Contracting Request - HealthPartners

HealthPartners AGA Contracting Request
Thank you for your interest in contracting with HealthPartners. AGA is partnered with our Integrity Partner, IFC, for us to offer HealthPartners to our agents. To get started complete the HealthPartners IFC Contracting Request Form. Once this request form is completed you will be sent a DocuSign from IFC to collect your information and to move forward with your carrier specific contracting.

Please note this carrier's processing time normally takes 3-6 weeks
Agent Full Name*

First NameMiddle NameLast NameSuffix
Agent Email*
example@example.com
Agent NPN*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How will your commission be paid?*
HealthPartners state selection

IAILMNNDSDWI
Contracting with HealthPartners*

NEW AGENT - I have never been contracted with HealthPartners previously.TRANSFERRING AGENT - I have a current appointment with HealthPartners through another FMO and would like to transfer that appointment under IFC.TRANSFERRING AGENT (Direct) - I have a current appointment direct to HealthPartners and would like to transfer that appointment under IFC.
Upload the HealthPartners Transfer Form that is signed by your current upline:
Cancelof
Should be Empty:

HealthPartners AGA Contracting Request