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The Alliance provides these Forms and Applications which can be filled out online, downloaded, and sent to the Alliance. To view these files, you will need Acrobat Reader - software that is distributed free of charge.
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Group Forms
If you are applying for first time coverage, please visit the Certified NMHIA Agent page and select an agent in your area who can assist you in the application process. This will ensure that your application is complete and will not cost you additional premium.
Required Documentation - For new and renewing groups
Employee Enrollment/Waiver -This form can be printed and faxed or mailed to the Alliance for employees wishing to enroll or waive coverage.
New Business Affidavit
Full-time Employment Affidavit
Electronic Funds Transfer Form - This form can be filled out online, printed and faxed to the Alliance for those individuals and groups who want their premium withdrawn from their bank account. Premium payments are withdrawn on the 1st of every month.
Group Change Request Form
- Employer/Employee address changes
- Employer/Employer name changes
- Employee dependent additions or deletions
- Cancellation of group coverage
- Cancellation of employee coverage
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