National Insurance Markets, Inc

www.NIMBroker.com

With over 8 Million Dollars in new Health Premiums in 2006

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1-800-235-2013
(9-5 EST M-F)

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	:: E & O Application

	:: Fidelity Security Life

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	:: Individual Major Medical

	:: Ancillary Health Products

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	:: Individual Dental and Disability

	:: Student Health Insurance

	:: Senior Products

	:: 2010 Medicare Part D

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	:: Group Medical Insurance

	:: Group Life, Dental, Disability & Vision

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	Contact Us
915 Saxonburg Blvd, Suite 217 Pittsburgh, PA 15223 Telephone: (412)782-1979 Toll Free: (800)235-2013 Fax: (412)782-2868 eMail: info@nimbroker.com
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Highmark Blue Cross / Blue Shield
:: Individual Medical
:: Group Medical
:: Short Term Medical
:: Senior Products

Individual Medical
Application Forms
:: CompleteCare Application (revised 1-09)
:: DirectBlue Application (revised 1-09)
:: KeystoneBlue HMO Application (revised 1-09)
:: PPOBlue HDHP Application (revised 6-06)

Individual Medical Plan Brochures

:: Click here for Individual Medical Plan Brochures

Online Application Process

:: On-line Application Instructions (doc)

:: Producer News - Electronic Submission Mandatory 1/1/08 (pdf)

Miscellaneous Forms

:: HBCBS Producer Manual Rev. 09-2009 (pdf)
:: CompleteCare, DirectBlue and PPOBlue Replacement Form
:: Individual Products non-medical change form
:: HBCBS MedicalRecords Fax CoverSheet (doc)

:: KeystoneBlue Replacement Form

:: HIPAA Statement

:: Pay it Easy EFT Form (revised 9-05)

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Group Medical
New Group Enrollment Forms
:: Small Group Employer Application Rev. 11-2009 (pdf)
:: Small Group HRA Setup Options (pdf)
:: PPOBlue Employee Application (pdf)
:: POS-HMO Employee Application (pdf)
:: HBCBS Employee Waiver Form (pdf)
:: Group Submission Aide (pdf)
:: HBCBS Group Transmittal Form (pdf)

Miscellaneous Forms
:: Admin and Billing Guide (pdf)
:: HBCBS 51+ Group Census Form (xls)
:: HBCBS 51+ Groups Rate Request From (doc)
:: HBCBS Agent of Record Letter (doc)
:: HBCBS Group Enrollment Activity Report (pdf)
:: HBCBS Group Member Change Form (pdf)
:: HBCBS Group Termination Request Form (pdf)
:: MANP (Manufacturers' Association) Application (pdf)
:: Small Group Underwriting Guidelines (pdf)
:: Student Dependent Certification (pdf)

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Short Term Medical
Application Forms
:: HBCBS ShortTermBlue Application (pdf)
:: HBCBS ShortTermBlue Producer Certificate - required with every application (pdf)

Miscellaneous Forms
:: HBCBS Short Term Blue Application Instructions (pdf)
:: HBCBS Short Term Blue Drug Claim Form (pdf)

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Senior Products
Western PA Only
:: FreedomBlue PFFS Applicaton
:: FreedomBlue PPO Application
:: BlueRx Application
:: Highmark Broker/Agent Enrollment Addendum
:: Highmark Other Ins. Enrollment Addendum
:: Highmark Scope of Appointment

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Providing Affordable High Quality Health Plans since 1961