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Creating an agent account

If you are an agent who sells Priority Health products, complete these steps to request an online user account. It may take us up to a week to verify your information and give you access.
  • Required fields are indicated by *
  • Field help is available by clicking

Agent information

1. *Enter the Agency Name - the name of the agency you represent.

2. Enter your Priority Health Broker No., if known.
Note: Your Broker Number can be found on your Priority Health commission statement.

3. *Enter the mailing address of the agency in Address Line 1.
Note: This can be a street address or a post office box.

4. Enter any additional address information in Address Line 2.

5. *Enter the City name.

6. *If other than the default of Michigan (MI), select the State from the drop-down list box.

7. *Enter the five-digit Zip Code.
Note: Do not enter the zip code extension.

8. Enter the name of Office Contact/Manager.

User Information

9. *Enter your First Name.

10. *Enter your Last Name.

11. Enter your Job Responsibility or title.

12. *Enter your full E-mail Address, in the following format: yourname@domain.com

13. *Enter your Phone Number in the four fields provided.
Note: Area code should be entered in the first field. An extension is not required.

14. Enter your Fax Phone Number in the four fields provided.
Note: Area code should be entered in the first field.

15. *Enter the User Login Name that you will use to access your account.

  • Usernames must contain 6 to 12 characters.
  • Use letters and numbers only, no special characters or spaces.

16. *Enter the Password that you want to use.

  • Passwords must be 8 or more characters, and contain at least one number and one letter.
  • Passwords are case-sensitive, so note any capital letters you use.

17. *Enter the password a second time in the Password Confirmation field. It must match the first one exactly.

Internet Connection Type

18. Select the appropriate Internet Connection Type:

  • Select Dial-up (telephone modem) if you connect to the Internet through a phone line.
  • Select Broadband (DSL/Cable/T1) if you connect to the Internet through a high-speed connection.
  • Select I don't know if you are unsure what type of Internet connection you have.

Tools

19. Select the online tools you want to use. Several are selected for you by default; you must select at least one tool.

  • Several online Employer tools are available for Agents, but only if the Agent obtains written permission from the Employer.
    Request employer permission to access employer tools. These tools are not included on the User Account Request form.  You can request access later.

Subscription E-mail

20. To receive periodic e-mail newsletters on changes and updates from Priority Health, leave the Subscription E-mail checkbox checked. If you do not want to receive these newsletters, uncheck the checkbox.

21. Click CONTINUE.

The Account Request Security Questions page is displayed.

SECURITY QUESTIONS

22. *Select a question from the Question 1 drop-down box.

23. *Enter the answer to the question in the Answer 1 field.

24. *Enter the answer a second time in the Retype Answer 1 field. The second answer must match the first one exactly.

25. *Repeat Steps 22 - 24 to select two more questions and enter the answers.

26. Click CONTINUE.

The Agent Account Request Terms and Conditions of Use page is displayed.

TERMS AND CONDITIONS OF USE

27. Read the Terms and Conditions of Use page carefully.

  • You must accept the terms and conditions before we can give you access to employee and billing information.
  • If you do not agree to abide by the Terms and Conditions of Use, click I DO NOT AGREE. You will be returned to the priorityhealth.com home page.
  • If you agree to abide by the Terms and Conditions of Use, click I AGREE.

The Account Request Submission Confirmation page is displayed.

ACCOUNT CONFIRMATION

28. Review your account request.

A Priority Health Web administrator may call you to verify information. We will e-mail you when your request for an online account is approved or denied.



Last modified 05/21/08