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Contact us at National Insurance Markets, Inc. Contact Us
915 Saxonburg Blvd, Suite 217
Pittsburgh, PA 15223

Telephone: (412)782-1979
Toll Free: (800)235-2013
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Individual Medical Insurance

:: Health AmericalOne
:: Highmark BC/BS
:: Highmark BlueShield
:: IAC (Insurers Admin Corp.)
:: Time Insurance (Fortis/Assurant)
:: UPMC

Health AmericalOne

:: Individual Medical Application (5-2011)
:: Pre-Existing Condition Exclusion Form (10-2009)
:: Payroll Deduction Form (7-2008)

Links:
:: Goto Agent Licensing
:: Goto the Individual Medical Product Summaries


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Highmark BC/BS

:: Combined Individual Medical Application (12-2011)

Online Application Process:
:: On-line Application Instructions (doc)
:: Producer News - Electronic Submission Mandatory (1-2008)

Miscellaneous Forms:
:: PHI Medical Records Release Form
:: HBCBS Producer Manual Rev. (9-2009)
:: HBCBS Individual Plan Change Form (1-2012)
:: HBCBS MedicalRecords Fax CoverSheet (doc)
:: HIPAA Statement
:: Pay it Easy EFT Form (9-2005)

Links:
:: Goto Agent Licensing
:: Goto the Individual Medical Plan Brochures


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Highmark BlueShield

:: Combined Individual Medical Application (12-2011)

Online Application Process:
:: Medically Underwritten Online Application Instructions (doc)
:: Sept. Producer News Bill Me Later - Online App (doc)

Miscellaneous Forms:
:: PHI Medical Records Release Form
:: HBS Producer Manual Rev. (9-2009)
:: HBS MedicalRecords Fax CoverSheet (doc)
:: HBS Individual Plan Change Form (1-2012)
:: HBS Pay It Easy EFT Form
:: HIPAA Statement

Links:
:: Goto Agent Licensing
:: Goto the Individual Medical Plan Brochures


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IAC (Insurers Admin Corp.)

:: Individual Medical Application (4-2010)

Links:
:: Goto Agent Licensing
:: Goto the Individual Medical Product Summaries


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Time Insurance (Fortis/Assurant)

:: PA Individual Medical Application (9-2011)
:: PA HIPAA Authorization
:: Check-o-matic Form
:: PA Replacement Form
:: Preferred Rating Questionnaire
:: Underwriting Authorization Form

Links:
:: Goto Agent Licensing
:: Goto the Individual Medical Product Summaries


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UPMC

:: UPMC Individual Advantage Application (1-2012)


Links:
:: Goto Agent Licensing
:: Goto the Individual Medical Product Summaries


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The Medicare Frontier
Today’s Fastest Growing Market

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