Complete the contracting application
• You will see the tabs below and must complete all information on tabs.
Bright Health Plan Contracting & Certification Guide (for Agents) 2
Contracting Checklist:
1. General Information Tab
Most fields are pre-populated from NIPR, so you will need to confirm the information is correct
2. Licenses Tab
Active l
icenses according to NIPR are displayed at the top of the tab
Select the States and corresponding Lines of Business that you would like to apply for appointment with Bright Health.
Place a check mark beside the state(s) you want to be appointed in
Place a check mark beside the Line of Business you want to offer (Individual(ACA) and/or Group and/or Medicare).
3
. Appointments Tab
(No action needed)
4. Background Questionnaire Tab
Answer the 6 Yes/No Questions
5. Background Agreement Tab
Op
e
n ALL
three
required
forms, review, and electronically
sign for the background check. (FCRA Agreement,
Disclosure Agreement, and Authorization Agreement)
Be sure your name matches what is listed on the General
Information tab.
6. E&O Insurance Tab
Enter t
he required
information
from
your
E&O insurance
and upload a copy
7. Banking Information Tab (Bright Health can pay either a contracted agency or the agent directly)
Pay selection:
If
selecting “pay myself...",
please enter your
banking information.
Upload your W9
8. W9 Tab (only appears if you select Direct Deposit above)
Confirm federal tax classification
Upload a copy of W9
9. Agreement Tab
Review and Accept th
e Agent Agreement.
Be sure to enter your name as it appears on the General
Information Tab (First, Middle, Last).
10.Certification 1 Tab
For Individual Plan Agents: ACA Individual Certification
Enter your FFM User ID
Select Off Exchange Only or Off/On Exchange
For Medicare Agents:
Provide your AHIP (or equivalent) and completion date
11. Certification 2 Tab (Medicare only)
Complete the 2021 Bright Health Medicare Certification
course.
12.Submit Tab
Click Submit
7/15/2020
From the drop-down list select:
Box below may be populated by your upline
If selecting “Pay an Agency”, please enter the Agency TIN
(agency must be contracted with Bright Health)
TIN:
When applicable select your:
Individual/ACA GA
Group GA:
MA FMO
