• Member Grievance

The Grievance Procedures, as outlined in 13.10.17 NMAC states the requirements for filing and processing grievances against health care insurers that provide, offer or administer health benefit plans, including those with a point-of-service option that allows covered persons to obtain health care services out of network; provided by an entity that purchases or is authorized to purchase health care benefits pursuant to the New Mexico Health Care Purchasing Act; and utilizing a preferred provider network, as defined under NMSA 1978 Section 59A-22A-3.

OSI regulates member and provider grievances for major medical health insurance plans. See details below on OSI’s member grievance regulatory requirements.

Guidance Chart

Updated Guidance Chart Coming

Member Grievance Compliance FAQ’s

Regulations

Bulletins and News

Member Complaint Form

Grievance Logs

Recent News

Get the latest information about rule changes, legislation, industry information and consumer news.

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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 […]

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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. […]

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