Health Plans USA Contracting

Health Plans USA

Intake Information
Name*
Agency NPN (if applicable)
Agent NPN (principal if agency) *
Medicare Carriers

Aetna/SilverscriptAlignmentAmerigroup (Anthem/Elevance)BannerBCBS of AZCentene/WellcareCignaCloverDevotedeternalHealthGold KidneyHumanaImperialKaiserMolinaPacific SourcePremeraRegenceSCANSelect HealthUHC
ACA

AetnaAmbetterBCBS of AZCignaMedicaMolinaOscarUHC
Dental & Vision

AmeritasDelta DentalNCD ($10k Annual Max Benefit!)
Carriers Not Listed
Click Here to Get Contracted for Dental ($10K Annual Max Benefit!)
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RECEIVE A PERSONALIZED WEBSITE FOR QUOTING AND ENROLLING ALL LINES OF BUSINESS

To find out more and to request a demo, please reach out to Health Plans USA at:
- Contracting@HealthPlansUSA.com
- Direct: (480) 691.2500
Email*
Resident State (please select one)*
States (multiple selections using the "Ctrl" key and clicking)
Mailing Address (Business and Residential)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
SSN*
Agency EIN
DOB*

MonthDayYear
Date
Notes
Files (Licenses, ACH forms, W-9, E&O, etc.)

Cancelof
Download, Fill out and Upload Forms Above
W-9 Form
ACH/Direct Deposit Form
Agent Agreement
Should be Empty: