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Register as a Broker Agreement

Please provide the following information

A senior official in each office of your brokerage organization must sign a Confidentiality and Limited Access Agreement confirming that the information in NJM Insurance Group's claims database will be used for appropriate business purposes only. Private medical information may not be distributed outside your control, not even to your own employees unless they have a direct business-related need to know.

You will be permitted to view only active accounts for which you are recognized as the broker of record.

A signed Confidentiality and Limited Access Agreement for each office is required. However, if more than one person affiliated with this office will access this database under the same Confidentiality and Limited Access Agreement, each user must register individually.

Fill in the data fields below, and follow the instructions to receive your authorized User ID and Password.

*Required Fields

e.g. 123-456-7890