1. Step Two: Primerica Carrier Appointment Instructions
To be completed after Common Application Submission
Copyright 2017 GoHealth | All rights reserved.

2. The following instructions are for agents who have already completed the Common Application. If you have NOT completed the Common Application, please refer to Primerica Online for instructions.
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

3. Table of Contents Overview 4 Anthem 5-6 7-8 9-11 12 BCBS MI 13 HCSC 14
Indiana, Kentucky, Missouri, Nevada, Ohio, Virginia, Wisconsin
5-6
Georgia
7-8
New Hampshire
9-11
Maine 12
BCBS MI 13
HCSC 14
Humana 15
Time Insurance Company/National General
16-17
UHO 18
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

4. Appointment Instructions Overview
Before following any instructions on subsequent pages of this document, you must have already completed the Common Application with GoHealth.
In order to complete the Common Application, please go to
Once you complete the Common Application, you can complete the steps on the following pages to become appointed with the various carriers.

5. Anthem: Indiana, Kentucky, Missouri, Nevada, Ohio, Virginia, Wisconsin
You must use Internet Explorer version 5.01 or higher and Adobe Acrobat Reader 6.0 or higher to complete this application!
Click here.
Enter your First Name, Last Name, SSN and desired password to create an account with Anthem. Click “Logon To nomoreforms” once this information is complete
Click “SubAgent Instructions”
Scroll to the bottom of the page and click “Agree”
Click “PDS States”
Section 1: Producer Information
Complete the required fields, which are indicated by red boxes
Date of birth (MM/DD/YYYY)
Home phone no. – Use: Your own phone no.
Producer business phone number
Residence mailing address – no PO box – Use: Your home address
Business mailing address
Physical location business mailing address
I prefer to receive mailings at: – Check “Business mailing address”
Personal address
Business address
Are you bilingual? – Check “Yes” or “No ”
Have you used any other names or aliases in the last seven (7) years? – Check “Yes” or “No.” If “Yes” ”, add the previous name(s) and then check if the name change was First or Last (check both boxes if applicable)
Section 2: Appointment Information
Type of Appointment: Check “Subagent”
When asked if you authorize for this to be your Exchange relationship on this new assignment, select “Yes”
Section 3: Commission Assignment
Agency Name: GoHealth
Agency Tax ID:
Agency Principal Name: Michael Owens
Agency Business address: 214 W Huron, Suite 100 Chicago, IL Cook
Agency Physical Location: check same as business address box
Agency Phone Number: (888)
Section 4: Commission Hierarchy
Leave blank
Section 5: Previous Addresses
Continue on next page
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

6. Section 9: Business Practices
Check “Yes” or “No” to all questions A-L below
If “Yes” is answered to any of these questions, please attach a signed written explanation with all relevant information and supporting documents
Section 10: Remarks
Leave blank unless you wish to add any additional information from Sections 5, 6, and/or 7
Section 11: Authorization- Signature Required
Enter your name in the Signature box and today’s date (MM/DD/YYYY)
Click “Save Your Info” at the bottom of the page
Click “MAPD Addendum”
Scroll down to the last page – Your first name, Last name, and SSN will be already populated.
Fill in today’s date (MM/DD/YYYY)
By - Sign your name
Title – Use: Agent
Agency tax ID# (if appl) – Use:
Business Address – 214 W. Huron, Chicago IL
Address
Producer Phone Number
Click “Agree”
Submitting your application:
Once all forms have been completed click the “submit forms” button on the bottom right side
Enter the password you created at the beginning of this process. The re-entered password acts as a wet signature for all your documents. Click the “submit forms” button on the bottom right
Click the “submit forms” button one last time on the bottom right
Once a screen appears with your confirmation number the online appointment paperwork has been submitted to Anthem
If you have lived anywhere other than the home address you previously entered above in the last two (2) years check “Yes”, otherwise check “No”. If you checked “Yes”, please list your previous address(s).
f. Section 6: Employment History
i. Select “Yes”
ii. Provide employment history for the last two years
g. Section 7: License Information
i. Resident license state: select state from drop down menu
ii. Residence license number
iii. Check the boxes for the states you are appointed with and paid non-resident appointment fees for
h. Section 8: E&O Policy Information
i. Policy amount:
Policy number:
Policy carrier:
Effective date:
Expiration date:
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

