If you are a NH resident and are eligible for the NHHP you may contact your insurance producer, locate a preferred producer in your area for additional information, or call BMI customer service at 1-877-888-NHHP (6447).

You can also request an Application Packet via our online form.

Applicant’s Checklist

For your application to be processed, you must submit the following items:

PROOF OF NH RESIDENCY

• Residency Affidavit (page 3 of the application form)
  

ELIGIBILITY CERTIFICATION
(only one requirement must be met)

• Rejection letter from another carrier, or;
• Offered coverage but at premium rate exceeding NHHP, or;
• Have one of the pre-qualifying diseases, or;
• Not eligible, not offered or have exhausted COBRA coverage

PREMIUM PAYMENT OPTIONS
All premiums are payable to the New Hampshire Health Plan

• Check
  If this option is chosen, an additional $10 monthly fee must be included.
• Debit (Automatic monthly withdrawal)
  1. The first premium must be paid by check or money order.
  2. A voided check must be included.
     Please note: Only one month's payment, for the exact amount due, is allowed. Any checks with multiple payments or wrong amounts will be returned.

Include HIPAA CERTIFICATE OR OTHER EVIDENCE OF PREVIOUS COVERAGE(S) SENT

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