Reminder: Per our recent compliance initiative, all brokers should make sure they’ve signed a new Business Associate Agreement (BAA) and have submitted it to EmblemHealth. Any other documentation in need of an update should also be submitted at this time.
Execute the following:
A fully executed signature page of the Selling Agent Agreement will be returned to you. You will receive your broker number to use on all forms when submitting new groups. Please allow up to five business days to execute the contract.
- A copy of your current New York State individual or corporate broker license issued under section 2104 of the insurance law, or agent license issued under section 2103(a) of the insurance law that stipulates accident and health accreditation. (If you are applying as a corporation, include both parts of the corporate broker license.)
- A completed W-9 form.
- If applicable, your Errors and Omissions Insurance Policy. Return only the front page.
Submit your documents
You can submit all completed documents using one of the following methods:
Small Group Off-Exchange Commission (Effective January 1, 2019)
PNC EFT Enrollment Instruction Guide
PNC EFT Enrollment
Medicare Supplement Commission (Effective January 1, 2019)