HERE ARE FORMS THAT YOU MAY NEED, PLEASE COPY AND PASTE ANY FORM IN A WORD DOCUMENT AND PRINT AS NEEDED
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MEMBERS FORMS
MEM01 A ADDITIONAL FORMS FOR HEALTH INSURANCE
MEM05 NHAC MEMBER REFERRAL FORM
MEM08 NHAC REFERRAL SOURCE ENROLLMENT FORM
PROVIDER FORMS
PRO1 PROVIDER AUTHORIZATION REQUEST
PR02 PROVIDER AUTHORIZATION CREDIT REQUEST
PR11 TRANSMITTAL AND ORDER REQUEST FORM
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On purchase of health care by paying with pre-tax dollars!
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. 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.
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CONTACT INFORMATION:
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