Agent Appointments


Agent Appointment form

Please use the application below to add new agents to your Agency or Brokerage account. If you do not yet have an account, please see the New Agency (Brokerage) form. If you are a sole proprietor or independent agent, please see the Sole Proprietor form.

Please note that processing time for agent applications can take up to two weeks. You will receive a welcome email notifying you when your appointment is complete.

Required attachments to be uploaded with application

  • State insurance license(s)

Have questions or need help? Email us at agentlicensing@wellfirstbenefits.com or call us toll-free at 877-317-3046



Application form

 *Required

*We partner with Plan Advisors a Field Marketing Organization for Medicare sales
Please answer the following questions truthfully and completely. Please include an explanation of any "yes" answers in the text box provided below.
Please include dates, persons and  government entities involved, and attach relevant documentation, such as court decrees or findings of investigation.
Required: Copy of insurance license from each state in which you are seeking an appointment
Please use a mouse or your finger to sign your name in the box above.