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
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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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HealthAmerica
:: HealthAssurance Group Medical
:: Individual Medical

HealthAssurance Group Medical
New Group Enrollment Forms
:: Employer Information Sheet (pdf)
:: PPO (2-50 EE) Employee Application (pdf)
:: HSA, HRA, and POS (2-50 EE) Employee Application (pdf)

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

Individual Medical
:: Individual Medical Application (rev. 01-10)
:: Pre-Existing Condition Exclusion Form
:: Payroll Deduction Form

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Providing Affordable High Quality Health Plans since 1961