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Home > Clear Spring Health Form
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Clear Spring Health Form



Contracting Invitation Request Form


FAQ

  1. Contracting is only available through the Clear Spring platform (invitation link)
  2. Agent must complete training before the carrier will start background review
  3. Training consists of (AHIP) and CSH Product Certification


New Agent Information
NPN *
First Name *
Last Name *
Phone Number *
ZIP / Postal Code *
E-Mail Address *
Will agent be contracting their corporation? *
If NO then just enter NA in the NPN and Agency Email fields
If YES - the following two fields are mandatory
NPN *
Agency Email (must be different from above email address) *
Commission Level




Products


Note: If BOTH - you will receive two separate contracting links
Is this agent/agency currently contracted with Clear Spring Health for Medicare Advantage (MA)?


Notes
Please direct any questions to: admin@brightstarins.com
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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Contact us 5850 Canoga Ave
Suite 400
Woodland Hills, CA 91367
Phone: 855-909-STAR (7827)
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