National Insurance Markets, Inc

www.NIMBroker.com

Providing Agents with Specialty Health & Life since 1961.

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

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	:: Home


	:: Licensing Forms


	:: Applications & Product Forms

	:: Dental Insurance

	:: Disability Insurance

	:: E & O Application

	:: Group Medical Insurance

	:: Individual Medical Insurance

	:: Life Insurance

	:: Senior Medical

	:: Short Term Health Insurance

	:: Student Health Insurance


	:: Training & Certification


	:: Individual Products

	:: Individual Major Medical

	:: Ancillary Health Products

	:: Short Term Health Insurance

	:: Individual Dental

	:: Individual Disability

	:: Student Health Insurance

	:: Senior Medical

	:: 2010 Medicare Part D

	:: Long Term Care/Nursing

	:: Special Risk Health

	:: Travel Insurance


	:: Group Products


	:: Life Insurance


	:: Errors & Omissions

	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
: : Click Here to Send Us an eMail : : Staff List : : Directions

Group Medical Insurance
:: Health Americal/Health Assurance
:: Highmark BC/BS
:: Highmark BlueShield
:: UnitedHealthcare
:: UPMC

Health Americal/Health Assurance

:: Employer Group Application (11-2008)
:: Employee Medical Application (6-2010)

Miscellaneous Forms:

:: Underwriting Guidelines 2-50 EE’s
:: PPO and POS Enrollment Add-on and Change Form (7-2007)
:: 51+ Employee Group RFP Form (pdf)

Links:

:: Goto Agent Licensing
:: Goto the Group Medical Benefit Summaries

:: Top

Highmark BC/BS

New Group Enrollment Forms (HHIC):

:: HHIC Small Group Business Application (7-2010)
:: HHIC Enrollment Change Waiver Form (7-2010)
:: Small Group HRA Setup Options (3-2010)
:: Group Submission Aide
:: Fax Routing Instructions (5-2010)
:: Fax Routing Sheet (5-2010)

Miscellaneous Forms:

:: Admin and Billing Guide
:: HBCBS 51+ Group Census Form (xls)
:: HBCBS 51+ Groups Rate Request From (doc)
:: HBCBS Agent of Record Letter (doc)
:: HBCBS Group Enrollment Activity Report
:: HBCBS Group Termination Request Form
:: MANP (Manufacturers&rsquo: Association) Application
:: HHIC Small Group Underwriting Guidelines (7-2010)
:: Student Dependent Certification
:: HHIC New Business Submission Guide with Sold Group Checklist (WPA)

Links:

:: Goto Agent Licensing
:: Goto the Group Medical Plan Benefit Summaries

:: Top

Highmark BlueShield

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

Miscellaneous Forms:

:: HBS 51+ EE RFP Form (doc)
:: HBS Member Change Form
:: Revised Underwriting and Enrollment Guidelines (doc)

Links:

:: Goto Agent Licensing
:: Goto the Group Medical Plan Benefit Summaries

:: Top

UnitedHealthcare

:: Employer Form HelpSheet
:: UHC Employer Application 2-99 Employee Group
:: UHC Group Checklist 2-50 Employees
:: UHC Employee Application 2-19 Employee Group
:: UHC Employee Application 20-99 Employee Group

Links:

:: Goto Agent Licensing
:: Goto the Group Medical Benefit Summaries

:: Top

UPMC

:: UPMC - BOR Authorization Form
:: UPMC Enrollment Commitment Form (doc)
:: UPMC Medical Questionnaire Checklist
:: UPMC Employee Application (6-2010)

Miscellaneous Forms:

:: UPMC Agent of Record Letter (doc)
:: UPMC Employee Termination Form
:: UPMC FT Student Verification Form)
:: UPMC HSA Application (doc)
:: UPMC Non-Medical Add-on and Change Form
:: UPMC EMap Membership Form (5-2010)
:: UPMC MBA Membership Form (5-2010)
:: UPMC Group Cancelation Form (5-2010)
:: UPMC HRA Setup Document (5-2010)

Links:

:: Goto Agent Licensing
:: Goto the Group Medical Benefit Summaries

:: Top

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