contact us | forms | faq | en espanol  


Get updates, information and surveys, by joining now. You will also receive info on any upcoming trainings to become a certified agent.

name:
(required)
email:
(required)
phone:
address:
city:
state:
zip:
 

Electronic Signatures

Agent/Broker IH Tools:
Rate Quote | Referral Kit | Brochure | Application | W-9 Form

Beginning November 1st, Inclusive Health will begin to accept an Electronic Signature
on the on-line version of the application for coverage. We will no longer require a
wet signature for the individual or the agent signature.

The completed application and the supporting documentation may be faxed to (586) 258-1877 or scanned and emailed to [email protected].
North Carolina Health Insurance Risk Pool, Inc.
Home :: Links & Resources :: En Espanol :: Contact Us :: Doctors/Providers :: Agents/Brokers :: Applicants :: Members :: About Us    
© 2009 Inclusive Health - Federal Option. All Rights Reserved.