Please complete the following contracting papers. Remember to sign in the required
areas. The more complete the application, the sooner it will be approved.
Agents Name:
Appointing Agent/Agency:
State(s) to Be Appointed In:
Checklist:
 Complete W-9 form
 Attach state licenses for appointment states
 Complete EFT Form and Attach Voided Check
 Sign Agent Contract
 Attach E&O Coverage
 Complete and Sign Agent Appointment Information
Please return by mail, fax, or email to:
Benchmark Insurance Group
ATTN: Contracting
1515 Mockingbird Lane, Suite 820, Charlotte, NC 28209
Ph: (800) 998-9997
Fax: (704) 527-7371
[email protected]
888-490-6030
Humana Med Advantage
How To Do Business Guide
Supplies
Certified agents may call Humana's agent support line 1-800-309-3163 and a representative will
assist you with the ordering process. You can also submit the supply order forms via email
using the documents below:
Humana MAPD Order Form (Excel)
MAPD Order Form Instructions (PDF)
Humana PDP Order Form (Excel)
PDP Order Form Instructions (PDF)
Website
www.humana.com.
You may access available plans in your area by visiting www.humana-medicare.com.
Software
Currently, there is no software available. Rates are calculated from the Summary of Benefits
based on the county.
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Humana Med Advantage
How To Do Business Guide
Contracts
Access the contract by clicking here: http://www.messerfinancial.com/pdfs/contracts/HUMContr
act.html
You may also call the Contracting Department at 1-866-568-9649 x710 if you have any
questions.
New Business
Agents may submit paper enrollments via fax or mail on the same day that they are signed by
the client. Agents are required to use Humana’s specific Scope of Appointment form rather then
a generic Scope of Appointment.
Click here for the Scope: Scope of Appointment
Click here for the Fax Cover: Fax Coverpage
Please fax to 1-877-889-9936.
Mail to:
Humana Medicare Enrollment
PO BOX 14309
Lexington, KY 40512-9801
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Humana Med Advantage
How To Do Business Guide
Underwriting
With Medicare Advantage programs, the only underwriting criteria is that the client does not
have End Stage Renal Disease. Humana offers a SNP for Dual Eligibles, available only in HMO
counties.
Commissions
Commission statements are generated every Wednesday and pay out every Friday. You may
access statements through the Humana Agent Portal.
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