AHIA - Contracting - New Agent Intake

Contracting

Top ACA/Marketplace carrier contracts are now available in your state with exciting product offerings for 2022!

AHIA is a National FMO!
As our agent, you are eligible to receive:

Weekly group and continuous one-on-one training (in-person and virtual)
Marketing and sales materials
An agent portal with resources and quoting tools
Dedicated contracting and licensing support
Top-level agent and agency contracts
Direct pay from carriers and free errors & omissions coverage
And More!

Please fill in the form below and we'll get you onboarded fast!

New Agent Request Form

Welcome to AHIA's Agent Intake Form. Please fill in the fields below and upload any needed documents requested. You will receive a confirmation of your information submitted by email. Once received please allow our contracting team 48hrs to contact you and complete your onboarding. Should you have questions you can reach us at 210.648.0555 or contracting@ahiabenefits.com.

Welcome to AHIA, where "It's About Family!"

Prefix

First Name

Middle Name

Last Name

Address

Address 2

City

State

Zip

Email

Mobile Phone

Business Phone

Preferred Method of Contact

Please select immediate upline from the drop-down menu, then fill in the full hierarchy in the fields below - AHIA down.

Next Level

Immediate Upline

How Are You Contracting?

Agent NPN

SSN

Agency Name

Agency NPN (If Applicable)

Agency Tax-ID (If Applicable)

Please Select How You are to be Set-up

What Contract Level is Being Requested?

Please select the carrier(s) you would like to contract with:

MEDICARE ADVANTAGE

Upload a Copy of Insurance License, E&O Certificate, AHIP Certificate, Voided Check, and/or Written Explanation for any "Yes" answer on background check.

Please only click once.

This is a nice alert!

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Contracting

Top ACA/Marketplace carrier contracts are now available in your state with exciting product offerings for 2022!

AHIA is a National FMO!
As our agent, you are eligible to receive:

Please fill in the form below and we'll get you onboarded fast!

New Agent Request Form

Please select the carrier(s) you would like to contract with:

MEDICARE ADVANTAGE

MEDICARE SUPPLEMENT

AFFORDABLE CARE ACT

ANNUITIES

FINAL EXPENSE

LIFE

PRE-NEED

DISABILITY

SHORT-TERM HEALTH

BIBLICAL HEALTHCARE

DENTAL / VISION

INTERNATIONAL MEDICAL

LONG TERM CARE

NO ADVANCE

CRITICAL ILLNESS

Upload a Copy of Insurance License, E&O Certificate, AHIP Certificate, Voided Check, and/or Written Explanation for any "Yes" answer on background check.

Please only click once.

Contracting

Top ACA/Marketplace carrier contracts are now available in your state with exciting product offerings for 2022!

AHIA is a National FMO!As our agent, you are eligible to receive:

Please fill in the form below and we'll get you onboarded fast!

New Agent Request Form

Please select the carrier(s) you would like to contract with:

MEDICARE ADVANTAGE

MEDICARE SUPPLEMENT

AFFORDABLE CARE ACT

ANNUITIES

FINAL EXPENSE

LIFE

PRE-NEED

DISABILITY

SHORT-TERM HEALTH

BIBLICAL HEALTHCARE

DENTAL / VISION

INTERNATIONAL MEDICAL

LONG TERM CARE

NO ADVANCE

CRITICAL ILLNESS

Upload a Copy of Insurance License, E&O Certificate, AHIP Certificate, Voided Check, and/or Written Explanation for any "Yes" answer on background check.

Please only click once.

AHIA is a National FMO!
As our agent, you are eligible to receive: