Health Insurance Administration, Inc.


Health Insurance Administration, Inc. Service Sets Us Apart!	Call (248) 349-8680 or email us: hiainc@hiainc.org

Name of Business:		Contact Name:
Number of Employees:		email:
Present Plan :		Day Time Phone:
Desired Annual Deductible:		Address:
Coverage Types: (check all that apply)	Health Short Term Disability Long Term Disability Dental Life	City:
		State:
		Zip :
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