Texas Broker Appointment
Below is a list of items needed to complete a formal Broker Appointment with Prominence Health Plan:
- Broker Appointment Checklist (PDF) >
- HealthFirst of Texas HMO Agent/Broker Contract (PDF) >
- Broker Agreement (PDF) >
- Agent Appointment Preliminary Information (PDF) >
- Direct Deposit Enrollment Form (PDF) >
- W-9 (PDF) >
You must also provide a copy of the broker or agency health license for the state of Texas.
Return all completed forms and Texas license copy to:
Prominence Health Plan
Attn: Sales Department
1510 Meadow Wood Lane
Reno, NV 89502
Please contact [email protected] or call 888.840.9080 if you have questions relating to broker appointment.