Get Help Tool Survey

Get Help Tool Survey

Are you an insurance agent/broker, do you represent a community partner organization, or are you a SHIBA/Medicare counseling site?*

Insurance agent/broker

Community partner organization

SHIBA counseling site

What is your NPN number?*

Note

If you have additional insurance agents/brokers who work in your office, please submit a separate form for each.

What is the name of the community partner organization or SHIBA organization where you work?*

What is your name and best contact information in case we have questions about this information?*

Have you completed the Medicare insurance agent listing process through the Oregon Health Insurance Marketplace or Oregon SHIBA?*

Yes

What is your email address so we can follow-up with you?*

Do you have current AHIP certification?

Note: You must upload documentation showing current AHIP certification below.

Yes

Are you appointed with at least two Medicare insurance carriers?

Note: you must upload documentation showing current appointment with 2 Medicare carriers below.

Yes

Do you have at least two years of Medicare health insurance experience?

Note: you must upload documentation showing that you have Medicare health insurance experience for at least 2 years.

Yes

Medicare agent documentation

Upload all required documentation, including:

Current AHIP certification.
Documentation showing current appointment with 2 Medicare carriers: A certificate or email from the insurer to prove you are authorized to sell policies by that company.
Medicare health insurance experience for at least 2 years: An AHIP certificate from 2 years ago, or documentation from an insurer from over 2 years ago. This requirement cannot be waived under any circumstance.

Drag and drop files here or

Medicare Code of Conduct

By agreeing to the statements below, I also understand that my participation can be terminated at the discretion of the Marketplace.

I will follow all of the guidelines spelled out by the Marketplace for participation.

I will keep all of my required certifications and appointments up to date and current.

I will follow all of the rules and regulations set forth by CMS regarding the sale of Medicare plans.

I will do my best to find the best plan for each and every person based upon their needs.

Are you currently assisting consumers with health coverage enrollment?*

Yes

Are you currently offering in-person assistance?*

Yes

Are you offering assistance over-the-phone or virtually?*

Yes

Would you like to add, remove, or change any listings on the Get Help tool? If you select "no," you will not be able to provide location information and you will not be added to the tool.*

Select

What is the address of the location or locations you wish to remove?*

Please indicate the number of locations where your organization offers assistance.*

If you only need to update information for a current location, please indicate how many locations you need to update.

If you are offering assistance at a different organization, what is the name of location where you are offering assistance?

Street address of first location where offering assistance*

City of location listed above*

Zip code of location listed above*

County of location listed above*

Select

Office phone number where someone would call to make appointment*

Phone

Email contact for assistance

Website or booking link to schedule appointment

Are translation services available?*

Yes

If you are offering assistance at a different organization, what is the name of location where you are offering assistance?

Street address of second location where offering assistance*

City of location listed above*

Zip code of location listed above*

County of location listed above*

Select

Office phone number where someone would call to make appointment*

Phone

Email contact for assistance

Website or booking link to schedule appointment

Are translation services available?*

Yes

If you are offering assistance at a different organization, what is the name of location where you are offering assistance?

Street address of third location where you are offering assistance*

City of location listed above

Zip code of location listed above*

County of location listed above*

Select

Office phone number where someone would call to make appointment*

Phone

Email contact for assistance

Website or booking link to schedule appointment

Are translation services available?*

Yes

If you are offering assistance at a different organization, what is the name of location where you are offering assistance?

Street address of fourth location where you are offering assistance*

City of location listed above*

Zip code of location listed above*

County of location listed above*

Select

Office phone number where someone would call to make appointment*

Phone

Email contact for assistance

Website or booking link to schedule appointment

Are translation services available?*

Yes

If you are offering assistance at a different organization, what is the name of location where you are offering assistance?

Street address of fifth location where offering assistance*

City of location listed above*

Zip code of location listed above*

County of location listed above*

Select

Office phone number where someone would call to make appointment*

Phone

Email contact for assistance

Website or booking link to schedule appointment

Are translation services available?*

Yes

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Note

Location one

Location two

Location three

Location four

Location five