Healthcare Reform

For Consumers:

Office of Superintendent of Insurance has the regulatory responsibility for licensing Qualified Health Plan (QHP) issuers and the regulatory responsibility of form and rate compliance.

You can follow the Health Reform Timeline for a general overview of the Health Reform.

For Carriers submitting Qualified Health Plans for review:

Similar to the QHP certification process in previous years, the New Mexico Office of Superintendent (NMOSI) will conduct reviews of qualified health plans (QHPs) and stand-alone dental plans (SADPs) and provide to CMS the determinations for the current year. NMOSI evaluates health and dental plans against QHP and SADP certification standards as part of the state’s traditional regulatory role for the insurance industry and/or enforcement of Title XXVII of the Public Health Service Act (PHS Act), or otherwise for state purpose.

2021 ACA Timelines

OSI has taken into consideration the concerns of the carriers with regard to the submission timeframe for large group filings. Large Group submissions in SERFF will now be allowed to be submitted throughout the year. However, OSI strongly recommends that no new plans/filings be submitted during the ACA review timeframe, as this will hinder a timely review of the carrier’s large group filing.

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

QHP Application, materials, and other resources from CMS

https://www.qhpcertification.cms.gov/s/Application Materials

Rate Decrease Information

The Superintendent of Insurance allows for rate changes in the small group market outside of the submission window under the following conditions:

 

  • The small group plan is sold off-exchange only; meaning the small group plan cannot be mirrored to a plan sold on the exchange.
  • The overall rate impact of the filing is a decrease
  • No policyholder is receiving a rate increase (i.e. all individual rate changes must be decreased or stay neutral).

 

New Mexico Health Insurance Exchange Information

Information about the next meeting of the New Mexico Insurance Exchange is available on the Health Insurance Exchange

Continue Reading »

 

Carrier questions about the New Mexico Health Insurance Exchange can be e-mailed to: Carrier Questions.

General Carrier Assistance for QHP and SADP plans:
QHP and SADP Life & Health Rate and Form Filing Bureau Assistance for Carriers

QHP and SADP forms and rates are submitted via System for Electronic Rate and Form Filing (SERFF)

QHP and SADP Company Licensing Bureau Assistance for Carriers: