Northeast Benefits Management

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Employee Benefits Simplified

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Employee Benefits Simplified

Forms

Welcome to our Forms page. These PDF forms can be completed on line with an electronic signature or printed and sent to us at info@nbmus.com.

  • Authorization to Release Information
  • Change in Status
  • Corporate Bank Account Information
  • Debit Card Use Verification
  • Dental Claim Form
  • Dependent Care Claim Form
  • Doctors Note / Letter of Medical Necessity
  • Employee Direct Deposit
  • Health Care FSA Claim Form
  • HRA Claim Form
  • STD Claim Form
  • STD Physician Statement Form

 

Contact

Northeast Benefits Management, LLC
620 Hinesburg Road, Suite 120
PO Box 2363
South Burlington, VT 05407-2363

Tel (802) 865-0239
Fax (802) 419-3094
info@nbmus.com

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