Qualified Health Plan Submission Information
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.
2020 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.
Major Medical / Qualified Health Plans (QHP) – Individual & SHOP/Small Group.
Pediatric Dental Plans – Individual & Small Group.
Affiliated Binders
Affiliated Rates
| Activity | Dates: (Subjected to change) |
|---|---|
| Early Bird Submission (VOLUNTARY) | 4/25/19 – 5/26/19 |
| Submission | 5/27/2019 – 6/5/2019 |
| Rate Amendment | 7/15/2019 – 7/19/2019 |
| 48 hour correspondence turn – around | 8/9/2019 |
| Approval & Certification DEADLINE – INDIVIDUAL AND SHOP | 8/16/2019 |
| NMOSI SERFF Transfer DEADLINE – SHOP | TBD |
| NMOSI SERFF Transfer DEADLINE – INDIVIDUAL | TBD |
| Open Enrollment | 11/1/2019 |
Major Medical / Qualified Health Plans (QHP) – Individual (Mirrored & Non-Mirrored) & SHOP/Small Group (Mirrored & Non-Mirrored).
Pediatric (and Non-Pediatric) Dental Plans – Individual (Mirrored & Non-Mirrored) & Small Group (Mirrored & Non-Mirrored)
Affiliated Rates
| Activity | Dates: (Subjected to change) |
|---|---|
| Early Bird Submission (VOLUNTARY) | 4/25/19 – 5/26/19 |
| Submission | 5/27/2019 – 6/5/2019 |
| Rate Amendment | 7/15/2019 – 7/19/2019 |
| 48 hour correspondence turn – around | 8/9/2019 |
| DEADLINE for approval | 8/16/2019 |
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).
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
Carrier questions about the New Mexico Health Insurance Exchange can be e-mailed to: Carrier Questions.
General Carrier Assistance for QHP and SADP plans:
- SERFF templates for Submission
- The New Mexico Qualified Health Plan Submission Guide
- Qualified Health and Dental Plans
- Student Plan Submission Guidelines
- The Frequently Asked Questions (FAQ’s) for QHP Requirements can be found here: QHP FAQ.
- Frequently Asked Questions (FAQ’s) for Pediatric Dental & Vision Requirements can be found here Dental-Vision FAQ.
QHP and SADP Life & Health Rate and Form Filing Bureau Assistance for Carriers
- Individual Form Guidelines
- Group Form Guidelines
- Pediatric Vision Checklist
- Pediatric Dental Checklist
- EHB Benchmark
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:
- Certificate of Authority information can be found under our Company Licensing Bureau