UHC Additional State Appointment Request
IMPORTANT NOTES:
UHC has Non Resident state appointment fees (
See Fee Schedule here
). Agents are responsible for these fees, and they will be deducted from future commissions by UHC.
Garity is licensed and appointed in all 50 states. If you work with a GA please be sure that they are also licensed in appointed in the states you wish to be appointed.
If you have your own agency and you will to be appointed as an agency please be sure your agency is also properly licensed.
UHC appointments can take 3-5 business days at the carrier to process, you will receive an email confirmation once complete. You can also check your Jarvis portal for all active state appointments and updates.
You cannot submit business in the requested state until
UHC provides you with the RTS notification for the state
. If you submit business before receiving your RTS notification, this may cause compliance and commission issues.
I am requesting to be appointed as an:
*
Individual
Agency
Both
Agent Name
*
First Name
Last Name
Agency Name (if applicable)
Residential State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Carrier(s)
*
Aetna/Silverscript
Aetna Senior Supplement
Ameritas
Anthem
Anthem Maine Health (ME)
BCBS (RI)
CarePartners of Connecticut (CT)
Cigna Med Supp
Cigna HealthSpring (MAPD only - PDP not available)
Combined
Connecticare (CT)
Emblem Health (NY)
Empire (NY)
Fallon Health (MA)
Foresters
Gerber Life Insurance
Globe Life (NY)
GTL
Harvard Pilgrim Healthcare - Med Advantage (MA, ME, NH)
Harvard Pilgrim Healthcare - Med Supp (MA, ME, NH)
Health New England (MA)
Humana
Lasso Healthcare (VA)
Mary Washington (VA)
Mutual of Omaha - PDP
Mutual of Omaha - Med Supp
OptimaHealth (VA)
Oxford Life
Premier Senior Health Plan
Royal Neighbors of America
United American
UnitedHealthcare® Medicare Solutions
WellCare
Other
UHC State Appointment Request
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Florida County
*
Upload a copy of your Health Insurance License(s)
Browse Files
Cancel
of
Submit
FOR GARITYADVANTAGE USE ONLY
Appointment Submitted to UHC
YES
NO - Issue
New License - Waiting
Upline not appointed
JIT State
Duplicate request
Territory Manager
Bailey, Victoria
Feit, Jane
Gontarek, Theresa
HOUSE
Koteras, Tricia
Tyler, Jennifer
UNASSIGNED
Young, Susan
GARITY NOTES/Appointment Issue
Should be Empty: