Making Changes?

It’s as easy as 1, 2, 3.

Group Forms

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Electronic Funds Transfer Form (EFT) - This form is for NMHIA Employer Groups who want the monthly premium payment withdrawn from their business bank account. Premium payments are withdrawn on the 1st business day of every month.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.

Group Change Request Form - This form can be printed and either faxed or mailed to our office for the following changes:

Employer/Employee address changes
Employer/Employee name changes
Employee dependent additions or deletions
Cancellation of Employer Group coverage
Cancellation of employee coverage

Full-time Employment Affidavit - This form can be printed and either faxed or mailed to our office.