Appointments and Certifications

Important Notice:

Broker Appointment Policy: Please ensure all required documentation is complete, legible and signed. If any required information is missing, incomplete or illegible, we will work with you to resubmit the application.

Broker Appointment Changes: Please email broker appointment changes to The Broker Appointment Form should be used for new appointments only.

Appointment Requirements

The items below are required to complete the appointment application:

  1. Ohio and Health License or Ohio Health License (required)
  2. Agency License (if applicable)
  3. OhioHealthy Substitute W9 (SF-W9) Form
  4. Broker Agreement (includes Business Associate and QHP Amendments)
  5. Portal User Profile (access to secure Broker Portal)

Approved General Agencies

Agency Name Contact Name Contact Email Contact Phone
Benefit Mall Matt Amicon 1 (614) 987.3359
Rogers Benefit Kevin Conrad 1 (614) 761.8994
National United Brokers Randy Ayers 1 (614) 890.7373
Cornerstone Nelson Culp 1 (937) 610.5744

Get Appointment

By starting your application you acknowledge that you have read and agree to the above requirements.

I Agree, Start Application

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