Notice to Applicants

Only "original" application forms will be accepted. Applications that are faxed or received by Email will no longer be accepted.

Application for Coverage

Purpose of form: This form is to be used to submit information to NMMIP for an initial application of changes to current coverage.

Low Income Premium Program Application

Purpose of form: This form is used to determine if an applicant would qualify for a reduced premium rate.

Application for Coverage (Spanish)

*Application undergoing review process and will be posted upon approval.

Purpose of form: This form is to be used to submit information to NMMIP for an initial application of changes to current coverage.

Low Income Premium Program Application (Spanish)

*Application undergoing review process and will be posted upon approval.

Purpose of form: This form is used to determine if an applicant would qualify for a reduced premium rate.

Application for Newborn Coverage

Purpose of form: This form is to be used to submit information to NMMIP for an initial application of changes to current coverage.

Medicare Carve-out
Application

Purpose of form: This form is to be used to submit information to NMMIP for the Medicare Carve-Out application.

For further information and assistance regarding Applications please contact Customer Service at 1-844-728-7896.