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.

2022 ACA Timeline

2022 Letter to Issuers Participating in New Mexico’s state based exchange (the beWellnm System”) can be viewed here.

PY2022 On and Off Exchange Major Medical/Qualified Health Plan (QHP) Review

Early Bird Submission (VOLUNTARY) 4/22/2021
Individual and SHOP Plan Forms Submission Due Date 6/11/2021
1st Transfer of Individual Plans (Forms Only) 06/15/2021-06/15/2021
1st Transfer of SHOP Plans (Forms Only) 6/18/2021
Individual and SHOP Plan Rates Submission Due Date 6/25/2021
2nd Transfer of Individual Plans (Form & Rates) 6/26/2021
2nd Transfer of SHOP Plans (Form & Rates) 06/28/2021   
Rate Amendment 07/14/2021-7/15/2021
3rd Transfer of Individual Plans (Form & Rates) 7/16/2021
3rd Transfer of SHOP Plans (Form & Rates) 7/18/2021
48 hour correspondence turn-around 8/2/2021
24 hour correspondence turn-around 8/9/2022
Approval & Certification for Individual and SHOP plans 08/14/2020
Open Enrollment begins 11/01/2020
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:

Phone: 1-855-4ASK-OSI (1-855-427-5674)
1120 Paseo de Peralta, Suite 428
Santa Fe, NM 87501