Anchor Health
Agent Onboarding — ACA
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1 About you
2 Licensing
3 Appointments
4 Background
5 Documents
6 Sign
Voluntary Onboarding Form

While not required, by successfully completing this form, you allow Anchor Health Insurance Agency to assist with the onboarding process including but not limited to, agent background checks, carrier appointments, agency specific agent accounts and more. This disclosure and authorization are provided to you in connection with your request to contract as a 1099 sales agent with Anchor Health Insurance Agency and Premier Health Solutions, LLC. If your contracting paperwork is accepted and processed, you will be a 1099 contractor with us—you will not be an employee. According to a 2011 report released by the FTC, background reports conducted on volunteers and contractors are considered for “employment purposes.” The background reports requested pursuant to your authorization may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be ordered include but are not limited to: Social Security number verification, criminal record report, credit report, UCC filings and Vector One® reports.

About you

Legal name exactly as it appears on your insurance license.

Where we reach you day to day.
Month and year you moved in. As close as you can get — an estimate is fine, a blank is not.
Background checks search court records county by county, using the addresses you have lived at. A missing move-in date or a missing middle name is the most common reason a check comes back needing rework.

Required for carrier contracting.

Background check details

Our carrier partner runs the check. These are the fields that decide whether it comes back clean the first time or sits in rework for a week.

Records are matched on name. Leave blank if there are none.
Optional. Helps separate you from someone with the same name.
One per line, with rough years. Criminal records are searched county by county, so an address we don't have is a county nobody looks in.

Licensing

These are two different numbers. Your NPN (National Producer Number) is one national number that follows you to every state and every carrier. Your resident license number is issued by your home state and is printed on that state license. Find both by searching your name: NAIC license lookup (most states — shows your NPN and each state license number) or, for a Florida license, Florida DFS licensee search. Your NPN is also at nipr.com.

Tick every state. Your resident state counts too. 0 selected

Every carrier sends your appointment invitations and verification links to the email on your NIPR record — not to the email you gave us above, unless they are the same. It is often an old address. Look it up before you answer: nipr.com → Licensing Center → log in → Contact Information shows the email of record. You must be able to open that inbox, or your contracting stalls.

Please note: you must be able to open the inbox on file with NIPR — carriers send appointment invitations and verification links there, and we cannot complete your appointments if you can't access them. Your state also sends license renewal and CE notices to this address.

Our recommendation: once your onboarding is complete and your @anchor-agency.com email is set up, update your NIPR email of record to that address. That way our team can see and help you stay on top of carrier invitations and renewal notices. Stuck? Hit the ? button and I'll walk you through it.
How to update your NIPR email (takes ~2 minutes)
  1. Go to nipr.com and open the Licensing Center.
  2. Log in with your SSN or NPN. Forgot your login? Use "Retrieve my NIPR ID" on the same page.
  3. Open Contact Information (sometimes under "Manage my PDB / profile").
  4. Change the email of record to the address you want carriers to use — after onboarding, we recommend your @anchor-agency.com address.
  5. Save. The change flows to state DOIs and carriers automatically, usually within 48 hours.
On your license. Unsure? Look yourself up at nipr.com.

E&O coverage

You’re covered — nothing to do here. Every Anchor agent writes under the agency E&O policy, so you do not need to buy, carry, or send us your own. Your name goes on the policy addendum when your account is created. If you happen to carry a personal policy as well, keep it — just let Akash know; we don’t need the paperwork.

How you get paid

Pay is direct deposit only. Tell us whether it goes to a business (LLC) or to you personally — this is what we set you up with in payroll, so it has to match the account that will receive the money.
We’ll need a W-9 for the business — you can upload it later under Docs.
We do not ask for your CMS password — nobody at Anchor needs it.

Existing carrier appointments

Done with this section. Nothing to release or transfer.

Check only carriers where you're currently appointed. For each: who your upline is and whether a release is needed. Passwords are optional — only if you tick the box at the bottom.

This is entirely optional and you can leave it blank. If you tick it, Anchor may sign in to the carrier portals listed above solely to complete or update your carrier appointments and contracting on your behalf. We will not use your logins for anything else, and you can withdraw this at any time by telling us or changing your password. Anything you enter is encrypted the moment you submit — nobody can read it by browsing our system, and every time it is unlocked we record who did it and when.

Some carriers' broker portal terms prohibit sharing credentials. Check your own agreements before ticking this, and if you'd rather not, leave it unticked — it will not affect your onboarding.

Background questionnaire

Required. Answering yes doesn't automatically disqualify you — but not disclosing does.

Voluntary Onboarding Form

While not required, by successfully completing this form, you allow Anchor Health Insurance Agency to assist with the onboarding process including but not limited to, agent background checks, carrier appointments, agency specific agent accounts and more. This disclosure and authorization are provided to you in connection with your request to contract as a 1099 sales agent with Anchor Health Insurance Agency and Premier Health Solutions, LLC. If your contracting paperwork is accepted and processed, you will be a 1099 contractor with us—you will not be an employee. According to a 2011 report released by the FTC, background reports conducted on volunteers and contractors are considered for “employment purposes.” The background reports requested pursuant to your authorization may contain information bearing on your character, general reputation, personal characteristics, mode of living and credit standing. The types of information that may be ordered include but are not limited to: Social Security number verification, criminal record report, credit report, UCC filings and Vector One® reports.

