What are you looking for? Patients 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 InsuranceOther Types of Health InsuranceStay Ready for Disasters!FloodWildfireWind & HailWinter Storm 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.
August 11, 2026 Announcements ORDER ESTABLISHING PARAMETERS FOR DEFRAYAL UNDER 13.10.41 NMAC, COVERAGE FOR SPECIFICED SEX TRAIT MODIFICATION PROCEDURE Pursuant to NMSA, Section 59A-2-8 General powers and duties of superintendent, this order provides an initial interpretation of what specified sex trait modification procedures and prescriptions are eligible for defrayal starting Plan Year 2027 for health plans sold on the New Mexico BeWell Exchange. Office of Superintendent of Insurance (OSI) staff may revisit this interpretation […] Read More
June 22, 2026 Bulletins MEDICAL MALPRACTICE PREMIUM REDUCTION BULLETIN 2026-010: The New Mexico State Legislature appropriated $5 million to the New Mexico Office of Superintendent of Insurance (OSI) to address medical malpractice insurance costs for individual providers. The appropriation was part of a supplemental appropriation package passed in 2025. This one-time appropriation directs OSI to provide a premium subsidy for private medical malpractice insurance policies. […] Read More
