NEW: Broker Material Request Form

For immediate use

2022 Broker Material Request Form

The new and improved Broker Material Request Form for 2022 Medicare materials is now available on the Molina Broker Portal. Please use and bookmark this hyperlink to access it:

Broker Material Request Form

The form is a fillable PDF, so you can type your information directly onto the page. Please use it to order enrollment kits, Benefits-at-a-Glance, Summary of Benefits, and general marketing materials. When completed, please submit it via:

Fax: (866) 891-2422

Email: Broker@MolinaHealthcare.com

Questions? Please contact:

Medicare Broker Services

1-866-440-9788

Agents must be ready to sell, which means certified, contracted, licensed in the applicable states and appointed by Molina Healthcare, Inc. in accordance with state law prior to engaging in the sale of Molina Healthcare products. Any dissemination or distribution of this material is strictly prohibited and may result in corrective action up through termination of your contract with Molina Healthcare, Inc.