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New agency (brokerage) 

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 an 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 reviews all applications for new contracts. If approved, your contract will go into effect the month you submitted your application.

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 agentlicensing@deancare.com or call us toll-free at 877-317-3046

Application form

 *Required

**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), and sales history and expectations.
Please use a mouse or your finger to sign your name in the box below.

Have you attached all the proper documents to this application? Your application will not be processed without all of the proper documentation that is needed with this request.