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Agent Appointment Request
Sign up to receive email updates from Molina Healthcare about your state billing requirements, authorization changes, quality improvement initiatives, training and other important information.
By providing your email address, you are opting to receive healthplan information and marketing email communications. You can unsubscribe at any time.

By submitting my information via this form, I consent to having Molina Healthcare collect my personal information. I understand and agree that my information will be used and shared in accordance with Molina Healthcare's Privacy Policy and Terms of Use. Privacy Policy and Terms of Use.

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To qualify as an agency and become contracted with Molina Marketplace, the agency must:

  • Have a minimum 1 year experience selling ACA products
  • Hold active license in all states where agency and downline agents plan to sell Molina Marketplace
  • Contract 50+ downline agents with Molina Marketplace
  • Be capable of paying all agent level commissions
  • Commit to writing 1,500+ Molina Marketplace policies per year

By checking this box, you are agreeing that your agency meets these requirements, and that you are the Principal Agent of your agency.

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