Online Forms for NMTA Trust Members

The secure server will encrypt your information and is fully compliant with all HIPAA Privacy and Security Rules. You should be using Internet Explorer 6.0 or greater, or Firefox 1.5 or greater.

After you submit your form, you will be given a confirmation number, and will be able to download/save/print a PDF of the submitted form. Please retain the confirmation number and/or PDF for your records.

Regular Forms:

NMTA Change Transmittal to Cancel a Dependent


EPK Benefits now has an on-line portal for managing your NMTA account.  If you don’t have a login and would like access to the site,  please e-mail your request to