New Hampshire Chamber of Commerce Benefits Program

IMPORTANT: In order to sell these products you must meet ALL of these requirements: Be an active chamber member, an authorized Patriot Healthcare producer, and an authorized Genworth Financial producer.

1. To become a chamber member: Please contact your local Chamber of Commerce
2. To become an authorized Patriot Healthcare Producer: Go to our forms and complete the broker application, broker agreement, and W-9 and fax to Dina Parker at 603.296.0315.
3. To become an authorized Genworth Financial Producer please click here.

Small Group (1-50)
Large Group (51+)
Local banks offering Health Savings Accounts (HSAs)

How to enroll a group into the program:

Employer Enrollment Process Checklist

Employer Enrollment Forms:

• Patriot Healthcare Employer Application
• Northeast Delta Dental Employer Application
• Genworth Employer Application

• Employer Election Of Wellness Fee
• EmployerWellnessAgreement
• Attachment 1 to Assoc Wellness Agreement

Please fax or drop off completed forms to Patriot Healthcare. You may fax them to 603.296.0315 or drop them off at 33 South Commercial Street, Manchester, NH 03101.