Life & Health Product Filings Bureau

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

Applicable Bulletins

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.

Prior Authorizations Data Call Reporting Template (Bulletin no. 2019-11)

  • 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 13.10.20.10(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

Rate Bulletins

Rate Bulletins

  • Bulletin 2016-009 Requirements for rate and form & rate filing submissions.
  • Bulletin 2016-007 Adjustment of presumptively acceptable credit life insurance and credit card accident and health insurance premium rates.
  • Bulletin 2014-004 Rate and Form Filing Request for Confidential 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.

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 13.10.22.8 NMAC SERFF Submission
Credentialing Report Every two years on or before February 1st beginning in 2019 13.10.28.10 NMAC SERFF Submission
Provider Contract Certificate Annually on or before March 1st 13.10.22.12 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 13.10.22.11 NMAC SERFF Submission
Consumer Assistance Annually on or before June 1st 13.10.13.13 NMAC SERFF Submission
Continuous Quality Improvement Plan Annually on or before Oct 1st; updates to be provided with QHP annual submission 13.10.22.10 NMAC SERFF Submission
Utilization Management Plan Annually on or before Oct 1st; updates to be provided with QHP annual submission 13.10.22.9 NMAC SERFF Submission

COBRA

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.

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CMS

The Centers for Medicare & Medicaid Services (CMS) is a federal agency that administers the Medicare program and works in partnership with state governments to administer.

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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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What’s Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy helps pay some of the health care costs that Original Medicare doesn’t cover, like:
  • Copayments
  • Coinsurance
  • Deductibles

Medigap policies are sold by private companies…Continue Reading

New Mexico Health Insurance Exchange

beWellnm is New Mexico’s official health insurance exchange where individuals, families and small businesses can compare plans and get ready to enroll…Continue Reading

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
Mailing Address

Office of Superintendent of Insurance
Life and Health Rate Filing Bureau
PO Box 1689
Santa Fe, NM 87504-1689
P: 1-855-427-5674
F: (505)-827-3833

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