Life, Health, Rate & Product Filing Bureau
The Life & Health Rate and Product Filing Bureau assists the Superintendent in reviewing and approving all life and health forms and health insurance rates to ensure compliance with the New Mexico Insurance Code, Federal Requirements and Office of Superintendent of Insurance (OSI) Rules & Regulations. This Bureau regulates accident and health, credit life and disability, life, annuity, long-term care and Medicare supplement insurance lines of insurance.
This office utilizes SERFF (System for Electronic Rate and Form Filing) which offers a technological solution and cost-effective method for facilitating the submission, review, and approval of product filings. For further information go to the National Association of Insurance Commissioners (NAIC) or System for Electronic Rate and Form Filing (SERFF) website.
Important Notice(s) and Bulletins
- The Life & Health Rate and Product Filing Bureau has published timeframes in which companies may submit certain products for review, please see the Healthcare Reform page for additional details.
- Consumer Scam Alert
- Changes for all Non-Compliant ACA Health Policies
- Understanding Air Ambulance
- Bulletin2019-006 Requirements – “The Consumer Notice required pursuant to Bulletin# 2019-016 shall apply to certificates of coverage issued on and after August 1, 2019.” The Certification of Coverage as Delivered to New Mexico Residents and Informational Policy Filing requirements in this Bulletin shall be submitted annually by December 31 of each year.
- Bulletin2019-011 Prior Authorization Data Call.
Accordingly, all health insurers subject to the Health Insurance Prior Authorization Act shall submit the required data to OSI using the attached reporting form by 12:00 p.m. MST on August 15, 2019, to Rolanda Pana here. The form is also available in an editable format on OSI’s website or upon request.
- Bulletin2019-009 H.B. 436, Align health insurance law with federal law, and H.B. 285, the short – term health plan and excepted benefit act.
- Bulletin2019-007 S.B. 337, Surprise Billing Protection Act.
- Bulletin2019-006 Group excepted benefit health policy annual certification and informational policy filing.
- Bulletin2019-005 Sale of Short-Term, Limited-duration plans.
- Bulletin2019-002 Notice to insurance companies regarding policyholders affected by the federal government shutdown.
- Bulletin2019-003 Termination of all major medical plans that are non-compliant with Affordable Care Act (“ACA”) requirements.
- Bulletin 2019-001 The reporting requirements of section 220.127.116.11(D) NMAC.
- Bulletin 2018-010 Retirees Group.
- Bulletin 2017-005 Stop loss filing requirements.
- Bulletin 2017-004 Data call.
- Bulletin 2017-013 Requirement to bring non-complaint forms into compliance.
- Bulletin 2016-019 Requirement to update all non-compliant forms.
- Bulletin 2016-010 Excepted benefit plans disclosure [Repeals and replaces insurance bulletins No. 2014-003 and 2015-015.
- Bulletin 2016-002 was issued to provide clarification on the requirement of the Summary of Benefits & Coverage (SBC) template.
- Bulletin 2015-028 provides information on the definition of Small Group Health Plans (2-50 Employees).
- Bulletin 2015-024 provides information on the definition of Large Group Health Plans (51+ Employees).
- Bulletin 2015-016 was issued to provide clarification on the requirements of OSI’s approval of Advertisement material.
- Bulletin 2015-015 was issued requiring a disclosure on all health products (excluding disability) to inform when coverage does not meet Minimum Essential Coverage (MEC).
- Bulletin2014-018 was issued to provide clarification on the requirement of approval of forms.
- Bulletin 2015-013 Autism Benefits.
- Bulletin 2015-006 Transparency of Costs.
- Bulletin 2014-007 was issued to provide clarification on Pediatric dental.
- Bulletin 2014-013 Mental Health Parity.
Please see the Bulletins page for more information
The Office of Superintendent of Insurance requires that insurance carriers file rates and rate-related forms along with corresponding forms in SERFF. The Life & Health Rate & Form Filing Bureau does not allow “file & use” as all forms submitted are subject to review and approval prior to any use.
PY2021 On and Off Exchange Major Medical/Qualified Health Plan (QHP) Review
|Early Bird Submission (VOLUNTARY)||04/23/2020 – 05/19/2020|
|Individual and SHOP Plan Submission||05/20/2020 – 06/10/2020|
|Individual Plans Initial Transfer||06/14/2020 – 06/15/2020|
|SHOP Plans Initial Transfer||06/16/2020 – 06/17/2020|
|Rate Amendment||07/17/2020 – 07/22/2020|
|48 hour correspondence turn-around||08/04/2020|
|Approval & Certification for Individual and SHOP plans||08/14/2020|
|Open Enrollment begins||11/01/2020|
MHC Compliance Annual Submission Due Dates
Annual Compliance Filing Schedule
|Filing Name||Due Date||Legal Authority||Method|
|Provider Director(ies)||Monthly on or before the 15th of each month||NM OSI Bulletin #2016-025||Data upload|
|Network Adequacy||Annually on or before Jan 1st; updates and ECP requirements to be provided with annual QHP submission||18.104.22.168 NMAC||SERFF Submission|
|Credentialing Report||Every two years on or before February 1st beginning in 2019||22.214.171.124 NMAC||SERFF Submission|
|Provider Contract Certificate||Annually on or before March 1st||126.96.36.199 NMAC||SERFF Submission|
|Provider Grievance Plan||Annually on or before March 1st||13.10.16 and 13.10.28 NMAC||SERFF Submission|
|Member Grievance Plan||Annually on or before March 1st||13.10.17 NMAC||SERFF Submission|
|Cultural & Linguistic Diversity Plan||Annually on or before June 1st||188.8.131.52 NMAC||SERFF Submission|
|Consumer Assistance||Annually on or before June 1st||184.108.40.206 NMAC||SERFF Submission|
|Continuous Quality Improvement Plan||Annually on or before Oct 1st; updates to be provided with QHP annual submission||220.127.116.11 NMAC||SERFF Submission|
|Utilization Management Plan||Annually on or before Oct 1st; updates to be provided with QHP annual submission||18.104.22.168 NMAC||SERFF Submission|
Centers for Medicare & Medicaid Services
Consolidated Omnibus Budget Reconciliation Act
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to continue their group health benefits under certain circumstances such as job loss, reduction in hours worked, a transition between jobs, death, divorce, and other life events.
New Mexico Aging and Long-Term Services Department
Aging and Long-Term Services
The New Mexico Aging and Long-Term Services Department (ALTSD) provides services to older adults, and adults with disabilities in assisting, obtaining and receiving benefits (i.e Medigap, Long-term care insurance and other Medicare issues)
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National Association of Insurance Commissioners
National Association of Insurance Commissioners (NAIC)
The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S…Continue Reading
Contact Life and Health Rate & Product Filing Bureau
Office of Superintendent of Insurance
Life and Health Rate Filing Bureau
PO Box 1689
Santa Fe, NM 87504-1689