Request to ADD a newly licensed State
Complete this form only if you already have contracts with Monarch Agency Solutions and would like to contract carriers in a State you have not previously requested contracting. Complete the information in the form below, and our team will reach out to you with contracting instructions.
Questions? Email us at: Support@MonarchAgencySolutions.com
Your Name
*
First Name
Last Name
NPN
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Resident State
Your Manager
Phone Number
-
Area Code
Phone Number
Email Address
List the additional State(s) are you adding:
*
Which of the following carriers are you currently appointed in ANOTHER State?
Aetna
Ambetter
Anthem
AmeriHealth Caritas
CareSource
Cigna
Christus
HealthFirst
Highmark
Imperial Health Plans
Medica
Molina
Oscar
United Healthcare
Upload your newly acquired State Licenses below.
If the license is for an exchange state, you will need to also send to upload the state certificate below.
Upload State License:
*
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Upload State License:
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Upload State License:
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Upload State License:
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Upload State License:
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State Certificate (if state exchange state)
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Please read before clicking submit!!!
Our contracting staff will begin to work on this, by submitting below you understand you will receive instruction emails to follow for all carriers in which you are currently appointed. This will come from Peek, not from the carrier. If it is a NEW carrier we are adding for the State, you will receive an onboarding link and will have 5 business days to complete before the link goes inactive. Make sure to update your HealthSherpa account with your new State and click "appointed" on the carriers once you have confirmation you are appointed to the carrier. Email support@monarchagencysolutions.com with any questions.
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