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Application for Coverage [Click
Here] 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 [Click
Here]
Purpose
of form: This form is used to determine
if an applicant would qualify for a reduced
premium rate.
Automatic Payment Form [Click
Here] Purpose
of form: Provides a format for automatic
payments on your policy.
2007 Insurer Direct Premium Request Form [Click
Here] Purpose
of form: A form for New Mexico licensed
insurers to report the total direct premiums
written in New Mexico for accident and health
insurance for calendar year 2006.
HIPAA Eligibility [Click
Here]
Purpose of form: A form to
determine if an individual qualifies as HIPAA
eligible. |
