LMS Registration Form

BeWell Assister Certification Request Form

This online form is for Plan Year 2025 Registration and Training for BeWell Certification.
Registration
We are not accepting any PY25 Certified Assister Training requests at this time. We will resume PY25 Certified Assister training requests on January 16th, 2025. Please consider re-submitting your request at this time.

Returning Assisters:

Returning assisters should log in to access the Learning Management System (LMS) and are automatically enrolled in the PY25 certification training courses. If you need help reactivating your LMS account or do not see your course assigned, please email us at partners@nmhix.com.

Important Tips:

- Principal Agents: If you are not currently established on the BeWell platfrom and would like to create an agency account, do not move forward, and reach out to partners@nmhix.com.

- Once the request is approved you will receive an email from partners@nmhix.com with instructions on how to access the training courses. If you have questions, reach out to partners@nmhix.com for asistance.

* Asterisks indicate required fields.

The information collected on this form will begin your registration process for the BeWell Learning Managment System.
Certification Request Form
Title: *
Select the Assister title to indicate whether you are new Broker or Enrollment Counselor.
First Name*
Last Name*
Are you aligned with an organization or agency?*

YESNO
Agency or Organization Name
Agency NPN Number
Agency NPN Number (Agents only)
Business Mailing Address: If you do not have a physical business address, you will be set-up as a virtual Agent/Broker ONLY. If you do not have a business address please mark NA in the required field below.*

Street Address (SHARED WITH CONSUMERS)

Street Address Line 2, Suite #

CityState / Province

Postal / Zip Code
Business City, State & Zip

Street Address

Street Address Line 2

CityState

Zip Code
Mobile Phone Number*
Business Contact Phone Number*
(THIS NUMBER IS SHARED WITH CONSUMERS)
Email address*
NPN Number*
National Producers Number
County*
Home Address for ID Proofing This address is your personal address used to verify identity *

Street Address

Street Address Line 2

CityState

Postal / Zip Code
(Enrollment Counselors Only) Date of Birth:*
Used for Background Check
(Enrollment Counselors Only) State issued Drivers License Number, please include the State issued*
Please indicate the State Issued, this is used for the background check.
NM Counties Served: *
List the Counties you serve in-person appointments in New Mexico.
Languages Spoken*
What languages do you speak?
(Enrollment Counselors Only) Supervisor Name and Email
Time*

Hour Minutes

AM/PM Option
Date Submitted*

MonthDayYear
Date
Should be Empty:

BeWell Assister Certification Request Form

Registration

Certification Request Form