Get Low Income Premium Program Application - Nmmip.org - Nmmip

The Low Income Premium Program Application is intended to assist individuals who qualify by providing a reduced premium for health coverage. This guide offers clear, step-by-step instructions for users to effectively complete the application online.

Follow the steps to successfully fill out your application.

1. Press the ‘Get Form’ button to access the application. This will allow you to obtain the form and open it for editing.
2. Enter your personal information in the 'Applicant Information' section. This includes your last name, first name, middle initial, address, city, state, zip code, and ID number.
3. Complete the 'Premium Payment Certification' by writing your name to certify that you or someone in your family will be responsible for paying the premiums.
4. In the 'Household Size' section, provide details about all members of your household. This includes listing their names, relationships to you, and dates of birth. Ensure you complete this for all household members as it impacts premium reduction eligibility.
5. Fill out the 'Household Income Information and Verification' section. Include the total annual income for all adults in the household, ensuring to reference the appropriate line from your Federal Tax Form.
6. If applicable, attach copies of last year's Federal Income Tax forms for household members who earned income. If someone did not file, ensure they complete the Other Income Source Affidavit.
7. Complete and sign the Federal Tax Form Affidavit (Affidavit A) or the Other Income Source Affidavit (Affidavit B), depending on your circumstances, and ensure all necessary signatures are included.
8. After ensuring all information is accurate, review and save your changes. You can then download, print, or share the completed form as needed.

Begin your application process online to secure your potential premium reduction.