NMMIP Members: The Automatic Payment Form (ACH) is now able to be filled out and submitted online. Please find both downloadable and online ACH forms in the Members dropdown, then click on Automatic Payment Form. 

Applications

For members applying for general NMMIP coverage, please use the Application for Coverage and the Application Checklist to make sure you have included all required supporting documentation. For members applying for the Low Income Premium Program (LIPP), please first complete the Application for Coverage before submitting a LIPP application. 

Para los miembros que solicitan cobertura general de NMMIP, utilice la Solicitud de Cobertura y la Lista de Verificación de la Solicitud para asegurarse de incluir toda la documentación de respaldo requerida. Para los miembros que solicitan el Programa de Prima para Personas de Bajos Ingresos (LIPP), primero complete la Solicitud de Cobertura antes de enviar la solicitud de LIPP.

Application Checklist, Medicare, Newborn, and General Applications for Coverage, Second Party Attestation Letter:

Lista de verificación de la solicitud; solicitudes de Medicare, recién nacido y cobertura general; carta de declaración de segunda parte:

2026 LIPP and Medicare Carveout LIPP Applications:

Solicitudes LIPP 2026 y Solicitudes LIPP de Exclusión de Medicare:

For further information regarding Medicare Carveout Rates:

If you are needing help finding the best plan for you, please see the following list of brokers approved for NMMIP.

For further information and assistance regarding Applications please contact Customer Service at 1-866-306-1882 .