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Forms and Applications

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NHHP-Fed Brochure

Eligibility

Rates

Applicant's Checklist

Applications and Forms

Pre-Qualifying Conditions

Preferred Producer List

Healthcare Provider Network

Benefit Plan Booklets & Schedules

FAQs

Applications & Other Member Forms

NHHP-Fed Application includes: NHHP-Fed Residency Affidavit 06-2010 NHHP-Fed Non-Tobacco User Affidavit 06-2010	2011-04	This is a comprehensive application form which consists of the application with a Residency Affidavit and a Non-Tobacco User Affidavit.
Notice of Privacy Practices	2010-07	NHHP-Fed's Privacy Policy
Applicant’s Checklist	2010-06	Helpful checklist of items needed to complete the application
How to File a Claim	2010-06	Helpful steps for Members on how to file a claim.
Authorization Agreement for Preauthorized Payments	2010-06	Authorization for monthly premiums deductions from bank account
Authorization to Release Protected Health Information	2010-06	Authorization to release information regarding a members policy to another individual
Form W-9	2007-10	Required form for Producers to receive incentive for policy placement

Current Benefit Plan Forms

NHHP-Fed Indemnity A - Schedule	2011-01
NHHP-Fed Indemnity A - Benefit Plan Booklet	2011-01
NHHP-Fed Managed Care A - Schedule	2011-01
NHHP-Fed Managed Care A - Benefit Plan Booklet	2011-01
NHHP-Fed Managed Care B - Schedule	2011-01
NHHP-Fed Managed Care B - Benefit Plan Booklet	2011-01
Maternity Benefit Rider	2011-01
NHHP-Fed Prescription Drug	2011-01

If your policy became effective prior to the date indicated next to the Benefit Plan Forms above, please call Customer Service at 877-505-0508 and they will assist you in obtaining the appropriate document for your coverage.

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Applicants
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Members
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Producers
Become a Producer for NHHP-Fed and receive numerous benefits.

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Healthcare Providers
Learn more about NHHP-Fed and how you can help patients gain access to health insurance.

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