Hayden Pedigo App #2021-0302

505-505-5050 email@juno.com

Assigned To: Trinity Angelino

Pending Review Under Review Reviewed & Approved Change Request Editing: Locked

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Retiree Information

Effective Date

Change Method

(ERB retirees are required to select option 2, automatic bank draft, if changing the method of payment)

I authorize a deduction from my pension earnings for NMRHCA insurance plan contributions I authorize an automatic bank draft on my checking account for NMRHCA insurance plan contributions

Download your documentation file

Please send the documentation file, along with a payment (check, cashier's check or money order made payable to the NMRHCA) to:
6300 Jefferson St. NE
Suite 150
Albuquerque, NM 87109

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Hayden Pedigo App #2021-0302

Assigned To: Trinity Angelino

Change Method of Premium Payment

Retiree Information

Change Method

Authorization for Deduction / Method of Payment

Trinity Angelino 12/05/21 8:30 am

Trinity Angelino 12/20/21 4:40 pm

Trinity Angelino 12/02/21 10:45 am

Shirley Collins 12/04/21 4:10 am

Trinity Angelino 12/20/21 9:40 am