For Information on our Plans, to Request a Complete Brochure or to Speak with One of Our Customer Service Representatives Please Call:

1-800-604-6113

Monday through Friday

8:30 a.m. to 5:00 p.m. EST

They can answer any questions you may have and some applications can even be taken over the phone!

To send us an email or request a phone call back, please click on the "CONTACT" button above and send us a message.

We would love to hear from you!

 

 

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Application Forms for NPMHU Members

Please click on a plan below, print out an application and mail it in!

Before completing an application, be sure to review the plan information for eligibility, options, and a complete description of the coverage.

Group Long Term Disability Insurance Plan Application

Group Short Term Disability Insurance Plan Application

Group Term Life Insurance Plan Application

Group Accidental Death & Dismemberment Insurance Plan Application