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Toll Free : 1-844-728-7896
TTY: 1-844-728-7987
FAX (Claims): 1-620-792-7053
FAX (Premium Billing & Enrollment): 1-620-793-1199
New Mexico Medical Insurance Pool

New Mexico Medical Insurance Pool

"When no one else will help, we're there."
  • Home
  • About Us
    • Who We Are
    • Who We Serve
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    • Benefits & Eligibility
    • What Benefits are Covered?
    • 2023 Rate Tables
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    • 2023 Medicare Carve-Out Plan
  • Resources for Members
    • 2023 Open Enrollment
    • Policy Book
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    • Additional Resources
  • Transparency
    • Statistics Packs
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  • Carriers
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Forms

Automatic Payment Form

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Automatic Payment Form (Spanish)

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PHI Release Authorization Form

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Termination Request Form

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Non-Tobacco User Affidavit

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Non-Tobacco User Affidavit (Spanish)

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

New Mexico Medical Insurance Pool

The New Mexico Medical Insurance Pool (NMMIP) was established by the 1987 New Mexico State Legislature.

The Pool was created to provide access to health insurance coverage to residents of New Mexico who are denied health insurance and considered uninsurable.

Executive Services

  • 1-866-622-4711
  • [email protected]
  • www.nmmip.org

  • 1223 St Francis Dr. Ste. B.
    Santa Fe, NM 87505

Administrator

  • 1-844-728-7896
  • [email protected]
  • www.benefitmanagementllc.com

  • P.O. Box 1090
    2015 16th St.
    Great Bend, KS 67530

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