"*" indicates required fields

Thanks for your interest in contracting with ICT Insurance Group. Complete the information in the form below, and our team will reach out to you with contracting instructions.

Questions? Call us at (316) 440-6111

Status*

New Agent/Agency

Current Agent/Agency

Name (as it appears on your license)*

First Name Middle Name Last Name

Nickname/Preferred Name

Mailing Address*

Street Address Street Address Line 2 City State Zip Code

Mailing Address Type*

Residence

Business

Primary E-mail*

Enter Email Confirm Email

Cell Phone Number*

Secondary Phone Number

NPN*

Resident State*

Are you requesting to appoint as an individual or an agency?*

Individual

Agency

Both Individual and Agency

Agency Name*

What level of agency will you be?*

Are you the principal agent for this agency?*

Yes

Agency NPN*

Agency/Manager Affiliation*

Enter ICT if you are not working with a specific manager or agency.

Direct Upline Manager

CONTRACT REQUESTS

Click the grey bars below to see all carriers available in that segment. Select the carriers you would like to request appointment with, and our contracting team will send you instructions for new appointments & transfers.

NOTE: Selecting carriers below indicates intent to contract; you will not be fully contracted until you complete all required paperwork/links for each carrier.

Under 65 - Individual

Click here to see which ACA & Non-ACA carriers are available by state.

ACA Carriers:

Ambetter - (KR)

New Appointment

Transfer

Add state(s)

Select the states that you're requesting to appoint with Ambetter:*

Ambetter transfers will close September 1st - April 15th

AmeriHealth Caritas - (KA)

New Appointment

Transfer

Add state(s)

Select the state(s) that you are requesting to be appointed to sell AmeriHealth Caritas:*

Anthem - (KA)

New Appointment

Transfer

Add state(s)

Select the states that you're requesting to be appointed to sell Anthem:*

BCBS of Arizona - (KA)

New Appointment

Transfer

BCBS of Illinois - (KW)

New Appointment

BCBS of Montana - (KW)

New Appointment

BCBS of New Mexico (KW)

New Appointment

BCBS of Nebraska (KW)

New Appointment

Transfer

BCBS of North Carolina - (DB)

New Appointment

Transfer

BCBS of Oklahoma - (KW)

New Appointment

Transfer

BCBS of South Carolina (ACA) - (TB)

New Appointment

Transfer

BCBS of Tennessee - (KR)

New Appointment

Transfer

BCBS of Texas - (KW)

New Appointment

Care Source (ACA) - (KR)

New Appointment

Transfer

Add state(s)

Select the states you are requesting to be appointed to sell Care Source ACA:*

CareSource Transfers closed Sept 1-Dec 31st.

Cigna (ACA) - (KA)

New Appointment

Transfer

Add state(s)

Select the states you are requesting to be appointed to sell Cigna ACA:*

I am currently set up with Cigna as a*

Direct Producer

Sub-producer under an Agency

I don't know

Christus (DB)

TX, LA Only

New Appointment

Transfer

Add state(s)

Select the states you are requesting to be appointed to sell Christus:*

Independence Blue Cross (KR)

Only Available in Pennsylvania

New Appointment

Transfer

Select the state you are requesting to be appointed to sell Independence Blue Cross:*

Medica - (KW)

New Appointment

Transfer

Add state(s)

Select the states you are requesting to be appointed to sell Medica:*

Oscar (ACA) - (DB)

New Appointment

Transfer

Add state(s)

Select the states you are requesting to be appointed to sell Oscar ACA:*

United Healthcare (ACA) - (DB)

New Appointment

Transfer

Add state(s)

Select the state that you are requesting to be appointed to sell United Healthcare:*

Non-ACA Health Programs & Carriers:

PSM (Population Science Management) - (KA)

New Appointment

Transfer

Ancillary Carriers

Click here to see which Ancillary Carriers are available by state.

Ancillary Carriers (Supplemental Products):

Ancillary Carrier for All States

Allstate

UHOne

Manhattan Life

Med Mutual

Over 65 - Senior

Medicare Advantage Carriers:

BCBS of SC - MA - (TB)

New Appointment

Transfer

Add state(s)

CareSource - MA - (TS)

New Appointment

Transfer

Add state(s)

Have you completed your FFM Certification?*

Yes

Note: All agents marketing ACA health plans are required to take the CMS (FFM) Certification. Most ACA carriers require agents to have this certification completed prior to contracting. Questions? Call our Agent Care Team at (316) 440-6111

Comments/Notes

Type any comments or notes you need to communicate to our contracting team.

How did you hear about ICT Insurance Group?

This form is NOT a contract and you must complete contracting paperwork and be appointed before you start selling/marketing any carrier products:*

By clicking "Submit" I understand that this form is not a contract and does not appoint or certify me to sell/market any carrier products. This is a contract request form to indicate my interest in appointing through ICT Insurance Group, and I am requesting contracting information for the carriers selected on this form. I understand that I will be receiving contracting links and emails for each carrier selected on this form, and I will not be ready to sell/market with these carriers until I complete each carrier's contract, complete any applicable certifications and the carrier has approved my appointment.

Consent*

By clicking Submit I provide my electronic signature expressly consenting to recurring contact from ICT Insurance Group regarding ICT Insurance Group’s contracts and training at the phone numbers end email address I provided. Messages may come to me via live, automated or prerecorded telephone call, text message, or email. I understand that my telephone company may impose charges on me for these contacts, and I am not required to enter into this agreement as a condition of purchasing property, goods, or services. I understand that I can revoke this consent at any time.*

SMS Messages

I consent to receive marketing text messages from ICT Insurance Group at the phone number provided. Frequency may vary. Messages & data rates may apply. Text HELP for assistance, reply STOP to opt out.

I consent to receive non-marketing text messages from ICT Insurance Group about my order updates, appointment reminders etc. Message & data rates may apply.

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