What are you looking for? Other Types of Health InsuranceStay Ready for Disasters!Winter StormFloodWildfireWind & HailPatients Debt Collection Protection ActReport Insurance Fraud in New MexicoInsurance TypesTitle InsuranceHomeowners InsuranceCondo InsuranceRenters InsuranceAuto InsuranceHealth InsuranceManaged Health Care ReviewGrievance Procedures RulesWhat Consumers need to know about Surprise BillingIndependent Review OrganizationBilling ExamplesHealthcare Provider ArrangementsMultiple Employer Welfare Arrangement (MEWA)Life Insurance OSI Events Calendar View our calendar of events Exclusive providers Enrollees must go to providers associated with the plan for all non-emergency care in order for the costs to be covered. Any providers Enrollees may go to providers of their choice with no cost incentives to use a particular subset of providers. Usual, customary, and reasonable (UCR) charges conventional Indemnity plans operate based on usual, customary, and reasonable (UCR) charges. UCR charges mean that the charge is the provider’s usual fee for a service that does not exceed the customary fee in that geographic area, and is reasonable based on the circumstances. Instead of UCR charges, PPO plans often operate based on a negotiated (fixed) schedule of fees that recognize charges for covered services up to a negotiated fixed dollar amount. Reference Sources Survey definitions from The National Compensation Survey definitions (BLS), The Medical Expenditure Panel Survey definitions (AHRQ), and The National Employer Health Insurance Survey definitions (NCHS). Definitions from other Federal agencies and surveys, such as: The Current Population Survey (BLS/Census) ERISA Related definitions (from PWBA) Glossaries and informational papers from websites such as: OPM’s Federal Employees Health Benefits Plans (glossary and specific plan booklets), Blue Cross / Blue Shield, The National Center for Policy Analysis, and The Health Insurance Association of America Publications such as: Employee Benefit Plans: A Glossary of Terms, Ninth Edition 1997, Judith A. Sankey – editor, International Foundation of Employee Benefit Plans. “Fundamentals of Employee Benefit Programs, Fourth addition” “Managed Care Plans and Managed Care Features: Data from the EBS to the NCS”, Cathy A. Baker and Iris S. Díaz, Compensation and Working Conditions, Spring 2001 EBRI Notes Vol. 16, no. 7, July 1995 HIAA Source Book Personal communications with staff from some of the data sources cited.
March 19, 2026 Bulletins REPEAL OF BULLETIN NO. 2021-026 BULLETIN 2026-006: Bulletin No. 2021-026 is hereby repealed. The process for enrollment reporting will be communicated to carriers through electronic mail and via the Office of Superintendent of Insurance website at: https://www.osi.state.nm.us/en/insurance-professionals/life-and-health-division/ For additional information about this repeal please contact the Life and Health Division at: life.health@osi.nm.gov ISSUED this 19th day of March, 2026. REPEAL OF BULLETIN […] Read More
January 30, 2026 Bulletins REPEAL OF BULLETIN NO. 2023-009 BULLETIN 2026-004: Repeal Note: This bulletin hereby repeals Bulletin No. 2023-009 issued on April 6, 2023. ISSUED this 27 day of January, 2026. REPEAL OF BULLETIN NO. 2023-009 Read More
