If you have an existing account with NMHIA please let us know of any change on your group plan or individual policy. Print the forms and fax or mail them to us. Please contact your agent for assistance.
Our fax number is: 505-988-3461
Our mailing address is:
P.O. Box 5095
Santa Fe, NM 87502
For current NMHIA Employer Group members the following forms can be downloaded and printed. You will need Acrobat Reader software which is found and downloaded from the internet free of charge.
Electronic Funds Transfer Form (EFT) - This form is for NMHIA Employer Groups who want the monthly premium payment withdrawn from their business bank account. Premium payments are withdrawn on the 1st business day of every month. This form can be printed and either faxed or mailed to our office.
Employee Enrollment/Waiver - This form can be printed for new employees that will be completing the employer’s insurance waiting period. The employee has the option to either enroll in the new plan or waive coverage. Once complete the form can either be faxed or mailed to our office.
Group Change Request Form - This form can be printed and either faxed or mailed to our office for the following changes:
Full-time Employment Affidavit - This form can be printed and either faxed or mailed to our office.