AGENT APPOINTMENT PROCEDURE

Please use the following steps in order to become an ATLANTIS HEALTH PLAN SELLING AGENT:

1. Complete a selling Agent appointment application form.
2. Submit one completed and signed copy of the Broker agreement.
3. Include a copy of your current State of New York, Insurance Department, Accident and Health Agent license or Broker's license. If applying as a corporation, include both parts of the corporate license. You must be licensed to sell health insurance in New York State.
4. Include a copy of errors and omissions insurance minimum of $1,000,000 dollars policy coverage.

Please send the completed documents to your general agent or to:

Atlantis Health Plan, Inc.
Licensing Department
39 Broadway Suite 1240
New York, NY 10006.