Broker Appointment forms
We work with many of the country’s most prominent health insurers and benefits organizations, and we make it easy for you to begin your new appointment paperwork with each.
Click below to access the required forms or links used by each of our carrier, health plan, or administrator partners.
Forms
- Carrier
- Word Documents
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Aetna
- aetna-producer-agreement
- Aetna-Appointment-process
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Anthem
- Anthem Appointment Process, Updated 4/29/2020 No More Forms Process, Updated 4/29/2020
- Anthem Appointment Process, Updated 4/29/2020
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Blue Shield
- Blue Shield Producer Agreement, A17540-B, Updated 12/23/2020 (pdf) Blue Shield Producer Agreement, Ref. 288591 2021, Updated 12/23/2020 (pdf) W-9 Form, Updated 10/26/2020 (pdf)
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CaliforniaChoice
- CHOICE Administrators Agent Agreement, Updated 4/29/2020 (pdf) CHOICE Administrators Schedule of Commissions, Updated 4/29/2020 (pdf) CHOICE Administrators Agent Agreement, CA0130, Updated 5/21/2021 (pdf) W-9 Form, Updated 10/26/2020 (pdf)
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Health Net
- Health Net Broker Contracting, Account Registration, Updated 4/29/2020 (pdf)
- Health Net Appointment Process, Document 1, Updated 4/29/2020 (Word File) Health Net Appointment Process, Document 2, Updated 4/29/2020 (Word File)
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Kaiser Permanete
- Kaiser Permanente Broker Essentials Guide, Updated 4/29/2020 (pdf)
- Kaiser Permanente Appointment Process, Document 1, Updated 4/28/2020 (Word File)
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UnitedHealthcare
- UnitedHealthcare Agent Appointment Process, Updated 4/29/2020 (Word File)
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MediExcel Health Plan
- Broker Appointment Form, Updated 12/09/2022
If You Have Questions, We Have Answers
Count on your Word & Brown representative to answer any questions you have about the forms needed to get a carrier, health plan, or administrator appointment. Reach out today via phone or email.
Count on your Word & Brown representative to answer any questions you have about the forms needed to get a carrier, health plan, or administrator appointment. Reach out today via phone or email.