AMBETTER CONTRACTING QUESTIONNAIRE
We will be granted a limited number of Agent appointments once contracting opens. To be considered, Ambetter does require additional information. Please complete the form below and we will place you on our waiting list. Once contracting is open we will let you know if they will offer you a contract.
Name
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First Name
Last Name
Phone Number
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Area Code
Phone Number
E-mail
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1. How many ACA Members did you enroll during open enrollment for last year?
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Please enter a value in member count
2. If Ambetter offers you a contract how many Members do you think you could enroll for them during an open enrollment season?
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Please enter a value in member count
3. Please list the states you would market Ambetter's ACA plans?
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List each State with the first state being the most important
4. If your ACA Member count last year was less than 50 (100 for FL or TX), Ambetter would like to know what additional marketing plans you have in place to increase sales? They have minimal production requirements to offer and keep a contract.
List one or two brief marketing plans
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