New agency (brokerage) 

group of agents sitting at a table talking during a meeting

New agency application

Thank you for your interest in joining us as a sales partner! Use this application to apply for a contract with Dean Health Plan, and establish an account to appoint multiple agents under your agency.

If you are seeking appointment through the account of an agency or brokerage that has an existing contract, see our agent appointment form. If you are a sole proprietor or independent agent, see our sole proprietor form.

Our sales leadership team meets monthly to review all applications for new contracts. Applications are due by the first of the month, and you will be notified of the decision by the 15th. If approved, your contract will be effective the first of the following month. The contracting period closes each year during the fourth quarter.

Required attachments to be uploaded with application

  • W-9
  • EFT Authorization form
  • Voided check or other bank document for commissions payment
  • Declarations page of current errors & omissions policy

Have questions or need help? Email us at or call us toll-free at 877-317-3046

Application form


**We partner with IPlanRx a Field Marketing Organization for Prevea360 Medicare sales.
Example: languages spoken
Please provide additional information to help us determine if our partnership will be an effective one, such as: - Background of agency - Mission statement - Geographic location(s) - Sales history and expectations
Please provide additional information to help us determine if our partnership will be an effective one, such as background of agency, mission statement, geographic location(s), and sales history and expectations.
Please use a mouse or your finger to sign your name in the box below.
Required: W-9, signed EFT Authorization form, check or bank document, and declarations page of current E&O policy