. .
www.NIMBroker.com
powered by National Insurance Markets, Inc
Powered by National Insurance Markets, Inc.
Providing Agents with Specialty Health & Life since 1961.           
.

Questions?

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

:: Submit Your Question
:: Request a Quote
Home Start Licensing Forms Applications & Product Forms Training & Certification Individual Products Senior Products Group Products Life Products Ancillary
Products		 Carrier Links
Search: Results by Google :: Bookmark this Site


Hot Topics

:: HealthCare Reform


:: Home
:: Licensing Forms
:: Applications & Product Forms
:: Ancillary Products
:: Dental Insurance
:: Disability Insurance
:: E & O Application
:: Group Products
:: Individual Medical Insurance
:: Life Insurance
:: Senior Medical
:: Short Term Health Insurance
:: Special Risk Health
:: Student Health Insurance
:: Training & Certification
:: Individual Products
:: Senior Products
:: Group Products
:: Life Insurance
:: Ancillary Products
:: Errors & Omissions
:: Misc Insurance News



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

Group Products

 :: Health Americal/Health Assurance
:: Highmark BC/BS
:: Highmark BlueShield
:: Reliance Standard
:: Time/Assurant Health
:: UnitedHealthcare
:: UPMC

Health Americal/Health Assurance
:: Employer Group Application (04-2012)
:: Employee Medical Application (4-2012)

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):
:: Small Group Business Application (8-2011)
:: Small Group Employee Enrollment Change Waiver Form (8-2011)
:: Sold Group Checklist (8-2011)
Note: The above forms should be used for all groups with July 1, 2011 effective date or beyond as Highmark will begin medically underwriting group cases.

:: Small Group HRA Setup Application (10-2011)
:: Group Submission Aide

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)
:: HHIC 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)
:: Small Group Business Application (8-2011)
:: Small Group Employee Enrollment Change Waiver Form (8-2011)
:: HRA Setup Application Central PA (10-2011)
:: Sold Group Checklist (doc)

Miscellaneous Forms:
:: HBS 51+ EE RFP Form (doc)
:: Revised Underwriting and Enrollment Guidelines (doc)

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


:: Top

Reliance Standard
:: RSLI MGA Standard Employer Application
:: RSLI PA Employee Enrollment Form (new Hires Only)

Miscellaneous Forms:
:: RSLI Beneficiary Form

Links:
:: Goto Agent Licensing
:: Goto the Group Ancillary Product Materials


:: Top

Time/Assurant Health
:: Time Employer Group Application (PA) (9-2007)
:: Time Employee Medical Application (PA) (8-2007)

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


:: Top

UnitedHealthcare
:: Employer Form HelpSheet
:: UHC Group Checklist 2-50 Employees
:: UHC PA Employee Application 2-50 Employee Group (4-2011)
:: UHC PA Employee Application - Employee Group (4-2011)

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


:: Top

UPMC
:: UPMC Enrollment Commitment Form (2-2012)
:: UPMC Medical Questionnaire Checklist
:: UPMC Employee Application (9-2011)
:: UPMC Employer Dental Application (12-2010)
:: UPMC Employee Dental Application (12-2010)

Miscellaneous Forms:
:: UPMC Small Group (20-50) Underwriting Guidelines (2012)
:: 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 (1-2012)
:: UPMC MBA Membership Form (1-2012)
:: UPMC HRA & HIA Group Setup Form (5-2010)
:: UPMC Group Cancelation Form (5-2010)

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


:: Top

The Medicare Frontier
Today’s Fastest Growing Market

:: Senior Product Home
:: Senior Product Materials
:: Applications & Forms
:: Training & Certification
:: Licensing Forms
:: Request a Plan Comparison


Search: Results by Google
:: Staff List :: Quotes :: Directions :: Contact Us :: About Us :: Privacy Policy
© National Insurance Markets 1999 - 2012