ENROLLMENT FORM

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TO ENROLL YOU MUST DO THE FOLLOWING

AGREE ON THE FEES THAT YOU WILL BE CHARGED (CLICK HERE)
UNDERSTAND HOW THE PROGRAM WORKS (CLICK HERE)
COMPLETE THE ENROLLMENT FORM
1. CLICK HERE TO ENROLL ON LINE (NO CHARGE)
  Note: In this form you will be asked to enter who referred you to NHAC, if you are not sure for a list of referral sources.
2. TO FAX OR MAIL THE ENROLLMENT FORM, PLEASE COMPLETE AND PRINT THIS PDF FORM AND MAIL IT WITH A $25 CHECK ISSUED TO NOVA MEDICAL SOLUTIONS, INC. (An independent processing service) at 3131 S. Anita Ave, Suite 104, El Monte, Ca. 91733. NOVA will enter your application in our website on your behalf.

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On purchase of health care by paying with pre-tax dollars!

A Cafeteria Plan established with the assistance of GMA allows you to pay for health and child care with pre-tax wages. How? By allowing you to pay for certain benefits such as:

1. Employee contribution toward group or individual medical insurance premiums.

2. Amounts for medical expenses that are not covered by your other insurance (such as deductibles or co-payments).

3. Day care for a dependent child, disabled spouse or dependent parent.

The GMA program is intended to assist an employer in establishing a Cafeteria Plan that qualifies under Section 125 of the Internal Revenue Code. Tell your employer about this no cost program. It can only benefit the employer and employee.

Insurance Services Available

Now through GMA’ licensed professional insurance brokers, you can purchase all the insurance that you need. From health to auto or any other! Just send us a feed back form and someone will contact you.