2024-10-10
Toggle navigation
The Right Place for the Right Plan
Call Customer Service
1-888-813-9220
Broker Registration
Personal Information
First name *
Please provide a first name.
Last name *
Please provide a last name.
Date of Birth *
Please provide a date of birth.
Email *
Please provide a email address.
NPN *
Please provide a NPN.
Broker Agency Information
NOTE: If you are not associated with a broker agency, please enter your personal information. Do not enter a General Agency or Third Party Administrator‘s Information.
Legal Name *
Please provide a legal name.
DBA
Practice Area *
Select Practice Area
Small Business Marketplace ONLY
Please select a practice area.
Select Language(s)
Afrikaans
Albanian
Amharic
Arabic
Armenian
Basque
Bengali
Bulgarian
Catalan
Central Khmer
Chinese
Croatian
Czech
Danish
Dutch
English
Estonian
Fijian
Finnish
French
Georgian
German
Greek
Gujarati
Hebrew
Hindi
Hungarian
Icelandic
Indonesian
Irish
Italian
Japanese
Korean
Latin
Latvian
Lithuanian
Macedonian
Malay
Malayalam
Maltese
Maori
Marathi
Mongolian
Nepali
Norwegian
Panjabi
Persian
Polish
Portuguese
Quechua
Romanian
Russian
Samoan
Serbian
Slovak
Slovenian
Spanish
Swahili
Swedish
Tamil
Tatar
Telugu
Thai
Tibetan
Tonga (Tonga Islands)
Turkish
Ukrainian
Urdu
Uzbek
Vietnamese
Welsh
Xhosa
Hold Ctrl or Command (mac) to select multiple
EVENING/WEEKEND HOURS?
ACCEPT NEW CLIENTS?
ACH Routing Information
Account Number *
Please provide an account number.
Routing Number *
Please provide a routing number.
Routing numbers dont match
Routing Number Confirmation *
Please provide routing number confirmation.
Routing numbers dont match
Office Location
Address *
Please provide a valid address.
Kind *
Primary
Mailing
Branch
Please select an address kind.
Address 2
City *
Please provide a valid city.
State *
SELECT STATE
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Please select a state.
Zip *
Please provide a valid zipcode.
Phone
Area Code *
Please provide a valid area code.
Number *
Please provide a valid number.
Add Office Location
By submitting this application to become a certified broker on the Health Connector for Business, I agree to the terms and conditions described in the
Massachusetts Health Connector Broker Agreement
.