E123: OPERATIONAL · Updated Mar 2, 2026 at 11:41 AM CST

Agent Support & Tools

Health insurance agent support tools, system status, and E123 outage reporting — all in one place.

Monday – Friday : 7:00 AM – 7:00 PM CST

Agent Support: Submit a Request

Your Name(Required)

First Last

Your Email Address(Required)

Please enter email address you want Agent Support to respond to.

Agency(Required)

Support Request Type(Required)

This is for member related requests.

Use this for payments after the first payment as been made

PLEASE DO NOT ADD CREDIT CARD INFORMATION HERE

All credit card information should be entered into E123

Member ID(Required)

Member Name(Required)

Member Date of Birth(Required)

New Address(Required)

Street Address Address Line 2 City State Zip Code

New Phone Number(Required)

New Email Address(Required)

Old Name to Change(Required)

New Name(Required)

Name of Person to Change DOB(Required)

New Date of Birth(Required)

Name of New Dependent 1(Required)

First Last

Dependent 1 Relation to Insured(Required)

Dependent 1 Date of Birth(Required)

Dependent 1 Gender(Required)

Name of New Dependent 2

First Last

Dependent 2 Relation to Insured

New Dependent 2 Date of Birth

New Dependent 2 Gender

Name of Dependent(s) to Remove(Required)

Click the + sign to add more than 1 dependent

Cancel All Products?(Required)

Yes

Name of Product(s) to Cancel(Required)

Click the + arrow to add more products

Reason for Cancellation(Required)

Please describe requested changes(Required)

E-Signature Purpose(Required)

Is this for all products?(Required)

Yes

Name of Product(s)(Required)

Click the + arrow to add more products

New Requested Active Date(Required)

Request Type(Required)

Payment Request(Required)

Image Upload

Max. file size: 10 MB.

Please provide any relevant screenshot related to plan change request.

Desired Monthly Billing Date(Required)

Desired Post Date(Required)

Post Date Requested Date(Required)

Payment comments / Requests(Required)

Error Description and Fix(Required)

File Upload

Drop files here or

Max. file size: 10 MB.

Include any additional files or images that are helpful to complete your request.

Comments

Agent Support & Tools

Agent Support: Submit a Request

Report E123 Outage