Hosted Agent Application

Fewer than 2525–99100–249250–9991,000+

Growing my book of businessRecruiting agents to my teamJoining a new upline / FMOSelling my book of businessAdding new product linesImproving operations / efficiencyLearning / no active mode

Producer / AgentCarrier RelationshipManagerOperations / AdminTrainerOther

Just me2–56–1516–5051–150150+

Fewer than 2525–99100–249250–9991,000+

Growing my personal book of businessConsidering becoming an independent agentMoving to a different agency / uplineAdding new product lines to my mixImproving my skills / trainingLearning / no active modeOther

Yes — I'm the owner / principalYes — I'm part of executive leadershipNo — I'm not in agency leadership

Just me2–56–1516–5051–150150+

Less than 2 years2–5 years6–10 years11–20 years20+ years

Fewer than 100100–499500–9991,000–4,9995,000–9,99910,000+

Under 5050–249250–9991,000+Not applicable

Growing the agencyRecruiting new producers / downlineSelling the agencyAcquiring other agencies / booksAdding new product linesImproving operations / efficiencySuccession planningOther

Carrier or parent company is captured by the Company field at the top of the form.

Fewer than 2525–99100–249250–9991,000+

Growing my book within my current carrierConsidering becoming an independent agentExpanding into new product linesJoining an agency or IMOImproving my skills / trainingLearning / no active modeOther

Under 50 contracted agents50–249250–9991,000–4,9995,000+

Regional (1–3 states)Multi-state (4–15 states)National (16+ states)

Less than 2 years2–5 years6–10 years11–20 years21–30 years30+ years

Medicare AdvantageMedicare SupplementLife InsuranceAnnuitiesGroup BenefitsRetirement / Financial PlanningOther (please specify):

If personally licensed, your NPN (optional)

RecruiterMarketer / MarketingTrainer / EducationAgent Services / SupportOperations / AdminOther

Fewer than 5050–249250–9991,000+Not applicable / not in a support role

Medicare AdvantageMedicare SupplementLife InsuranceAnnuitiesGroup BenefitsRetirement / Financial PlanningOther (please specify):

Please describe your role *

Short single-line, e.g., "VP of Sales Operations", "Founder", "Director of Marketing".

Carrier / Health PlanTechnology platform / SaaSLead generationTelesales / TPMO / Call centerCompliance servicesMarketing / advertising servicesProfessional services (legal, accounting, consulting)Investment / capital / M&AMedia / publisherIMO-adjacent service providerTrade association / nonprofitOther

Briefly describe what your company does and who you sell to or serve *

Hosted Agent is designed for independent agents and agencies. Please explain why you're applying through this path rather than as a Sponsor, Attendee, or invited guest. *

Options are grouped by cluster — pick everything that applies to your book of business.

Medicare AdvantageMedicare SupplementDual Eligible (D-SNP)ACA / Individual Markets (including ICHRA)Supplemental — DentalSupplemental — VisionSupplemental — HearingSupplemental — Fitness & WellnessSupplemental — Mental / Behavioral HealthAncillary — DentalAncillary — VisionAncillary — HearingAncillary — Hospital IndemnityAncillary — Critical IllnessAncillary — AccidentLife Insurance (Term / Whole / IUL)Final ExpenseAnnuitiesLong-Term CareWealth Management / Retirement PlanningOther (please specify):

Individual Hosted AgentTeam Hosted Agent