Applications
The ".pdf " files are for you to download, Print, fill out and mail in to our office for processing. You will need to have Adobe Acrobat Reader®  Adobe Acrobat Reader installed on your computer.
          Application Instructions          
Contact Information :
Walter Palmer - (612) 825-4990
Toll-Free - 1 (877) 825-4990
Cell - (612) 559-0961
FAX: (612) 825-9126
wpalmer@healthinsurancemn.com
state of minnesota Member of the
Minnesota
Minnesota Better Business Bureau
For Minnesota residents only
        See our Privacy Statement        
Thank-you for visiting the healthinsurancemn.com Website and we hope that you found the information you needed. Feel free to contact me during normal business hours. I will be happy to assist you if you have any questions or if you prefer to have any Quotes or Applications mailed to you.
Electronic Submittal Applications Available Electronic Applications
  Group Applications
 Small Group Employee Enrollment App  VIEW 
( small_group_employee.pdf )  301 Kb
 Small Group Employer Reform Application my favorite  VIEW 
( small_employer_reform.pdf )  232 Kb
  NON-Group Applications
 Insta-CareSM my favorite  VIEW 
( instacare.pdf )  471 Kb
 Aware CareSM Options Blue my favorite  VIEW 
( awarecare_optionsblue.pdf )  310 Kb   Additional Page
 SelectAccount HSA Custodial Application  VIEW 
( F7315-R5.pdf )  459 Kb
 Pay-O-Matic HSA Custodial Application  VIEW 
( F1915-R26.pdf )  139 Kb
 Simply BlueSM my favorite  VIEW 
( simply_blue.pdf )  269 Kb
  Medicare Applications / Forms
 MedicareBlue Rx my favorite  VIEW 
( medicare_blue_rx.pdf )  177 Kb
 MedicareBlue PPO my favorite  VIEW 
( medicare_blue_ppo.pdf )  179 Kb
 Medicare Advantage Enrollment my favorite  VIEW 
( med_adv_ind_enroll.pdf )  184 Kb
 Medicare Prescription Drug Enrollment my favorite  VIEW 
( med_pres_drug_ind_enrol.pdf )  174 Kb
 Medicare Supplement/Medicare Select my favorite  VIEW 
( med_sup.pdf )  367 Kb
  Dental Applications
 Dental Medicare Supplement/Select Members my favorite  VIEW 
( med_sup_dental.pdf )  208 Kb
 Dental for Aware Care Members Application my favorite  VIEW 
( aware_dental_app.pdf )  338 Kb
 Dental for OptionsBlue Members Application my favorite  VIEW 
( optionsblue_dental.pdf )  345 Kb
 Dental for SimplyBlue Members Application my favorite  VIEW 
( simplyblue_dental_app.pdf )  263 Kb
  Extra Insurance Applications
 Disability Insurance custom application from Illinois Mutual  VIEW 
( Illinois Mutual Secure Download )  239.2 Kb
  Authorization Form
 Authorization for Release of Information custom application  VIEW 
( release.pdf )  88 Kb
  Other Forms
 Group Employee Information Quote Form custom application  VIEW 
( group_quote_form.pdf )  73 Kb