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2016 Plan Year Qualified Health Plan Submission Information:

For Consumers:


Office of Superintendent of Insurance has the regulatory responsibility for licensing Qualified Health Plan (QHP) issuers and the regulatory responsibility of form and rate compliance.

You can follow Health Reform Timeline for a general overview of the Health Reform.

 

For Carriers submitting Qualified Health Plans for review:  


Similar to the QHP certification process in 2014 and 2015, the New Mexico Office of Superintendent (NMOSI) will conduct reviews of qualified health plans (QHPs) and stand-alone dental plans (SADPs) and provide to CMS the determinations for year 2016. NMOSI evaluates health and dental plans against QHP and SADP certification standards as part of the state’s traditional regulatory role for the insurance industry and/or enforcement of Title XXVII of the Public Health Service Act (PHS Act), or otherwise for state purpose.

 

Timelines

 

On-Exchange Individual and SHOP Form & Rate Filings and Binders:
Activity Dates:
(Subjected to change)
Submission and Review Process Submission 4/1/2015 – 4/10/2015
Qualified Health Plan (QHP) Rate Ammendment 6/1/2015 – 6/15/2015
and 48 hour correspondence turn-around 7/1/2015
Stand Alone Dental Plan (SADP) DEADLINE for Approval & Certification 7/15/2015
Affiliated Binders NMOSI SERFF Transfer

Plans MUST be Approved & Certified for transfer
7/20/2015
Affiliated Rates CMS Testing TBD
Open Enrollment   11/1/2015


Off-Exchange Individual and Small Group Form & Rate Filings:

Activity Dates:
(Subjected to change)
Submission and Review Process Submission 4/1/2015 – 4/10/2015*
Major Medical
Individual (Mirrored & Non-Mirrored)
Small Group (Mirrored & Non-Mirrored)
Individual Student Plans
Rate Ammendment 6/1/2015 – 6/15/2015
Pediatric Dental
Individual (Mirrored & Non-Mirrored)
Small Group (Mirrored & Non-Mirrored)
48 hour correspondence turn-around 7/15/2015
Rates
For all the above kinds of business
DEADLINE for Approval & Certification 7/15/2015
BLACK OUT DATES   4/10/2015 - 12/31/2015

* Form and/or Rate filings that fall under the above categories, submitted after April 10, 2015, will be rejected.


Large Group Form & Rate Filings

Activity Dates:
(Subjected to change)
Submission and Review Process Submission 8/1/2015 – 8/15/2015*
Major Medical
Large Group
48 hour correspondence turn-around 10/15/2015
Rates
For Large Group Plans
End Date 11/1/2015
BLACK OUT DATES

For Plan year 2016

  1/1/2015 - 7/31/2015
8/15/2015 – 12/31/2015

*Large Group Rate and/or Form filings for plan year 2016, submitted before 7/31/2015 and submitted after August 15, 2015, will be rejected.

 


General Carrier Assistance for 2016 QHP and SADP plans:

  • The Frequently Asked Questions (FAQ's) for QHP Requirements can be found here: QHP FAQ's
  • Frequently Asked Questions (FAQ's) for Pediatric Dental & Vision Requirements can be found here: 2016 Dental FAQ's

 


QHP and SADP Company Licensing Bureau Assistance for Carriers:

  • Submit Statement of Attestation to Company Licensing Bureau. Guidance can be found here.
  • Certificate of Authority information can be found under our Company Licensing Bureau

 


QHP and SADP Life & Health Rate and Form Filing Bureau Assistance for Carriers:

QHP and SADP forms and rates are submitted via System for Electronic Rate and Form Filing (SERFF)


New Mexico Health Insurance Exchange Information:


Information about the next meeting of the New Mexico Insurance Exchange is available on the Health Insurance Exchange website:www.nmhix.com


Carrier questions about the New Mexico Health Insurance Exchange can be e-mailed to: CarrierQuestions@nmhix.com