Agents Health Alliance by Trusty Health Insurance Agency

Step 1 of 3

Who should we contact?

First name * Last name *

Agency name *

Work email * Phone number *

Agency ZIP code *

Which best describes you? *

I am the agency owner I am authorized to evaluate benefits for the agency

Step 2 of 3

Estimate participation

How many people work at your agency, including you? *

About how many people may want coverage? *

Include employees and family members.

Estimated people by age range

Best estimate only. Do not enter names or health information.

I’m not sure about the age ranges yet

What matters most? *

Lower monthly cost Broader coverage and provider access A balance of both Not sure yet

Step 3 of 3

Confirm your agency

How should we contact you? *

Phone means direct follow-up only, not automated texts.

Email Phone Either

Count my agency and contact me for the secure census. I understand this is interest only, not insurance, enrollment, an application, or a quote. I will keep current coverage until replacement coverage is confirmed in writing.

By submitting, you agree that the Alliance team may use this information to contact you about next steps. Do not submit health information.

Interest only. No quote, enrollment, or coverage commitment.

Make sure your agency is counted.

Count your agency in.

Thank you for letting us know.

Who should we contact?

Estimate participation

Confirm your agency

Your Agency Is Counted

A simple first step before the secure census.

We count interested agencies

We send a secure census

We share next steps

Before you submit

Know another State Farm agent?