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Powered by National Insurance Markets, Inc.
Providing Agents with Specialty Health & Life since 1961.           
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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
Fax: (412)782-2868
eMail: info@nimbroker.com
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Individual Medical Insurance

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

Health AmericalOne

:: Individual Medical Application (2-2010)
:: Pre-Existing Condition Exclusion Form (10-2009)
:: Payroll Deduction Form (7-2008)

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


:: Top

Highmark BC/BS

:: CompleteCare Application (revised 1-2009)
:: DirectBlue Application (revised 1-2009)
:: KeystoneBlue HMO Application (revised 1-2009)
:: PPOBlue HDHP Application (revised 6-2006)

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

Miscellaneous Forms:
:: HBCBS Producer Manual Rev. (9-2009)
:: 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 (9-2005)

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


:: Top

Highmark BlueShield

:: DirectBlue Application (9-2010)
:: PPOBlue HDHP Application (8-2010)

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

Miscellaneous Forms:
:: HBS Producer Manual Rev. (9-2009)
:: HBS, DirectBlue and PPOBlue Replacement Form (pdf)
:: Individual Products non-medical change form
:: HBS MedicalRecords Fax CoverSheet (doc)
:: HBS DirectBlue Producer Manual
:: HBS Pay It Easy EFT Form
:: HIPAA Statement

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


:: Top

IAC (Insurers Admin Corp.)

:: Individual Medical Application (4-2010)

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


:: Top

Time Insurance (Fortis/Assurant)

:: PA Individual Medical Application
:: 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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