National Benefit Advisory Association2

Name:
Address:
City:	State:	Zip:
Phone:	Fax:
Company Name:
E-mail Address:
MESSAGE

Please be specific in the message box so we can reply to your email in a quick and timely manner.
You can also get in touch with us: 1-877-202-7574

Disclosure:
1) This plan is not a health insurance policy.
2) This plan provides discounts at certain healthcare providers for medical services.
3) This plan does not make payments directly to providers of medical services.
4) The plan member is obligated to pay for all healthcare services but will receive a discount from those healthcare providers who have contracted with the discount medical plan organization.
5) National Benefit Advisory Association, the discount medical plan organization, is located at 4704 Highway 377 South, Fort Worth, Texas 76116.