The easiest way to quote and have clients fill out applications is through your own Agent Portal. You must be a contracted agent with HealthAmerica in order to register for the Agent Portal, as well as to write business and receive commission. Once you’ve contracted, however, you’re ready to begin!

Once registered, you’ll be able to run quotes, email quotes, have your clients apply online, and track your activities, all in one place.

In addition, you can easily find participating providers in our network by utlizing our online Provider Search.

Already registered? Learn more about the Agent Portal:

Agent Portal Tip Sheet
Full Agent Portal Guide

While there are clear advantages to electronic submission, we understand that you may need paper applications and support materials. Further, there are some materials that are not available through the quote and application tool. Please see the below forms, materials, and samples list for downloadable, printable documents.

Broker Submission Cover Sheet PDF

Application PDF

Pre-Ex Acknowledgement Form PDF

Request for Cancellation Form PDF

Bank Change Form PDF

MRS Authorization Form PDF

Medical Claim Form PDF

Caremark Claim Form PDF

DenteMax Dental Claim Form PDF

Literature Request Form PDF

Member Representative Authority Form PDF

PDP Form - Individual PDF

PDP Company Agreement 5+ Members PDF

PDP training instructions PDF

2009 Application Submission Calendar PDF

Rx Formulary PDF

Ways to Submit New Business PDF

Why HealthAmericaOne? PDF

Brochure PDF

Benefit Grid PDF

Broker Trifold PDF

Co-op ad sample PDF

HSA trifold PDF

Dental Benefit Flyer PDF

Eye Med Vision Flyer PDF

Health Equity Custodial Agreement Privacy Notice PDF

Health Equity Account Authorization Form PDF

HealthEquity Fee Schedule PDF

Rate Card - CPA1 - 12/1/09 PDF

Rate Card - CPA2 - 12/1/09 PDF

Rate Card - CPA/SEPA - 12/1/09 PDF

Rate Card - SWPA1 - 12/1/09 PDF

Rate Card - SWPA2 - 12/1/09 PDF

Rate Card - NWPA - 12/1/09 PDF

Rate Card - OH - 12/1/09 PDF

Rate Card - CPA1 - 1st Q 2010 PDF

Rate Card - CPA2 - 1st Q 2010 PDF

Rate Card - CPA/SEPA - 1st Q 2010 PDF

Rate Card - SWPA1 - 1st Q 2010 PDF

Rate Card - SWPA2 - 1st Q 2010 PDF

Rate Card - NWPA - 1st Q 2010 PDF

Rate Card - OH - 1st Q 2010 PDF

Rate Card - CPA1 - 4th Quarter PDF

Rate Card - CPA2 - 4th Quarter PDF

Rate Card - CPA/SEPA - 4th Quarter PDF

Rate Card - SWPA/NWPA - 4th Quarter PDF

Rate Card - SWPA/OH - 4th Quarter PDF

Copay 100% $0 $20/$40 PDF

Copay 100% $0 $25/$50 PDF

Copay 100% $1200 PDF

Copay 90% $1000/$2000 OOP PDF

Copay 90% $1000/$3000 OOP PDF

Copay 90% $2000 PDF

Deductible 80% $500 PDF

Deductible 80% $750 PDF

Deductible 100% $5000 PDF

QHDHP 100% $1250 PDF

QHDHP 100% $2500 PDF

QHDHP 100% $3750 PDF

QHDHP 90% $1200 PDF

QHDHP 90% $2000 PDF

QHDHP 90% $3000 PDF

QHDHP 80% $1200 PDF

QHDHP 80% $3000 PDF

Didn’t find what you’re looking for?

Marketing materials, including professionally produced print ads, brochures, trifolds and radio copy, as well as other sales support materials, like the Producer’s Guide to Medical Underwriting, are available through your Account Executive upon request.

More Information: Please click here to be directed to even more Broker information that is available on our commercial plan site!

email page
print page
text size A A A

secure broker portal

Coming in 2009 - access your CoventryOne online Broker Account.

coverage for your clients

CoventryOne is offered in 22 states. Choose a state and click 'go' to learn more about the available plans

locate a provider

Find more information

HealthAmerica
Find out about our other local products and services in Pennsylvania and Ohio

Quoting, Application, & Sales Support Info

Already registered? Learn more about the Agent Portal:

Didn’t find what you’re looking for?

secure broker portal

coverage for your clients

Find more information

CoventryOne

Coventry Health Care