Learn how to submit paper applications for specific carriers.
Click the arrow drop-down menu to view instructions on how to download paper applications and submit them directly to our carrier partners. If a carrier is not listed, it’s recommended that you consult the carrier’s broker support for instructions.
Aetna
Aetna
Submitting Applications via Fax
Fax the application to the applicable fax number below
Fax to Attention: Enrollment Department - Fax: 1-844-984-0393
Aetna recommends you confirm your form was received once you’ve faxed it.
Alignment
Alignment
Paper application submission instructions coming soon.
Anthem
Anthem
Coming Soon
Cigna
Cigna
Submitting Applications via Fax
Paper applications can be submitted to Cigna via fax. When sending your application via fax, please use the follow cover pages:
Fax the application to the applicable fax number listed below:
2025 Applications: 1-877-818-8163
Arizona HMO 2025 Applications: 1-855-531-9754
Arizona PPO 2025 Applications: 1-877-818-8163
Single SOA Forms Only: 1-877-818-9299
After your paper application is submitted, you should be able to see it within your broker portal within 2 business days. If you do not see the application, please contact Cigna broker support directly.
Devoted
Devoted
Enrollment Receipt
Print the enrollment receipt for your prospects who prefer a paper copy, or if you will be submitting a paper application to us via fax or mail.
Submitting a Paper Application
Applications must be submitted within 48 hours of being completed, and must be submitted along with an enrollment receipt.
Fax Number: 1-877-264-3859
Mailing address:
Devoted Health — Enrollment
PO Box 211127
Eagan, MN 55121
Humana
Humana
Navigate to https://www.salesenablementlibrary.com/; search for the plan name and use the filters along the left to filter for enrollment books
Email Enrollment Applications
Molina
Molina
Submitting Applications via Fax
Paper applications can be submitted to Molina via fax. When sending your application via fax, please use the following cover pages:
All paper Enrollment Forms can be faxed to: (844) 541-6848
UHC
UHC
Submit Applications via Secure Email and Fax
Wellcare
Wellcare
Download Enrollment Materials
You can access and download all enrollment materials by logging into Single Sign-On and selecting Sales Materials Ordering Portal (i.e., CustomPoint).
Visit the CustomPoint Resource Page for more information.
Send Applications Via Fax
Brokers/Agents have the ability to submit paper applications via fax*. To ensure timely and accurate processing, be sure to submit enrollment applications to the correct health plan fax number. When submitting enrollment applications, be sure to use the appropriate broker identifier.
Note: Wellcare By Fidelis Care: paper applications submitted should include the Wellcare By Fidelis Care unique broker identifier: FB + NPN (ex. FB123456).
For a full listing of our health plan website addresses and health plan fax numbers, refer to the Medicare Health Plan Reference Guide:
Important Reminders
Be sure to use the appropriate Application and Scope of Appointment (SOA), determined by the health plan of choice and the effective date/plan year. For example, a 11/1/2024 effective enrollment should be completed on a 2024 application. A 1/1/2025 effective enrollment should be completed on a 2025 application..
Enrollment applications must be received by Wellcare no later than the calendar day following receipt from the beneficiary.
Upload Applications via Centene Workbench