Empower Brokerage Retail Opportunities

    Sign-Up Instructions

    Please complete steps 1-4 to register for a retail opportunity. To finalize your submission, you must click SUBMIT during STEP 4.
    You must also complete and fax the necessary deposit authorization, if applicable, to (817) 410-5999.
    Agents without a deposit on file, and who choose an opportunity that requires one, will not have the opportunity to bid on locations each summer, prior to MAPD Sales Season. When bidding is over, the agent will not be able to participate in the current year opportunities.

    IT IS IMPORTANT TO REGISTER AND SUBMIT YOUR DEPOSIT EARLY, TO ENSURE THE ABILITY TO OBTAIN A LOCATION.

    • STEP 1 - Agent Information
    • STEP 2 - Select Opportunities
    • STEP 3 - Select Locations
    • STEP 4 - Acknowledge & SUBMIT


    1 - Agent Information
    Sales Agent Name
    Agent Email
    Agent Phone
    National Producer #
    Contracted with Empower Brokerage?
    2 - Select Opportunities

    Walmart KioskCVS KioskBothOther

    Walmart Program Information
    The Walmart Retail Program spans MA and ACA selling seasons. The program requires a $500 up-front refundable deposit, per store, before any store bidding will occur. Download the PDF credit card authorization form HERE.

     

    CVS/Silverscript Program Information
    Silverscript Part D is a stand-alone PDP through CVS Caremark

     

    Other Programs
    Other retail opportunities include the Aetna store program, operating in stores such as Rite-Aid, Walgreens, Safeway, Kroger, Albertsons, and more. It is like the Walmart and CVS programs, but is sponsored by Aetna.

    3 - Select Locations

    List 3 locations you will accept, beginning with your most desired, followed by your second and third choice.

    Walmart Kiosks
    1st Choice Store # (if known)
    Street Address
    City
    State
    Zip
    2nd Choice Store # (if known)
    Street Address
    City
    State
    Zip
    3rd Choice Store # (if known)
    Street Address
    City
    State
    Zip
    CVS Kiosks
    1st Choice Street Address
    City
    State
    Zip
    2nd Choice Street Address
    City
    State
    Zip
    3rd Choice Street Address
    City
    State
    Zip
    Other
    1st Choice Street Address
    City
    State
    Zip
    2nd Choice Street Address
    City
    State
    Zip
    3rd Choice Street Address
    City
    State
    Zip

    4 - Acknowledge & SUBMIT

    Please verify that all the information you have entered is correct.
    Then click the Submit button to send us your registration.

    By submitting this registration you agree that you will:
    Fax the completed credit card authorization to (817) 410-5999, and
    Get contracted, through Empower Brokerage, for at least 3 of the primary MA and PD carriers for your area, within 72 hours.
    The only exceptions will allowed in areas that have one or two total MAPD plans available.

    Walmart Kiosk Participants must pay a $500 Deposit via THIS FORM, before stores can be granted.

     

    Deposit Form

     

    Credit Card Deposit Form
    ***Payment Options Are Available***
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