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How To Complete Your Enrollment Application

NMIADA Employer Group

Online Application for Non-Members

  • Electronically fill out the application and then complete ALL enrollment information and plan options which apply.​

  • Please complete in its entirety, each section of the document​, signed and dated

NMIADA Non-Member Enrollment Form
  • 1 - Open your NMIADA Enrollment Form by clicking on the NMIADA Non-Member Enrollment Form above.

  • 2 - Fill out your NMIADA Enrollment form. Make sure you fill out all of the required fields.

  • 3 - Please save your completed enrollment form as a new file with your first and last name. (Example, NMIADA Enrollment Form John Smith).

  • 4 - Alternatively, you may fax your completed enrollment form to the following fax number: 915.519.0261

  • 5 - You may mail your completed enrollment form to the following address:

Five Points Health Benefit Plans, LLC

6006 North Mesa Street - Suite 108

El Paso, Texas   79912​​

We have created a video to help you easily enroll for your mobile phones or tablet.

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