New Mexico Health Insurance Guide
New Mexico Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a resident of New Mexico you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for New Mexico State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
New Mexico is not a guarantee issue state. By law, private insurance companies that sell individual policies must medically underwrite them and are required to sell you an individual health insurance policy if you do not meet their criteria. You can be turned down for any number of reasons including your past or current health and lifestyle habits. In New Mexico, insurers are permitted a six month exclusionary period and a six-month look-back period for pre-existing conditions, but they must grant you credit for prior creditable coverage. New Mexico also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions. Premiums, which are not regulated by the state, can be based on your health, your age and history of tobacco use. There are no requirements for insurers to issue standardized policies to individuals.
New Mexico is a guarantee issue state for group health plans issued to small businesses, providing a minimum participation requirement is met. If your New Mexico health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. The insurer can impose a six-month exclusionary period and a six-month look-back period for pre-existing medical conditions. Credit for prior creditable coverage is mandated if you have had no more than a 63-day break in your health insurance coverage. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 20% of its index rate if your group has a history of unfavorable health. determined by location, age and type of work and health status of the group with a permissible rate adjustment factor of 15%.
New Mexico is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
New Mexico Mandated Health Benefits
New Mexico laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Anti-Psychotic Drugs
- Birthing Centers and Midwives
- Bone Mass Measurement
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Clinical Trials
- Colorectal Cancer Screening
- Contraceptives
- Dental Anesthesia
- Diabetes Supplies
- Emergency Services
- Hair Prostheses
- Home Health Care
- In Vitro Fertilization and Other Fertility Services
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity and Maternity Stays
- Parity Mental Health
- Newborn Hearing Screening
- Off Label Drug Use
- PKU/Formula
- Prostate Cancer Screening
- TMJ Disorders
- Well-Child Care
- Coverage for newborns under parent's policy
- Coverage for adopted children under parent's policy
- Coverage for handicapped dependents under parent's policy
- Coverage for continuation/dependents under parent's policy
- Coverage for dependent students under parent's policy
- Coverage for non-custodial children under their parent’s policy
- Coverage for domestic partners
- Coverage for continuation/employees
- Coverage for conversion to non-group
Types Health Insurance Plans Available in New Mexico
The following major medical health insurance plans are generally available in New Mexico. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in New Mexico
The New Mexico Medical Insurance Pool
NMMIP is the state-sponsored high-risk pool that offers health insurance to state residents who have been unable to secure coverage from private insurers because of a pre-existing condition or certain other qualifiers. NMMIP also provides health benefit portability coverage if you have exhausted COBRA benefits and have no other options. Other factors determine whether you are eligible for the Standard or Portability programs. You can choose from three 80% PPO plans and three 100% PPO plans. Deductibles, co-pays, coinsurance and maximum out-of-pocket expenses will vary based on the plan you choose. Premiums are based on the plan you select, your sex and your age, but are capped at 125% of the standard rate charged for similar coverage in New Mexico.
NECHIP enrollment is open and coverage becomes effective on the first day of the month after your application is approved. There is a six-month exclusionary period for pre-existing conditions, but federal law provides that it can be waived under certain circumstances.
New MexiKids
This program provides comprehensive free or low-cost health care for resident children up to age 19, whose families meet income requirements. Families can choose from four managed care organizations. Premiums, co-pays and coinsurance will vary depending on family income. Waiting periods may be imposed. Enrollment is open but is subject to review and renewal every 12 months.
Regulating Agency
The Insurance Division of New Mexico Public Regulation Commission is responsible for regulating New Mexico’s health insurance industry.
Get access to New Mexico health insurance quotes from http://www.einsurance.com/health-insurance.
New Mexico Public Regulation Commission – Insurance Division
PO Box 1269
Santa Fe, NM 87504-1269
(888) 427-5772
http://www.nmprc.state.nm.us/id.htm
New Mexico Medical Insurance Pool
111 S Kentucky Ave
Roswell, NM 88203-4518
(575) 622-4711
http://www.nmmip.org
New MexiKids
(888) 997-2583
http://www.insurenewmexico.state.nm.us/NewMexiKidsandTeens.htm
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/