Are you a US citizen?

Have you been convicted of a misdemeanor, had a judgment withheld or deferred, or are you currently charged with committing a misdemeanor within the last 10 years (arrested waiting on disciplinary action)?

THIS INCLUDES: traffic citations, driving under the influence (DUI), driving while intoxicated (DWI), driving without a license, reckless driving, or driving with a suspended or revoked license. You may exclude juvenile adjudications (offenses where you were adjudicated delinquent in a juvenile court).

Have you ever been convicted of a misdemeanor including an alcohol or drug related offense within the last 10 years?

Have you been convicted of a felony, had a judgment withheld or deferred, or are you currently charged with committing a felony (been arrested awaiting decision)?

“Convicted” includes, but is not limited to, having been found guilty by verdict of a judge or jury, having entered a plea of guilty or nolo contendere or no contest, or having been given probation, a suspended sentence, or a fine.

Have you ever had your driver's license revoked within the past 3 years?

Have you ever had your Insurance License SUSPENDED and/or REVOKED by any department of insurance (even if later reinstated) for ANY REASON?

Have you ever had a complaint reported against you (even if later dismissed) by ANY CONSUMER, ANY INSURANCE CARRIER, CMS OR STATE INSURANCE DEPARTMENT?

Have you EVER had to pay a fine for license restitution or insurance disciplinary reasons greater than $500.00 USD?

Have you ever received a warning from CMS for compliance?

Have you ever had your FFM suspended or terminated by CMS?

Have you ever been convicted, had a judgment deferred, or are currently facing charges for a military offense?

Have you been named or involved as a party in an administrative proceeding, including a FINRA sanction or arbitration proceeding regarding any professional or occupational license or registration?

“Involved” also means having a license or registration application denied, or the act of withdrawing an application to avoid a denial.

Have you been notified by any jurisdiction to which you are applying of any delinquent tax obligation that is not the subject of a repayment agreement?

Are you currently a party to, or have you ever been found liable in, any lawsuit, arbitration or mediation proceeding involving allegations of fraud, misappropriation or conversion of funds, misrepresentation or breach of fiduciary duty?

Have you or any business in which you are or were an owner, partner, officer or director, or member or manager of a limited liability company, ever had an insurance agency contract or any other business relationship with an insurance company terminated for any alleged misconduct?

Do you have a child support obligation in arrearage?

If yes, tell us in the explanation box whether you have a repayment program with the state.

Have you ever declared any form of bankruptcy?

Asked on the Premier Health Solutions / Champion producer packet.

GA specific: Have you ever been convicted of a crime, charged with a crime, or admitted guilt without a conviction (such as pleading no contest or receiving first-offender treatment), other than for a minor traffic violation?

Are you a member or veteran of the armed forces, or the spouse or surviving spouse of a service member or veteran?

If you answered YES to any question, do you have the documentation uploaded to NIPR?

If you answer YES to any background question, or need help understanding one, contact our Head of Licensing and Contracting: Akash Narayanan (508) 816-5982 before you submit.

Identity documents

You must upload two different forms of ID. Carriers require these to verify you before they will issue an appointment. PDB report not needed — we pull it from your NPN.

Only these four are accepted:
  • Driver's license or State ID — must be ACTIVE, not expired
  • Social Security card
  • Birth certificate
  • US Passport — must be ACTIVE, not expired
Anything else will be rejected and will hold up your contracting. Make sure the whole document is in frame, all four corners visible, and the text is readable.

If you have not completed FFM training for this plan year yet, leave this blank — you can send it to us as soon as you finish.

Social Security number

Carriers and the background check require your SSN to issue an appointment. It is encrypted the moment you submit — nobody at Anchor can read it by browsing the system, and every time a full number is unlocked we record who did it and when.

Never send your SSN by text, Slack or email. This form is the only place Anchor should ever ask for it.

Review & sign

Authorization to assist with licensing & contracting.

By signing below I request and authorize Anchor Health Insurance Agency and its licensing and contracting staff to assist me with my insurance licensing and carrier contracting. This includes:
  • submitting and tracking my carrier appointments and contracting paperwork;
  • obtaining and reviewing the status of my licenses, appointments and certifications, including NIPR, the FFM/CMS and carrier portals;
  • communicating with carriers, uplines and state departments of insurance on my behalf about my licensing and appointment status;
  • assisting with releases, transfers and renewals relating to my appointments.

I understand Anchor is assisting me and that I remain responsible for the accuracy of my own licensing information and for maintaining my licenses in good standing. I may withdraw this authorization at any time by notifying Anchor in writing.
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