To become an ancillary group producer, complete the online application, which includes the following:
- Agent Request for Appointment
- Agent Agreement/Product Addendum
- W-9 Form
- Investigative/Consumer Report Authorization
We have various agent appointment due diligence rules to comply with individual state department of insurance guidelines. Please see the Agent Appointment Due Diligence Rules for state specific details.
Ancillary insurance products issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148. Blue Cross and Blue Shield of Illinois is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.