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How To Complete Your Enrollment Application

NMIADA Non-Members

Online Application for Non-Members Made Easy

  • Please click on ONLINE ENROLLMENT to fill out your enrollment application.

  • ​Please choose one of the four plans chosen for NMIADA non-members.

  • Please complete all sections of your enrollment application.

  • Please submit payment with your application.

As a second option, you may submit your paper enrollment and payment through our secure email or secure fax.

  • 1 - Open your NMIADA Non-Member Paper Enrollment Application and ACH Payment Form by clicking on the NMIADA Non-Member Paper Enrollment Application and ACH Payment Form above.

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  • 2 - Fill out your NMIADA Non-Member Paper Enrollment Application and ACH Payment Form. Make sure you fill out all of the required fields.​

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

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  • 3a - Once completed, please attach your completed enrollment application and your ACH Payment Form and email it to the following POC: Alejandra@fivepointsmecplan.com

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  • 4 - Alternatively, you may fax your completed enrollment application and completed ACH Payment Form to the following fax number: 915.519.0261

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  • 5 - You may mail your completed enrollment application and completed ACH Payment Form to the following address:

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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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