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Appointment Instructions – please read carefully

Important Notice:

Broker Appointment Policy: Please ensure all required documentation is complete, legible and signed. If any required information is missing, incomplete or illegible, your request will be rejected and you will be required to resubmit the application in its entirety.

Broker Appointment Changes: Email broker appointment changes to The Broker Appointment Form link below should be used for new appointments only.

Appointment Requirements

Items below are required to complete the appointment application:

1. Virginia Life and Health License (required)
2. Agency License (if applicable)
3. Optima Health Substitute W9 (SF-W9) Form ***SEE NOTE BELOW
4. Broker Agreement (includes Business Associate and QHP Amendments)
5. Portal User Profile (access to secure Broker Portal)
6. We require all new agents to work with a General Agency. By completing this form, you will be assigned to work with GarityAdvantage Agency. PLEASE SEE NOTE BELOW REGARDING WHAT TO FILL OUT ON APPOINTMENT FORM

Before you begin this process, there are two important items to note about the appointment form:

  1. First, near the top of the form, Optima asks the following question: “Are you currently working with an Optima Health General Agency”
Are you currently2

Then please complete the next four answers with ‘GarityAdvantage’, BLANK, ‘Victoria Bailey’,vbailey@garityadvantage.comas shown below:

Agency Name
  1. The Second question that needs an explanationis found in the ‘Attach Required Documents’ section.  
Attached Required Documents

Here you will find a request to attach your W-9 form.

This is not necessary to complete for agents requesting Medicare contracting BUT you still need to upload something to allow you to proceed in the process. Optima recommends downloading the SF-W9 form and simply re-upload the unfilled/blank file to their system. 

Get Appointment

Click the button below to access the Optima Medicare Appointment form. By starting your application, you acknowledge that you have read and agree to the above requirements.

If you have any difficulties with the application once you receive it, please contact us for support – 800-234-9488 or

Thank you for requesting Optima Medicare contracting