Request New Contracts
Use our Contracting Request Form to request new carrier contracts. Whether you're getting newly contracted or want to get aligned to Health Plans USA, this form helps us gather the details we need to get you set up quickly.
What can you upload:
Request new carrier appointments
Indicate if you're transferring or starting fresh
Select the states you want to sell in
Provide agent or agency details
Upload Documents Securely
Use our Secure Upload Portal to send important documents safely and efficiently. This ensures your contracting and compliance files are always current.
What can you upload:
Resident and Non-Resident Licenses
E&O Insurance Certificates
AHIP and FFM Certifications
Any other required documentation
Update Your EFT or W-9 Information
If you’ve changed your banking information or need to submit a new W-9, you can do so quickly using our secure Adobe Webform.
When to use this form:
You’ve opened a new bank account
Your business name or tax ID has changed
You need to update your W-9 for compliance
You want to ensure timely and accurate commission payments
Already contracted with us?
This form is also available during initial onboarding, but we’ve made it accessible here for easy updates.