to be appointed to sell Imperial Health Plans:
    • Independence Blue Cross - only available in Pennsylvania - (KR)
    • Jefferson Health Plan - only available in Pennsylvania - (KA)
    • Kaiser - (DB)
    • Select the state(s) that you are requesting to be appointed to sell Kaiser:
    • Medica - (KW)
    • Select the states you are requesting to be appointed to sell Medica:
    • Mending - (TS)
    • Select the states you are requesting for Mending:
    • Molina (ACA) - (KR)
    • Select the states you are requesting to be appointed to sell Molina ACA:
    • Oscar (ACA) - (DB)
    • Select the states you are requesting to be appointed to sell Oscar ACA:
    • Priority Health (ACA) - only available in Michigan - (KA)
    • Quartz - (KW)
    • Select the state(s) that you are requesting to be appointed to sell Quartz:
    • Quartz: New agents must have business ready to submit prior to completing the contract. If you do not produce within the first month, your appointment may be terminated.  Do you have business ready to submit?
    • I commit to selling a minimum of 30 new Quartz Healthplans in MN & WI within the first 90 days of appointment.
    • Sentara / Optima - Virginia only - (KA)
    • Select Health - (DB)
    • Select the state(s) that you are requesting to be appointed to sell Select Health:
    • United Healthcare (ACA) - (DB)
    • UHC: Select the states you are requesting to be appointed to sell UnitedHealthcare ACA:

    • Non-ACA Health Programs & Carriers:

    • Allstate / National General - (TS)
    • MediShare - Medical Cost Sharing - (TS)
    • PSM (Population Science Management) - (KA)
    • Sedera - Medical Cost Sharing - (KR)
    • UnitedHealthOne - (DB)
    • INDIVIDUAL Health Products:
    • ➤ Ancillary Carriers 

    • Ancillary Carriers (Supplemental Products):

    • Foresters - (DB)
    • GTL - (KW)
    • Life Secure - (TS)
    • Manhattan Assurance (CUL) - (SG)
    • Have you submitted any Manhattan Assurance business in the last 6 months?
    • MedMutual - (TS)
    • Are you requesting advances with MedMutual?
    • Are you requesting a 3 or 6 month advance? (Subject to carrier approval)
    • Medico - (KW)
    • Mutual of Omaha - (DB)
    • National General / Allstate - (TS)
    • UnitedHealthOne - (DB)
    • Are you requesting a 3 mo advance with UnitedHealthOne?
    • ANCILLARY Carriers:

    • Non-Insurance Programs:

    • ➤ Group Health 

    • Group & Worksite Health Carriers:

    • BCBS of SC - Group - (TB)
    • I have an employer census in-hand and ready for a quote
    • CPEO - Group Health Referrals - (TS)
    • National General / TIC - (TS)
    • Manhattan Assurance (CUL) - (SG)
    • Have you submitted any Manhattan Assurance business in the last 6 months?
    • Group Premium Saver Plan (Morgan & White) - (KW)
    • GROUP Health Carriers:
    • ➤ Over 65 - Senior 

    • Medicare Advantage Carriers:

    • Aetna - MA - (TS)
    • Anthem - MA - (TS)
    • BCBS of SC - MA - (TB)
    • I commit to selling 5-10 BCBS MA policies in the next 12 months and I can commit to face to face selling in SC.
    • BCBS NC - MA - (TS)
    • Are you a resident of NC? Only NC residents can be appointed with this carrier.
    • Bright Health - MA - (TS) - Available in FL & CA only
    • CareSource - MA - (TS)
    • Cigna HealthSpring - (TS)
    • Clover - (TS)

    • Transfers are closed until 1/1/22

    • Devoted - MA - (TS)
    • Humana - MA - (TS)
    • Lasso MSA / Zing Health - (TS)
    • Molina - MA - (TS)
    • Oscar - MA - (TS)
    • United HealthCare - (TS)
    • Wellcare - (TS)
    • MEDICARE ADVANTAGE Carriers:

    • Medicare Supplement Carriers:

    • AARP / UHC - (TS)
    • Aetna Med Sup - (TS)
    • BCBS of SC Med Sup - (TB)
    • Cigna Med Sup - (TS)
    • CSO Life - (SG)
    • Heartland National - (DB)
    • Medico - (KW)
    • Mutual of Omaha - (DB)
    • Physicians Mutual - (TS)
    • Are you requesting advances with Physicians Mutual?
    • MEDICARE SUPPLEMENT Carriers:
    • ➤ Financial / Life 

    • Financial/Life Carriers:

    • Foresters - (DB)
    • Gerber Life - (DB)
    • Mutual of Omaha - (DB)
    • Royal Neighbors of America - (DB)
    • FINANCIAL / LIFE Carriers:
    •  
    • Have you completed your FFM Certification?

    • Note: All agents marketing ACA health plans are required to take the CMS (FFM) Certification.  Most ACA carriers require agents to have this certification completed prior to contracting.  Questions? Call our Agent Care Team at 877-612-7317

    • Request to add state(s) 

      If you selected "Add state(s)" to a carrier above, please note the following:

      1.  This request to add states will only apply to exisiting appointments that you have through PPI.  If you are not yet appointed through PPI for that specific carrier, you need to choose either "New Appointment" or "Transfer" for that carrier so that you can be set up through PPI.

      2.  You must be actively licensed in the the state(s) that you are selecting on this form. To add a state license/line of authority, go to NIPR.com.  Do not submit a request to add a state until your license has been approved in that state.

      3.  If you select carriers on this form that you do not have an active appointment with through PPI, your request to add a state will not be able to be processed.

      4.  Some carriers will require you to go into your agent portal in order to complete this request.  Look for emails from our team regarding any further action required.

      5.  You must upload a copy of your state license(s) for those states that you are requesting to add.

      Questions?  Call us at 864.228.2635

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    •  - -
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    • Don't see the Submit button?  No carriers have been selected yet.

      Scroll back up to the blue bars above and select the carriers you are requesting to apppoint with.

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