Health First

Get Appointed!

Thank you for your interest in becoming appointed with Health First Health Plans and Florida Hospital Care Advantage.

Please note, at this time, Medicare and Commercial appointments are being accepted as normal. Appointments to sell Individual products for 1/1/2019 effective dates has been closed. Appointments to sell Individual products will begin 2/1/2019.

To become appointed:
Enter all information
Upload required documents
Click on 'Submit to Health Plans'

You will be contacted when your appointment has been processed.

= Required Information

Agent Information

*Title
*First Name		*Last Name
*Date of Birth	[ 10/23/2018 ]	*Social Security Number
*Cell Phone		*Email
*Florida Insurance Number		*NPN # (National Producers Number)
Commissions Paid To		*Commissions Mailed To

Lines of Business Sold

*Group		*Individual
Medicare		Selling on the Individual or Shop Marketplace

Health Plans Sales Executive

Are you currently working with a Health Plans Sales Executive?

Home Address Information

*Home Street Address
*Home City
*Home State
*Home Zip
*County

Agency Information

Check here if you are not affiliated with any agency

*Agency Name
*Agency Main Phone
*Federal Tax ID

Agency Address Information

Home address is the same as agency address
*Agency Street Address
*Agency City
*Agency State
*Agency Zip

Required Documents

Click on each required document, review information, save and print a copy for your personal records. You will be asked to electronically sign the documents under the 'Acknowledgment Statement'.
Agent and Broker Agreement Business Associate Agreement
You are required to submit a signed W-9 to complete your appointment process, you can use th W9 template below or upload your own W9. Follow these steps to ensure proper processing of your appointment:
IRS Form W-9
1. Open the form above labeled IRS Form W-9.
2. Fill out the fillable PDF in its entirety.
3. Save the PDF for your personal records.
4. Sign the PDF using an E-Signature or print the form off, sign it and scan the signed form to your computer.
5. Upload the signed PDF in the below section.

Upload Required Documents

Signed W-9:
Proof of License:
Proof of Errors and Omissions (E&O) Coverage:
Copy of Current AHIP Certification:

Acknowledgement Statement


By checking the box and entering my name below, I am indicating my intent to electronically sign each of the listed documents. I acknowledge that I have been provided the required appointment documents, and that I have read and agree to be bound by the terms and conditions of the documents listed below. I warrant that all of the information that I have provided is true, complete, and accurate.

Business Associate Agreement
Agent and Broker Agreement

I agree that my electronic signature is the legal equivalent of my manual signature on this Agreement, and I agree that no third-party verification is necessary to validate my electronic signature.
*Full Name