This Bulletin repeals and replaces Bulletins 2021-017 and 2021-023.

The Office of Superintendent of Insurance (OSI) is amending the prior authorization standardized language previously issued in the bulletins to address the prohibitions outlined in Section 59A-22B-and 8 NMSA 1978. The Out-of-Network and Behavioral Health standardized language remains unchanged. Each issuer shall integrate the standardized language into their EOCs.

Additionally, for issuers offering Qualified Health Plans (QHPs), OSI previously developed an Administrative Data template. This template is unchanged and is available to download on OSI’s website. Each issuer shall continue to complete and file the template in SERFF, under the Supporting Documentation tab of their respective QHP binder.

Finally, an issuer who is discontinuing a QHP must crosswalk the existing enrollees to a new plan for the next plan year. To ensure that those enrollees receive accurate, and complete information concerning the discontinuation and crosswalk process, and open enrollment opportunities, OSI developed standard discontinuation and auto renewal notice forms. Editable versions of the forms will continue to be available for download on the OSI’s website.

Questions concerning these directives should be directed to the Life and Health Bureau at life.health@osi.nm.gov.

ISSUED this 14th day of August 2025.

08/15/2025 Correction: This bulletin now includes the standardized language as an attachment as referenced in the bulletin. The text of the bulletin is not being updated or amended.

For complete content please see PDF below.

STANDARD LANGUAGE, ADMINISTRATIVE DATA AND DISCONTINUATION NOTICES