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Monday-Friday
7:00 a.m. – 5:00 p.m.
Fax: 915.519.0261
How To Complete Your Enrollment Application
NMIADA Non-Members
Online Application for Non-Members
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Electronically fill out the application and then complete ALL enrollment information and plan options which apply.
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Please complete in its entirety, each section of the document, signed and dated
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1 - Open your NMIADA Enrollment Form by clicking on the NMIADA Non-Member Enrollment Form above.
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2 - Fill out your NMIADA Enrollment form. Make sure you fill out all of the required fields.
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3 - Please save your completed enrollment form as a new file with your first and last name. (Example, NMIADA Enrollment Form John Smith).
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3a - Once completed, please attach your enrollment form and email it to the following POC: Alejandra@fivepointsmecplan.com
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4 - Alternatively, you may fax your completed enrollment form to the following fax number: 915.519.0261
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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