7. You must use Internet Explorer version 5
You must use Internet Explorer version 5.01 or higher and Adobe Acrobat Reader 6.0 or higher to complete this application!
Anthem: Georgia
Section 2: Appointment Information
Type of Appointment: Check “Subagent”
When asked if you authorize for this to be your Exchange relationship on this new assignment, select “Yes”
Section 3: Commission Assignment
Agency Name: GoHealth
Agency Tax ID:
Agency Principal Name: Michael Owens
Agency Business address: 214 W Huron, Suite 100 Chicago, IL Cook
Agency Physical Location: check same as business address box
Agency Phone Number: (888)
Section 4: Commission Hierarchy
Leave blank
Section 5: Previous Addresses
If you have lived anywhere other than the home address you previously entered above in the last two (2) years check “Yes”, otherwise check “No”. If you checked “Yes”, please list your previous address(s).
Section 6: Employment History
Select “Yes”
Provide employment history for the last two years
Section 7: License Information
Click here
Click “Instruction Letter”
Scroll to the bottom and click “Agree”
Click “PDS No State”
Section 1: Producer Information
Complete the required fields, which are indicated by red boxes
Date of birth (MM/DD/YYYY)
Home phone no. – Use: Your own phone no.
Producer business phone number
Residence mailing address – no PO box – Use: Your home address
Business mailing address
Physical location business mailing address
I prefer to receive mailings at: – Check “Business mailing address”
Personal address
Business address
Are you bilingual? – Check “Yes” or “No”
Have you used any other names or aliases in the last seven (7) years? – Check “Yes” or “No”. If “Yes”, add the previous name(s) and then check if the name change was First or Last (check both boxes if applicable)
Continue on next page
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

8. Click “Agree” at the bottom of the page
Scroll down to the last page – Your agent name and SSN will be already populated.
Date
Agent Signature
Address
Click “Agree” at the bottom of the page
Click “GA MAPD Addendum ”
Click on “GA MAPD Addendum”
Scroll down to the last page page – Your First name, Last name and SSN will already be populated.
Fill in today’s date (MM/DD/YYYY)
By - Sign your name
Title – Use: Agent
Agency tax ID# :
Business Address – Use: 214 W. Huron, Chicago IL 60647
Address
Producer Phone Number
Click “Agree”
Submitting your application:
Once all forms have been completed click the “submit forms” button on the bottom right side
Enter the password you created at the beginning of this process. The re-entered password acts as a wet signature for all your documents. Click the “submit forms” button on the bottom right
Click the “submit forms” button again in the bottom right
Once a screen appears with your confirmation number the online appointment paperwork has been submitted to Anthem
i. Resident license state: select state from drop down menu
ii. Residence license number
iii. Check the boxes for the states you are appointed with and paid non-resident appointment fees for
Section 8: E&O Policy Information
Policy amount:
Policy number:
iii. Policy carrier:
iv. Effective date:
Expiration date:
Section 9: Business Practices
Check “Yes” or “No” to all questions A-L below
If “Yes” is answered to any of these questions, please attach a signed written explanation with all relevant information and supporting documents
Section 10: Remarks
Leave blank unless you wish to add any additional information from Sections 5, 6, and/or 7
Section 11: Authorization- Signature Required
Enter your name in the Signature box and today’s date (MM/DD/YYYY)
Click “Save Your Info” at the bottom of the page
Click “GA Agreement”
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

9. Anthem: New Hampshire Continue on next page
You must use Internet Explorer version 5.01 or higher and Adobe Acrobat Reader 6.0 or higher to complete this application!
Anthem: New Hampshire
Have you used any other names or aliases in the last seven (7) years? – Check “Yes” or “No.” If “Yes” ”, add the previous name(s) and then check if the name change was First or Last (check both boxes if applicable)
Section 2: Appointment Information
Type of Appointment: Check “Subagent”
When asked if you authorize for this to be your Exchange relationship on this new assignment, select “Yes”
Section 3: Commission Assignment
Agency Name: GoHealth
Agency Tax ID:
Agency Principal Name: Michael Owens
Agency Business address: 214 W Huron, Suite 100 Chicago, IL Cook
Agency Physical Location: check same as business address box
Agency Phone Number: (888)
Section 4: Commission Hierarchy
Leave blank
Section 5: Previous Addresses
If you have lived anywhere other than the home address you previously entered above in the last two (2) years check “Yes”, otherwise check “No”. If you checked “Yes”, please list your previous address(s).
Section 6: Employment History
Select “Yes”
Click here
Enter your First Name, Last Name, SSN and desired password to create an account with Anthem. Click “Logon To nomoreforms” once this information is complete
Click “PDS No State”
Section 1: Producer Information
Complete the required fields, which are indicated by red boxes
Date of birth (MM/DD/YYYY)
Home phone no. – Use: Your own phone no.
Producer business phone number
Residence mailing address – no PO box – Use: Your home address
Business mailing address
Physical location business mailing address
I prefer to receive mailings at: – Check “Business mailing address”
Personal address
Business address
Are you bilingual? – Check “Yes” or “No ”
Continue on next page
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

