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Click Here to fill and submit PIC Producer Appointment Application 

or fill out the form below with the following information : 

1. Name (as it appears on your insurance license). 

 

2. National Producer Number (NPN).

 

3. Social Security Number (If contracting with Molina Healthcare). 

 

4. Specify which states you want to get appointed in:

           TX, FL, CA, SC, LA, MS, TN. 

 

5. Specify which companies you want to get appointed with:

           Molina, Ambetter, BCBS, OSCAR, Humana

           Wellcare, Cigna, Aetna, UnitedHealth.