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!
Get Adobe Acrobat
To view the form(s), you will need Acrobat Reader.
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 Legal Services Plan Enrollment Form
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