Health Care Affordability Fund

During the 2021 Legislative Session, the New Mexico Legislature passed and Governor Michelle Lujan Grisham signed Senate Bill 317, which placed a moratorium on out-of-pocket costs for mental health services for state-regulated plans and created a Health Care Affordability Fund to lower health care costs for New Mexicans. The law allows the Fund to be used to:

1. Reduce premiums and out-of-pocket health care costs for New Mexicans who qualify for coverage on beWellnm, the state’s Health Insurance Marketplace;

2. Reduce premiums for small businesses and their employees;

3. Provide resources for planning, design and implementation of health care coverage initiatives for uninsured New Mexico residents; and

4. Provide resources for administration of state health care coverage initiatives for uninsured New Mexico residents.

The Fund and its programs are administered by the New Mexico Office of Superintendent of Insurance (OSI).

Materials Published in 2024

Final 2025 Health Insurance Marketplace Affordability Program Guidance

• 2025 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual FINAL
• 2025 Plan Year Marketplace Affordability Program FAQs for Issuers (Updated April 26, 2024)
• 2025 Plan Year BeWell Clear Cost Plan Requirements FINAL
• 2025 Plan Year BeWell Clear Cost Plan AV Calculator Screenshots FINAL (Downloads Excel File)
• Non-AVC Clear Cost Benefits Co-Pay Category (Downloads Excel File)

Materials Published in 2023

2024 Health Insurance Marketplace Affordability Program Guidance

• 2024 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual (FINAL)
• 2024 Plan Year Marketplace Affordability Program FAQs for Issuers (Updated May 10, 2023)
• 2024 Plan Year Supplemental SOPA Template (Downloads Excel file)
• 2024 Plan Year Standardized Health Plan Requirements
• 2024 Plan Year Standardized Health Plan AV Calculator Screenshots (Updated May 10, 2023) (Downloads Excel file)

Final 2023 Plan Year SOPA Reconciliation Guidance for Health Insurance Issuers

1. Final SOPA Reconciliation Guidance (Version 2)
2. OSI Responses to Carrier Questions Following Jan 2023 SOPA Reconciliation Training – Mar 2023
3. Template A – Issuer and Plan Level SOPA
4. Template B – Policy Level SOPA-Reconciliation
5. Template C – SOPA Request for Reconsideration
6. Attestation Form A – EHB Inclusion
7. Attestation Form B – EHB Inclusion
8. Attestation Form C – Simplified Methodology Forms

Materials Published in 2022

Health Insurance Marketplace Affordability Program Information for the 2023 Plan Year

• Presentation for Assisters and Producers (October 2022)

2023 Health Insurance Marketplace Affordability Program Guidance

• 2023 Plan Year Health Insurance Marketplace Affordability Program Policy and Procedures Manual
• Marketplace Affordability Program FAQ for Issuers (Updated April 4, 2022)

• Bulletin 2022-022 – MAP Payment Process

• How reporting income changes after Open Enrollment could affect Turquoise Plan eligibility

Small Business Health Insurance Premium Relief Initiative

• Bulletin 2023-036 (January 2024-June 2024)
• Bulletin 2023-10 (July 2023-December 2023)
• Bulletin 2022-018 (January 2023-June 2023)
• Bulletin 2022-006 (July 2022-December 2022)

Materials Published in 2021

beWellnm Coverage Affordability Initiatives

• OSI slides for 9/1/2021 stakeholder meeting
• Proposed Income and Affordability Criteria
• Examples of Costs Under OSI Marketplace Proposals
• Automatic Retention Presentation
• Wakely Report on Affordability Options
• Myers & Stauffer Stakeholder Report

Small Business Coverage Affordability Initiatives

• OSI slides from a 9/8/2021 stakeholder meeting
• Wakely Consulting slides from a 9/8/2021 stakeholder meeting
• Wakely Report on Reinsurance