Get General Enrollment Application - Nmrhca Home

Filling out the General Enrollment Application for NMRHCA Home online can streamline your enrollment process. This guide provides clear, step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to complete your enrollment application accurately.

1. Press the 'Get Form' button to access the online application form.
2. Begin by filling out Section A with your retiree personal information. Ensure to include your Social Security number, full name, date of birth, and mailing address.
3. If you have changed your address, check the appropriate box in Section B and provide your new address details in Section A-4.
4. In Section C, determine if you need to change your level of coverage by selecting from the available options. Complete the necessary details for adding or changing dependents.
5. If applicable, fill out Section D to cancel any existing coverage. Ensure you provide all required details for a smooth cancellation process.
6. Complete Section E if you want to adjust your life insurance coverage—whether decreasing, increasing, or adding additional coverage. Attach the necessary documentation as instructed.
7. In Section F, specify your preferred method for premium payments, including any necessary attachments like a voided check if opting for a bank draft.
8. Finally, review all the information provided, sign in Section G, and confirm your understanding of the declarations. Ensure to send the original form to the stated address and keep a copy for your records.

Complete your enrollment application online today for a seamless experience.