Reminder: Per our recent compliance initiative, all brokers should make sure they’ve signed a new Business Associate Agreement (BAA) and have submitted it to EmblemHealth. Any other documentation in need of an update should also be submitted at this time.
Execute the following:
Existing Brokers:
New Brokers:
- A copy of your current New York State individual or corporate broker license issued under section 2104 of the insurance law, or agent license issued under section 2103(a) of the insurance law that stipulates accident and health accredidation (if you are applying as a corporation, include both parts of the corporate broker license.)
- A complete W-9 form.
- If applicable, your Errors and Omissions Insurance Policy. Return only the front page.
Provide documentation
- A copy of your voided check based on the entity you would like appointed with EmblemHealth (Business or Individual). EmblemHealth has started an initiative to enroll all brokers with EFT. For new brokers, the broker operations team will internally register you on the PNC Portal. For existing brokers who are already appointed with EmblemHealth, a designated email box has been set up for you to send a copy of your voided check. If you don’t have a voided check to provide, you may receive an ACH Transaction Routing Instruction form from your bank. Please email the ACH Transaction Routing Instruction form to EFTBrokerCommissions@emblemhealth.com
- A copy of your current New York State individual or corporate broker license issued under section 2104 of the insurance law, or agent license issued under section 2103(a) of the insurance law that stipulates accident and health accredidation (if you are applying as a corporation, include both parts of the corporate broker license.)
- A complete W-9 form.
- If applicable, your Errors and Omissions Insurance Policy. Return only the front page.
Submit your documents
You can submit all completed documents using one of the following methods:
Small Group Off-Exchange Commission (Effective January 1, 2019)
PNC EFT Enrollment Instruction Guide
PNC EFT Enrollment
Medicare Supplement Commission (Effective January 1, 2019)