Get Membership Application - Niagara Health Quality Coalition

Filling out the MEMBERSHIP APPLICATION for the Niagara Health Quality Coalition is an essential step for organizations seeking to gain insights and access valuable resources related to health benefit management. This guide provides a clear and supportive approach to completing the application online, ensuring that all users can navigate the process with confidence.

Follow the steps to successfully complete your membership application.

1. Use the ‘Get Form’ button to access the MEMBERSHIP APPLICATION and open it for editing.
2. Enter the date of application in the designated field at the top of the form.
3. Fill in the company or organization name, then provide the address, including city, state, and zip code.
4. In section A, provide general information regarding your industry, total US workforce, and breakdowns for Western New York and New York State workers, as well as total retirees.
5. List the health plans and vendors your organization currently has contracts with under the appropriate headings (PPOs, HMOs, PBM, etc.).
6. Identify the primary contact for NHQC by filling in their name, title, address, city/state/zip code, telephone, fax, and email in section B.
7. Proceed to section II regarding dues. Calculate and enter the appropriate membership dues based on your organization's category and workforce size, ensuring to tally any discounts if applicable.
8. Make your payment arrangements, ensuring to write the check payable to Niagara Health Quality Coalition and providing the address for mailing.
9. Review the completed application for accuracy before saving your changes. You can then download, print, or share the form as needed.

Complete your MEMBERSHIP APPLICATION online today to join the Niagara Health Quality Coalition and access valuable health benefits resources.