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Register as a Policyholder Agreement

Please provide the following information

A senior official in your company or 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 not be able to see information for any other policyholders.

Only one signed Confidentiality and Limited Access Agreement per organization is required. However, if more than one person affiliated with your organization 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. N12345-6
e.g. 123-456-7890