Benefits built around your business.

Get to know the CHAMP Plan™.

Let’s get to
know you.

Tell us about your business and the products you’d like to offer. We’ll review your request and follow up with the next steps.

Before you begin

Have your contact details and licensing information ready, including your National Producer Number (NPN), if you’re licensed.

New to insurance? You can share where you are in the licensing process.

Submitting a request does not confirm contracting approval.

Fields marked * are required.

01 Your details

First name *Last name *Email address *Phone number *Agency name (optional)Resident state *

02 Your experience & licensing

Licensing status *Insurance sales experience *

What products do you currently sell? *

Select all that apply.

Group healthIndividual health / ACAMedicareLife insuranceDental & visionSupplemental benefitsOtherNot selling yet

03 Your interests & referral

Which products would you like to offer? *

Select all that apply.

Group healthThe CHAMP PlanDental & visionLife insuranceIndividual health

Who referred you? (optional)Found us on your own? You can leave this blank.Anything else you’d like us to know? (optional)

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