CARRIER CONTRACT REQUEST
Contract NOW for 2020
Check the ACA Health Carriers that are in your state that you would like to be appointed with:
Cigna (AZ, CO, FL, KS, IL, MO, NC, TN, UT,and VA)
Oscar Health (TN)
Ambetter (TN, AR, AZ, CA, IL, IN, MS, MO, NV, NH, OH, TX and WA)
Bright Health (TN, AL, AZ, CO, FL, NC, NE, OK and SC)
Molina Healthcare (MS, CA, FL, MI, NM, OH, SC, TX, UT, WA and WI)
Are you in need of Short Term Medical Carriers?
National General
UnitedHealthcare
Dental Carrier (The Easy to Write Dental Carrier)
Spirit Dental and Vision
Name
*
First Name
Middle Name
Last Name
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Phone
*
-
Area Code
Phone Number
Alt Phone
-
Area Code
Phone Number
Fax Number
-
Area Code
Phone Number
E-mail Address
*
youremail@youremail.com
Tax ID Number
Tax ID Type
Social Security Number
Federal Tax ID
License Information
NPN Number
*
123456789
State(s) to be appointed in
List States
Submit Request
Broker Contracting
Erin Chamberlain : 603-329-6197
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