Groups that are new to this Association must complete this entire application.Application and Adoption Agreement for Association Health Plan Employer Group Enrollment • October 24th, 2022
ENROLLMENT (“Agreement”) in the association health plan program provided by Hometown Health Providers Insurance Company, Inc. and Hometown Health Plan, Inc. (collectively referred to as “Hometown Health”) and Builders Association of Northern Nevada Benefit Trust Fund (“Association”) is hereby submitted by the following Employer Group: