The forms below are to help you establish an account once you are ready to enroll in the marketplace.
It’s tax season. If you haven’t recevied your 1095-A for 2021 you can secure it from healthcare.gov.
Click here to learn more.
|BeWellnm Paper Application|
|BeWellnm Confidentality Statement|
|BeWellnm Consent Fillable Form|
|beWellnm Fillable Consent (Spanish)|
|Marketplace Account Information|
|NMHIX ACH Form for Premium Payments PDF|
|NMHIX-ACH-Form-for Premium Payment Word version|
|YesNM Account Information|
|Employer Coverage Tool – Worksheet|
|Zero Dollar Income Affidavit Spanish|