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With over 8 Million Dollars in new Health Premiums in 2006
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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 Shield

 :: Individual Medical
:: Group Medical
:: Short Term Medical
:: Senior Products

Individual Medical

 Application Forms
:: HBS DirectBlue Application (revised 10-06) (pdf)
:: HBS PPOBlue Application (revised 10-06) (pdf)
Individual Medical Plan Brochures
:: Click here for Plan Brochures
Online Application Process
:: Medically Underwritten Online Application Instructions (doc)

:: Sept. Producer News Bill Me Later - Online App.doc
Miscellaneous Forms
:: HBS Producer Manual Rev. 09-2009 (pdf)
:: HBS, DirectBlue and PPOBlue Replacement Form (pdf)
:: Individual Products non-medical change form (pdf)
:: HBS MedicalRecords Fax CoverSheet (doc)
:: HBS DirectBlue Producer Manual (pdf)
:: HBS Pay It Easy EFT Form (pdf)

:: HIPAA Statement (pdf)
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Group Medical

 New Group Enrollment Forms
:: HBS Agent of Record Letter (doc)
:: HBS Employee Enrollment Form (pdf)
:: HBS Employee Waiver Form (pdf)
:: HBS Employer Application (pdf)
:: Sold Group Checklist (doc)

Miscellaneous Forms
:: HBS 51+ EE RFP Form (doc)
:: HBS Member Change Form (pdf)
:: Revised Underwriting and Enrollment Guidelines (doc)
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Short Term Medical

 Application Forms
:: HBS Short Term Blue Application (pdf)

Miscellaneous Forms
:: HBS Short Term Blue Application Instructions (pdf)
:: HBS Short Term Blue Drug Claim Form (pdf)
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Senior Products

 Northeastern and Central PA Only
:: Highmark Broker/Agent Enrollment Addendum
:: Highmark Other Ins. Enrollment Addendum
:: Highmark Scope of Appointment
:: BlueRx Application

Northeastern PA Only
:: FreedomBlue PFFS Application
:: FreedomBlue PPO Application

Central PA Only
:: FreedomBlue PFFS Application
:: FreedomBlue PPO Application

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