2021-10-17

Broker Registration

Personal Information
Please provide a first name.
Please provide a last name.
Please provide a date of birth.
Please provide a email address.
Please provide a NPN.
Broker Agency Information

Please provide a legal name.
Please select a practice area.
Hold Ctrl or Command (mac) to select multiple

Office Location

Please provide a valid address.
Please select an address kind.
Please provide a valid city.
Please select a state.
Please provide a valid zipcode.

Phone

Please provide a valid area code.
Please provide a valid number.
Add Office Location
I have completed all required CoverME.gov trainings
I have an active license with health authority with the Maine Bureau of Insurance
I have read and agree to the CoverME.gov Broker Agreement