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 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 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.

2019 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.

On - Exchange

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)
Submission 6/1/2018 - 6/10/2018
Rate Amendment 7/16/2018 - 7/20/2018
48 hour correspondence turn - around 8/10/2018
Approval & Certification DEADLINE - INDIVIDUAL AND SHOP 8/20/2018
NMOSI SERFF Transfer DEADLINE - SHOP TBD
NMOSI SERFF Transfer DEADLINE - INDIVIDUAL TBD
CMS Testing TBD
Open Enrollment 11/1/2018

Off - Exchange

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 Binders
Affiliated Rates

Activity Dates:
(Subjected to change)
Submission 6/1/2018 - 6/10/2018
Rate Amendment 7/16/2018 - 7/25/2018
48 hour correspondence turn - around 8/10/2018
DEADLINE for approval 8/20/2018

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 decreases 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

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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 Company Licensing Bureau Assistance for Carriers:

1120 Paseo de Peralta | Santa Fe NM 87501 | 1-855-4-ASK-OSI | Copyright © 2018 - All Rights Reserved - OSI