ACA Consent

Andrew B Consent Form

Ashley T Consent Form

Kammy M Consent Form

Laura B Consent Form

Matt P Consent Form

MB and ALL Agents Consent Form

Way to get AOR


Yes, we will have a similar process in place as Aetna. The member can send an AOR change request to:  

Please advise the member to provide a written summary of the AOR change request, 3 HIPAA identifiers, and ensure that the email being sent is from their address listed on the enrollment file.

Hippa identifiers could be NAME, DOB, and last 4 of Social to make it easy or:

HIPAA Identifiers

  • Member’s Ambetter ID Number (U# or R#)
  • Member’s First and Last Name
  • Member’s Date of Birth
  • Member’s Full Home Address (including city, state & zip code)
  • Member’s Email Address
  • Member’s Phone Number
  • Member’s Last 4 of Social Security Number


Members are able to request a change. To request the change, the member will need to send an email to:

The member needs to include the following details:

  • Member’s first and last name
  • Home address
  • Phone number
  • Member ID
  • State if they want either to:
  • Add a new broker
  • Replace their existing broker
  • Remove their existing broker

We will validate the member’s email address against the one on file and we will not accept an email from the broker.

Also, broker changes will be accepted throughout open enrollment with the proper authorization from the client until the lock date. The date that was locked for 2024 OE was 12/31. If the date changes for the upcoming 2025 open enrollment, that date would be communicated.