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Broker Appointment Process

The following documents are required for broker appointment and apply to both new and existing brokers. Existing brokers can confirm their appointment status by contacting Broker Services at brokerservices@emblemhealth.com.

Required Documents:

• A completed Selling Agent Application. 
• A completed Selling Agent Agreement.
• An ACH form and/or voided check for the entity appointed with EmblemHealth (business or individual). If a voided check is unavailable, complete the ACH Transaction Routing Instruction form from your bank. Email the completed form to: EFTBrokerCommissions@emblemhealth.com. 
• A copy of your current New York State individual or corporate broker license issued under section 2104 of the Insurance Law, or an agent license issued under section 2103(a) of the Insurance Law that stipulates accident and health accreditation. If applying as a corporation, include both parts of the corporate broker license. 
• A completed W-9 form. 
• If applicable, the front page of your Errors and Omissions Insurance Policy. 
• Submit all completed documents by email to: BrokerOps_Licensing@emblemhealth.com.