Enrollment and Consumer Forms
Our most commonly used forms are listed below, including a paper application, which you can use to enroll in coverage. If you are looking for a form that you cannot find here, please contact our team at 1-833-ToBeWell (1-833-862-3935).
- BeWell Letter Of Explanation – Other Public Program (Non-ESI MEC)
- BeWell Carta De Explicación – Cobertura De Otro Programa Público (Non-ESI MEC)
- BeWell Paper Application (English)
- BeWell Paper Application (English – Large Print)
- BeWell Paper Application (Spanish)
- BeWell Paper Application (Spanish – Large Print)
- NMHIX ACH Form For Premium Payments (PDF)
- YesNM Account Information
- Employer Coverage Tool – Worksheet
- Zero-Dollar-Income-Affidavit (English)
- Zero-Dollar-Income-Affidavit (Spanish)
- Agent of Record Form
- Appeal Request Form
