Thank you for your interest in contracting to represent HealthSun Healthcare through Plan Advisors. Please complete the attached paperwork and return it to: email@example.com
When returning the paperwork, you must also include a copy of the following documents:
- Copy of DOI License
- Copy of Driver’s License
- Copy of AHIP certificate
- Copy of E&O declaration page (you must be listed as an insured)
- Write clearly and legibly. Include all requested information.
- Read and initial the code of Ethics
- Make sure you signature and date is included on pages 1, 2, 3 & 6.
Anthem Electronic Funds Transfer/Direct Deposit (included in “Appointment Application”)
- Page 2 of 3 (refer to page number on bottom right) Complete ALL sections of this form including – Trading Partner, Authorized Officer and Account Representative.
- Page 3 of 3 – complete with Bank Information. Complete bottom section (Account Representative).
- Read the Independent Broker Agreement.
- Initial the bottom right of each page.
- Page 1 – fill in name (refer to page numbers at bottom of page).
- Page 17 – fill in your information if you want correspondence.
- Page 18 (agent) – complete name, signature and date.
- Page 23 – sign your name, print name and date.
- Page 24 – fill in name at top of page. Sign, print name, write agent license number and state at bottom of page.
- Page 25 – fill in date and print name on business associate line.
- Page 30 – complete, name, signature and date on business associate section.
- Scan and return all 30 pages of this agreement.
Contracting typically takes 7 business days to process. You will need to attend a mandatory face to face training as part of the initial onboarding process. In addition, you will also need to complete the online certification. We strongly suggest you complete the online certification prior to attending the face to face class.
Access Code: External-Healthsun
**If you are currently certified for Simply for 2020 plan year, you have fulfilled Healthsun’s online certification requirement.
After attending the face to face class, you will receive an email from Litmos, Healthsun’s training platform, to complete the compliance and product training.
Again, thanks for contracting with Plan Advisors and HealthSun!