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 MEWA is a technical term under federal law that encompasses essentially any arrangement not maintained pursuant to a collective bargaining agreement(other than a State-licensed insurance company or HMO) that provides health insurance benefits to the employees of two or more private employers. Some MEWAs are sponsored by associations that are local, specific to a trade or industry, and exist for business purposes other than providing health insurance. Such MEWAs most often are regulated as employee health benefit plans under the Employee Retirement Income Security Act of 1974 (ERISA), although States generally also retain the right to regulate them, much the way States regulate insurance companies. They can be funded through tax-exempt trusts known as Voluntary Employees Beneficiary Associations (VEBAs) and they can and often do use these trusts to self-insure rather than to purchase insurance policies. Other MEWAs are sponsored by Chambers of Commerce or similar organizations of relatively unrelated employers. These MEWAs are not considered to be health plans under ERISA. Instead, each participating employer’s plan is regulated separately under ERISA. States are free to regulate the MEWAs themselves. These MEWAs tend to serve as vehicles for participating employers to buy insurance policies from State-licensed insurance companies or HMOs. They do not tend to self-insure. Multi-employer health plan Generally, an employee health benefit plan is maintained pursuant to a collective bargaining agreement that includes employees of two or more employers. These plans are also known as Taft-Hartley plans or jointly-administered plans. They are subject to federal but not State law (although States may regulate any insurance policies that they buy). They often self-insure. Premium Agreed upon fees paid for coverage of medical benefits for a defined benefit period. Premiums can be paid by employers, unions, employees, or shared by both the insured individual and the plan sponsor. Premium equivalent For self-insured plans, the cost per covered employee, or the amount the firm would expect to reflect the cost of claims paid, administrative costs, and stop-loss premiums. Primary care physician (PCP) A physician who serves as a group member’s primary contact within the health plan. In a managed care plan, the primary care physician provides basic medical services, coordinates, and, if required by the plan, authorizes referrals to specialists and hospitals. Reinsurance The acceptance by one or more insurers called reinsurers or assuming companies, of a portion of the risk underwritten by another insurer that has contracted with an employer for the entire coverage. Self-insured plan A plan offered by employers who directly assume the major cost of health insurance for their employees. Some self-insured plans bear the entire risk. Other self-insured employers insure against large claims by purchasing stop-loss coverage. Some self-insured employers contract with insurance carriers or third party administrators for claims processing and other administrative services; other self-insured plans are self-administered. Minimum Premium Plans (MPP) are included in the self-insured health plan category. All types of plans (Conventional Indemnity, PPO, EPO, HMO, POS, and PHOs) can be financed on a self-insured basis. Employers may offer both self-insured and fully insured plans to their employees. Stop-loss coverage A form of reinsurance for self-insured employers that limits the amount the employers will have to pay for each person’s health care (individual limit) or for the total expenses of the employer (group limit). Third-party administrator (TPA) An individual or firm hired by an employer to handle claims processing, pay providers, and manage other functions related to the operation of health insurance. TheTPA is not the policyholder or the insurer.
November 18, 2025 Bulletins CLARIFICATION ON COORDINATION OF BENEFITS (COB) PROVISIONS FOR MINOR CHILDREN BULLETIN 2025-015: This bulletin is issued in accordance with Sections 59-2-8, 59A-2-10, 59A-16-11(B) and 59A-46-31 NMSA 1978, and 13.1.2 and 13.10.13.11(B)(2) NMAC. The purpose of this bulletin is to clarify the position of the Office of Superintendent of Insurance (OSI) regarding allowable coordination of benefits provisions for a dependent child covered under more than one health insurance […] Read More
December 8, 2025 Announcements Mandatory Reporting Requirements Under the New Mexico Insurance Fraud Act NOTICE TO ALL LICENSEES, INSURERS, AND INSURANCE PROFESSIONALS Subject: Mandatory Reporting Requirements Under the New Mexico Insurance Fraud Act This notice serves as an official reminder that all insurers and licensed insurance professionals are required to comply with the mandatory reporting and cooperation requirements established under the New Mexico Insurance Fraud Act. These obligations […] Read More
November 17, 2025 News Releases NEW MEXICO OFFICE OF THE SUPERINTENDENT OF INSURANCE HOSTS TOWN HALL IN SILVER CITY ON WILDFIRE PREPAREDNESS, MITIGATION AND INSURANCE RESOURCES Contact: Elouisa Macias, Consumer Assistance Bureau ChiefEmail: Elouisa.Macias@osi.nm.gov Santa Fe, NM – On Wednesday, the Office of the Superintendent of Insurance (OSI) hosted a town hall in Silver City, NM related to wildfire preparedness and insurance resources. The town hall was moderated by Elouisa Macias, Consumer Assistance Bureau Chief, Civil Investigations Bureau at OSI. The […] Read More
