Agent Contracting Request Check boxes on contracts you want. Once complete, press the “Submit your Form” button to email this to your Marketer. Agent Information Agent Name Agent Phone Agent State Agent Email Aetna (Coventry)AHLIC , American Continental & Continental Life (Med Supps - AETNA Senior Supplemental)Ameritas (Dental)Affinity Health PlanAlignment HealthcareAIGAmerican National - Standard Life & Accident (ANTEX, SLAICO)American Retirement Life (ARLIC), Loyal American & CHLIC - CIGNAKSKJ LifeAmericoAmeriHealth (IBC - Independence)Amerihealth VIP/ IBCAmerigroupAssured Life AssociationBankers Fidelity & Bankers Fidelity AssuranceBCBS/ AnthemCapital Blue Cross MS U65CareMore Health PlanCSI LifeCSI - Central States IndemnityCenteneCIF – Cigna Individual and FamilyCigna HealthspringClover (CarePoint)Columbian Life/Columbian MutualCombinedConnecticareCrestPointDental Health Services EmblemEmpireEquitable National LifeEssenceEverence AssociationExcellusFamily LifeForestersFreedom Health GroupGateway HealthGeisinger Health PlanGerber Life (Final Expense)Gerber Life (MED SUPP)Global Health AgencyGovernment PersonnelGroup Health CooperativeGuarantee Trust LifeHarvard PilgrimHealth PartnersHealth SapiansHeartland National LifeHighmark Central & Western PAHumanaIndependence BCBS NJ (VIP)IAC - Individual Assurance Co.KemperLiberty Bankers LifeLCBA - Loyal Christian Benefits AssManhatten LifeMedica Health PlansMedico Insurance/ Medico CorpMeridianMolinaMutual of Omaha & AffiliatesNew EraNew ERA Under 65 + DentalNGL - National Guardian Life Old SuretyOptimumOxfordPan AmericanPekinPhoenix LifePremera BS / Regence (Asuris)(Washington)Priority HealthProminence/ QualChoice (Soundpath)ProsperityPuritanRenaissance DentalSanford Health PlanSecurity Life (Dental)Security National LifeSentinel Security LifeShenandoah LifeSilverScript PDPStandard Life & Accident - American National (ANTEX, SLAICO)Standard Life and Casualty (STNLC –Life,Savers Advantage)Standard PlusState MutualSterlingTransamerica (Stonebridge)United American (UAI)United Commercial TravelersUnited Health Care (AARP)United Home LifeUnited Teachers AssociationUniversal American (UAM)UPMC Health Plan VIP (Amerihealth VIP/ IBC)WellcareWestern Catholic Union Other / Notes