10. Click “NH Instruction Sheet” Scroll to the bottom and click “Agree”
Click “NH Commission Agreement”
Scroll down to the last page – Your name and SSN should be already populated. You can leave the Broker/Agency Name and Broker/Agent Title blank
Broker Title: Agent
Enter Today’s Date (MM/DD/YYYY)
Click “Agree” at the bottom of the page
Click “NH Ind Comm Agreement”
Scroll down to the last page – Your name and SSN should be already populated. You can leave the Broker/Agency Name, second signature, and Tax ID number blank.
Click “MAPD Addendum ”
Scroll down to the last page – Your first name, Last name, and SSN will be already populated.
Fill in today’s date (MM/DD/YYYY)
By – Sign your name
Title: Agent
Agency Tax ID number:
Business Address
Address
Producer phone number
Provide employment history for the last two years
g. Section 7: License Information
i. Resident license state: select state from drop down menu
ii. Residence license number
iii. Check the boxes for the states you are appointed with and paid non-resident appointment fees for
Section 8: E&O Policy Information
Policy amount:
Policy number:
Policy carrier:
Effective date:
Expiration date:
Section 9: Business practices
Check “Yes” or “No” to all questions A-L below
If “Yes” is answered to any of these questions, please attach a signed written explanation with all relevant information and supporting documents
Section 10: Remarks
Leave blank unless you wish to add any additional information from Sections 5, 6, and/or 7
Section 11: Authorization- Signature Required
Enter your name in the Signature box and today’s date (MM/DD/YYYY)
Click “Save Your Info” at the bottom of the page
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

11. Click “NH Group Amend 08-15”
Scroll down to the last page – Your First name, Last name and SSN will already be populated
Title: Agent
Signature: type your full name
Fill in today’s date (MM/DD/YYYY)
Click “Agree” at the bottom of the page
Click “NH Individual Amend 08-15”
Submitting your application:
Once all forms have been completed click the “submit forms” button on the bottom right side
Enter the password you created at the beginning of this process. The re-entered password acts as a wet signature for all your documents. Click the “submit forms” button on the bottom right
Click the “submit forms” button one last time on the bottom right
Once a screen appears with your confirmation number the online appointment paperwork has been submitted to Anthem
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

12. Anthem: Maine Appointment Instructions
If you requested an Anthem appointment in Maine during the common application process, you will receive an from
Once received, please click the link contained in the and fill in the required fields.
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

13. BCBS MI Appointment Instructions
If you selected BCBS MI as a carrier during the common application process, you will receive an from RightSignature.com.
Please click on the link within the , follow the required steps, and submit your signature.
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

14. HCSC Appointment Instructions
You will receive an from containing a link to finish the HCSC application. Once received, click the link and fill out the required fields
Complete basic appointment information
Select “No” when asked if you are covered by your parent’s E&O. From there, use the information from your E&O Policy to complete the E&O Section:
E&O carrier: Primerica
E&O policy number: Agency/Primerica
Effective date: 09/30/2016
Expiration date: 09/30/2017
Aggregate claim account: 100
W-9: This will automatically be populated with your information, but your commissions will be paid through Aflac
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

15. Humana Appointment Instructions
If you selected Humana as a carrier during the common application process, you will receive an from RightSignature.com.
Please click on the link within the , follow the required steps, and submit your signature.
Upon completion, you will receive a second from RightSignature.com. You must click on the link within this in order to verify your address and confirm submission to GoHealth.
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.

16. Time Insurance Company/National General
Follow the link to:
Enter username Go_Health and password: GoHea!th_0601 and click Log In, then Continue.
Enter your National Producer Number.
Select your resident state and click the blue start button.
Compelte the intake form.
Select Social Security Number and enter information.
Enter your name, date of birth and Social Security number.
Enter your resident address and business address.
Enter your phone numbers and address.
Indicate No regarding Hierarchy Discovery
Leave Account Type balnk
Enter NA NA as the Financial Institution
Enter NA NA as the Account Holder’s Name
Indicate No as authorized on this account
Enter as the Routing Number
Enter as the Account Number
Click the blue Save and Continue button.

17. Time Insurance Company/National General (continued)
Complete the Producer Application by answering the yes or no questions. Electronically sign by entering your name in the Signature field.
Review the Agent Agreement and electronically sign by entering your name in the Signature field.
Review the Advertising, Promotions and Marketing Policy and electronically sign by entering your name in the Signature field.
Complete the Disclosure and Background Authorization by answering the yes or no questions. Electronically sign by entering your name in the Signature field.
Complete the Taxpayer ID Number and W-9 Section.
Select Individual/Sole Proprietor LLC as the federal tax classification
Enter NA as the Tax Classification number
Enter NA as the Exempt Payee Code
Enter NA as the Exemption from the FACTA reporting code
Review prepopulated address
Leave “List account number(s) here” blank
Leave “Employer Identification Number” blank
Click the blue Save and Continue button.
Print and save your records. Download each of the six PDFS for your records by clicking on the document icons.
*Appointments added in this manner will not be recorded as “Pending” in the “Current Appointment Status” section of the Common Application. When your appointment is approved, it will appear as an “Active” appointment in this section.

18. UHO Appointment Instructions
If you selected UHO as a carrier during the common application process, you will receive an from UHO that will prompt you to click on a unique, secure link to complete the appointment process.
The link expires within 15 days from the date the is sent.
Copyright 2017 GoHealth | All right reserved | Proprietary Information of GoHealth, LLC. Do not distribute or reproduce without express permission of GoHealth. CMA has neither reviewed or approved these materials.