Broker Appointment

Below is a list of items needed to complete a formal Broker Appointment with Saint Mary’s Health Plans:

• Broker Appointment Checklist (PDF)
• HealthFirst HMO Agent/Broker Contract (PDF)
• Health Choice PPO Agent/Broker Contract (PDF)
• Agent Appointment Preliminary Information (PDF)
• Broker Agreement (PDF)
• Broker Addendum (PDF)
• Dignity Health Direct Deposit enrollment form (PDF)
• W-9 Taxpayer Identification Number and Certification (PDF) (if you have not received commission payments from SMHP in the past)

You must also provide a copy of the broker or agency health license for the state of Nevada.

Return all completed forms and Nevada license copy to:
Saint Mary’s Health Plans
Attn: Sales Department
1510 Meadow Wood Lane
Reno, Nevada 89502

Forms can also be faxed to 775.770.6454.

With questions related to appointment, please contact Linda.Harrison@dignityhealth.org.