Producer Appointment Information and Forms

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Frequently Asked Questions

Contact your Mutual of Omaha representative for more information. Don't have a Mutual of Omaha representative? Use Sales & Service Office Look-Up to find the office nearest you.

Before a Producer can sell, solicit or negotiate DentaBenefits plans, appointment to United Concordia is required. The following documents must be completed in their entirety for appointment:

Producer Information Form
Producer Agreement
W-9 Request for Taxpayer Identification Number And Certificate
New Mexico Certification form (for producers sitused in NM)

Review the Producer Information Form Checklist to ensure accurate form preparation.
Review the Producer Appointment Policy.

(All forms require Adobe Acrobat for download)

Return these documents to your Mutual of Omaha representative. You will be notified by mail when your appointment has been processed.

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