For Agents

To ensure the eligibility guidelines, brochures, applications and rates reflect current legislative requirements of the CHAND program, they are no longer available in paper form. Please refer to the links below.

It is the responsibility of the signing agent to ensure an applicant understands the application process and that any errors may affect coverage. Complete written eligibility documentation at the time of application is best. Failure to provide the information may affect ability to qualify for the plan and/or affect preexisting condition waiting period days.

The Lead Carrier staff is able to assist applicants who have submitted incomplete applications up to 30 days after receiving the application. If the application remains incomplete after 30 days, it will be returned as void. A new application will need to be submitted. The CHAND Service Center can assist in determining:

• Type of application to use
• Appropriate effective and signature dates
• Documentation to include with the application

Notices of changes in the CHAND program are communicated to all agents licensed to sell in the state of North Dakota.

If you have questions about completing a CHAND application, please refer to the Eligibility Guidelines or call the CHAND Service Center at 844-363-8457.

Status of Application

Without authorization from the applicant, subscriber or subscriber's authorized representative, an agent will not be provided with information regarding:

• Who is being asked to provide medical information
• Reasons an application was denied or voided
• If a waiting period is in place and/or the circumstances that caused the waiting period
• Whether a plan is active or cancelled for the purpose of updating files

Eligibility Guidelines

Guidelines Handbook
Traditional Brochure
HIPAA Brochure
TAARA Brochure
Standard Supplement Brochure
Basic Supplement Brochure

Applications

Traditional applicants must review the Creditable Coverage Disclosure Notice.
Traditional Application
HIPAA Application
TAARA Application
Supplement Application
Creditable Coverage Disclosure Notice

Forms

Authorized Release Form
Automatic Payment Withdrawal

Referral Fee

$25 per accepted application

Agent Address Change

Contact the North Dakota State Insurance Department at 701-328-2440.