Agents

Mid-America Associates, Inc. is pleased to have you as an Agent. On this page you will find various commonly used documents and forms.

Simply click on the document name below to view each file.

Applications
Multi-State Employee Application
Multi-State Employer Application

Brochures
Mid-America Fully Funded Self Insured Plans
Mid-America Fully Funded Self Insured HSA Plans

Licensing Forms
Agent Questionnaire NGL
Mid-America TPA – Agent-Agency General Authorization 3475 03-15
Multi-State Commission Agreement

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