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NPMA Private Health Insurance Exchange Census Form

In an attempt to plan for the implementation of the services, benefits, and plan for enrollments on the NPMA private health insurance exchange, we are attempting to determine our members' level of interest of interest in such a program.

The following services will be provided by a third party administrator:
  • Private health exchange
  • CDH reimbursement account (HRA, FSA, and HSAs) administration
  • Enrollment portal and benefit administration
  • Plan design and plan implementation oversight
  • Preparation of plan and trust documents
  • Technical support regarding plan qualification issues
  • Advice regarding legislative changes, their impact on the program and provide recommendations for appropriate modifications
In order to provide these services, we need you to complete the following survey. 

Please note, this is not a contract for service.  If you decide to join the NPMA private exchange, a separate service agreement will be prepared for you by a third party administrator.
1. Part One: Employer Demographics
Legal Organization of the Employer
2. Part Two: Benefit Information *This question is required.
Current Benefits Provided