Apply to become a BenefitX affiliate

5 minutes. Same-day approval. After this form, Stripe verifies your identity and your bank info. Then you can start sharing your link.

Contact information

First Name *

Last Name *

Email *

We'll send your dashboard link and payout notifications here.

Phone *

Shown on the marketplace landing pages of employers you refer.

Calendar / booking link (optional)

Calendly, Google Calendar, KAPOW booking page, or any direct booking URL. If a marketplace later displays you as the AOR, the "Book a call" button points here. Add or change this any time from your dashboard.

Licensure

You don't need an insurance license to refer employers and earn SaaS commissions. We ask the question below so we know whether to route you for an Agent-of-Record handoff if a referred Employer launches a private-branded marketplace. We don't capture license details here; the marketplace vendor will collect those at that point.

Are you currently a licensed insurance producer in any state? *

Yes, I hold an active insurance producer license in one or more states.No, I don't hold an insurance license. I will only earn SaaS referral commissions.

Profile photo (optional)

Headshot

No photo

Optional. Used only if a referred employer launches a marketplace and you end up as the AOR. Max 2 MB. PNG, JPG, or WebP. Add or change any time from your dashboard.

Recruiting credit

Upline affiliate email (optional)

If another BenefitX affiliate referred you, enter their email so they get credit. Leave blank if no one referred you.

Vendor

The licensed insurance agency or insurance company that will operate marketplaces for the employers you refer. If you weren't recruited by an existing affiliate, pick one here. AssureCor is the default.

I understand that commissions are paid only on BenefitX SaaS PEPM revenue, NOT on insurance product enrollment. Insurance commissions on individual policies that BenefitX members buy are separate and handled by licensed insurance producers at AssureCor under a separate agreement.I have read and agree to the BenefitX Affiliate Agreement. I understand my role is as an independent contractor and that Stripe will handle 1099 reporting on payouts of $600+ per calendar year. The license information I've provided is true and current; BenefitX may verify it with NIPR and remove my agent-of-record display if the information is inaccurate.

By clicking Submit, you'll be taken to your dashboard. You'll need to complete a short identity + bank verification with Stripe before you can start receiving commission payouts.