Get Nm Health Connections Enrollment/change Form

Filling out the NM Health Connections Enrollment/Change Form online is a straightforward process. This guide provides detailed steps to help you complete the form with ease and accuracy.

Follow the steps to successfully complete your enrollment form.

1. Press the ‘Get Form’ button to retrieve the NM Health Connections Enrollment/Change Form and open it for editing.
2. Begin by providing personal information in Step 1. Fill in your first, middle, and last name along with any suffix. Next, include your home address, city, state, ZIP code, and county. If your mailing address differs, provide that information as well.
3. Indicate your preferred method of communication by answering whether you want to receive information by email or text message. If you choose to receive texts, include your cell phone number.
4. Input your Social Security number, date of birth, and specify your sex. Provide information regarding your tobacco use and your racial or ethnic background by selecting the relevant options.
5. In Step 2, provide details about your employer, including the employer's name, your date of hire, and the employer's address.
6. Step 3 requires you to list any eligible dependents for enrollment. Fill in the required information for each dependent, including their personal details like name, relationship to you, date of birth, and preferred primary care practitioner.
7. Read and sign the application in Step 4, acknowledging your understanding of the provided information and the consent to use your confidential health information. Ensure that the signature matches the person listed in Step 1.
8. Once all sections are completed and reviewed, save your changes. You can then download, print, or share the completed form as required.

Complete the NM Health Connections Enrollment/Change Form online today to ensure you and your eligible dependents receive the necessary health coverage.