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CHANGE BENEFICIARY FORM New Mexico Retiree Health Care Authority A 4308 CARLISLE BLVD NE, SUITE 104 ALBUQUERQUE NM 871074849 1 (800) 2332576 Retiree / Surviving Dependent Personal Information Please
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Start filling out the form by entering your name, address, and other personal information as required.
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Indicate the year of the form, which in this case is 2017.
05
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Employees who have experienced a change in their benefits for the year 2017.
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Change bene formdoc is a document used to report changes in beneficiary information.
Beneficiaries or their authorized representatives are required to file change bene formdoc.
Change bene formdoc can be filled out by providing updated beneficiary information and submitting it to the appropriate authority.
The purpose of change bene formdoc is to ensure accurate beneficiary information is on file.
The information that must be reported on change bene formdoc includes beneficiary's name, contact information, and any updates to beneficiary status.
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