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Do you have an upline agency? <span class='custom-required'>*</span>

Do you have an upline agency? *

Please reach out to your upline agency to get onboarded.

Fill out the fields below to get started. ~

Select Onboarding Type *

For the Agency Email field, please provide the main email for the agency if applicable. For the Agency Principal fields, please provide the information of the agency's primary point of contact.

First Name

Last Name *

Email *

e.g. johndoe@site.com

NPN *

According to our records, the email used is already associated to someone who is already contracted with the Carrier. Please use a different email or for further assistance, please contact us at (800) 331-7880.You are not able to advance this Onboarding case at this time.

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Existing Users HTML

Please complete each tab for the state(s) and plan(s) you are requesting to market. You must be licensed in the requested state(s).

These selections represent your requested appointments, but please note that they are subject to approval by the carrier team.

Regional Health Plans
Asuris Northwest Health
BridgeSpan
Commencement Bay Risk Management
Upline Agencies
Upline

Regence BlueShield of Idaho, Inc. Appointments

Please note that this appointment requires you to have a WA state license.

Additionally, this appointment is required if you would like to sell Medicare Advantage in Asotin/Garfield Counties.

Medicare Sub-Types

If you would like to sell Medigap in Asotin/Garfield Counties, please go to the Asuris Northwest Health tab and select the WA appointment.

BlueCross BlueShield of North Dakota Appointments

NextBlue of North Dakota Appointments

Regence BlueCross BlueShield of Oregon Appointments

OR
WA - Clark County

If you would like to sell Group Stop Loss in OR, please go to the Commencement Bay Risk Management tab and select the OR appointment.

Please note that this appointment requires you to have a WA state license.

If you would like to sell Group Stop Loss in WA - Clark County, please go to the Commencement Bay Risk Management tab and select the OR appointment.

Regence BlueCross BlueShield of Utah Appointments

Regence BlueCross BlueShield of Utah Business Types

Medicare
Group
Individual

If you would like to sell Group Stop Loss in UT, please go to the Commencement Bay Risk Management tab and select the UT appointment.

Regence BlueShield Appointments (in parts of Washington)

Regence BlueShield Business Types

Medicare
Group
Individual

If you would like to sell Group Stop Loss in WA, please go to the Commencement Bay Risk Management tab and select the WA appointment.

Please note that this WA appointment does not include Clark County. Clark County appointments must be selected under the other Regence plans.

Asuris Northwest Health Appointments

If you would like to sell Group Stop Loss in WA, please go to the Commencement Bay Risk Management tab and select the WA appointment.

Asuris OR Medicare Sub-Types HTML

BridgeSpan Health Company Appointments

Business Type(s) *

Commencement Bay Risk Management Insurance Company (CBRM) Appointments

Business Type(s) *

Group Sub-Options

Agency Name

You will receive a generic invitation email from donotreply@webcomserver.com. If you do not receive the invitation within an hour of submitting this form, please check your spam or junk folder.

If you are still not receiving an invitation from this address, please call (800) 331-7880 for assistance.