Contracting Request - BCBS of MN

AGA BCBS of MN Request Form
Thank you for your interest in contracting with BCBS of MN. AGA is partnered with our Integrity Partner, IFC National Marketing, for us to offer this carrier to our agents.

Both UCare and BCBS MN require agents to either have a MN resident license, or a resident license of a bordering state (the address must also be within a bordering county).

Once this request form is completed, IFC will provide you with the instructions to pay their appointment fee(s) to BCBS MN. Individual agents must pay $138.50. If an agent has an agency they would like to contract the fee is $75.00 on top of any individual agent fees.

IFC will also send you a DocuSign to complete. It includes banking information, demographic information, license copies, E&O and some other questions regarding the agent’s specific agency orientation.
Agent Full Name*

First NameMiddle NameLast NameSuffix
Agent Email*
example@example.com
Agent NPN*
Agent Home City*
Agent Home State*
Agent Home Zip Code*
Carrier Selection
Carrier Request(s)*

BCBS of MN
Confirm you are a MN resident license, or a resident license of a bordering state (the address must also be within a bordering county).

Confirm
Should be Empty:

AGA BCBS of MN Request Form