This is an agreement between a broker and a healthcare company for brokerage
services. The broker is engaged to solicit applications for the healthcare company’s
services. In addition, the agreement provides that the broker will receive a commission
fee for any new clients the healthcare company receives due to the broker’s reference.
This document should be used by healthcare companies or other entities that want to
hire a broker to market and solicit new clients to the company.
PROSPECTIVE CLIENT BROKER AGREEMENT - HEALTHCARE
This Prospective Healthcare Company Broker Agreement (“Agreement”) is made and entered
into this _______________ [Instructions: insert date] by _______________ [Instructions:
insert name of Healthcare Company], (hereinafter “Healthcare Company”), located at
_______________ [Instructions: insert location] and _______________ [Instructions: insert
name of Broker] located at _______________ [Instructions: insert location] (hereinafter
“Broker”).
Recitals
WHEREAS both parties have the legal capacity to enter into this Agreement; and
WHEREAS Healthcare Company is a _______________ [Instructions: insert state] licensed
healthcare company that provides health care service plans to _______________ [Instructions:
Specify persons or groups that can obtain the plans. For example, employer groups
covering their employees and/or dependents, and individuals];
WHEREAS Broker has the requisite licenses and/or permits from the applicable governing
authorities to sell policies offered by Healthcare Company in the State of _______________
[Instructions: insert state]; and
WHEREAS Broker desires to enter into a relationship with Healthcare Company to solicit
applications for the policies offered by Healthcare Company in the State of _______________
[Instructions: insert state] and Broker wishes to accept such arrangement and in so doing earn
commission income.
Agreement
NOW, THEREFORE, Healthcare Company and Broker Agree as follows:
1. The above recitals are true and correct and form an integral part of this Agreement.
2. Responsibilities of Broker: The responsibilities of Broker are as follows:
A. Broker shall solicit applications for Healthcare Company’s health care services.
B. Broker shall perform his tasks under this Agreement in a diligent and appropriate manner
consistent with all applicable laws. Broker’s agents and employees shall also perform
their duties hereunder in the same manner and in compliance with all applicable laws and
this Agreement.
C. Broker shall not act as a broker for any other health care services company.
D. Limitations. Broker shall not have any additional authority, except that which is explicitly
set forth in this Agreement. The Broker and agents of Broker may only seek applications
in the following area: _______________ [Instructions: insert location].
E. Broker agrees to only quote rates that are approved by Healthcare Company.
F. Broker agrees to submit to Healthcare Company all applications for coverage within
_______________ [Instructions: insert number] days of receiving the application.
G. Broker is fully responsible for the actions of any agents of Broker. Broker shall make
sure that Broker’s agents comply with this Agreement and all governing laws.
H. In compliance with all applicable standards of recordkeeping, Broker shall keep complete
records of all applications and transactions pertaining to this Agreement. Broker must
treat these records as confidential.
I. _______________ [Instructions: set forth in detail responsibilities of Broker]
3. Healthcare Company’s Responsibilities: The responsibilities of Healthcare Company are as
follows:
A. _______________ [Instructions: set forth in detail the responsibilities of Healthcare
Company]
4. Commission: Healthcare Company will pay to Broker referral fees for _______________
[Instructions: insert qualification for paying commission]. The following commission
structure will apply:
A. Healthcare Company shall pay Broker a commission of _______________%
[Instructions: Insert percentage number] of the amount Healthcare Company receives
from a client referred by Broker.
B. A commission will be “earned” once the client’s payment is received by Healthcare
Company.
C. On a _______________ [monthly] [Instructions: Insert relevant timeframe] basis,
Healthcare Company will provide an accounting to Broker. Within _______________
[Instructions: Insert number of days] days of the end of each month.
D. Healthcare Company shall compensate Broker for the entire life of the relevant client
account with Healthcare Company, unless this Agreement is earlier terminated.
[Comment: User should edit the commission structure to reflect the specific agreement of
the parties]
5. Independent Contractor Status: Broker expressly acknowledges that Broker will be acting as
an independent contractor and not as an employee, for all purposes, including payment of
Social Security withholding tax and all other federal, state and local taxes. The Broker shall
be free to set its own hours and appointments. Broker shall not hold himself out to the public
as an employee, agent, partner or representative of Company.
6. Exclusivity: The appointment of Broker hereunder is _______________ [Instructions:
insert either “exclusive” or “non-exclusive”] [Comment: User should choose either to
© Copyright 2012 Docstoc Inc. 3
form an exclusive or non-exclusive relationship with the Broker. If User creates a non-
exclusive agreement, then user should also state “Healthcare Company, in Healthcare
Company’s sole discretion, is free to enter into similar agreements with other parties. In
this situation, Broker shall not be entitled to any compensation if a purchaser enters
into an agreement with Healthcare Company through the efforts of other brokers,
firms, or persons.”]
7. Separability and Governing Law: If any portion of this Agreement shall be found to be void
or unenforceable, it shall in no way affect the validity or enforceability of any other portion
hereof. This Agreement shall be interpreted according to the laws of the State of
_______________________ [Instructions: Insert state].
8. Power of acceptance: It is understood that this agreement is only authority to solicit offers,
and that such offers are to be submitted to the Healthcare Company for its approval and
acceptance.
9. Term and Termination: The term of the Agreement shall be for ____ [one (1)]. [Comment:
These numbers are not provided for by law, but can be any number the user chooses]
year and shall automatically renew unless terminated by either party. Either party may
terminate this Agreement at any time without cause upon thirty-day written notice to the
other party.
10. Time of essence: Time is declared to be of the essence of this agreement.
This agreement has been executed by the parties on the day and year first above written.
Broker: ________________________
By ________________________
Its ________________________
Date ________________________
Healthcare Company: ________________________
By ________________________
Its ________________________
Date ________________________
© Copyright 2012 Docstoc Inc. 4
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