The Life and Health Division reviews all health and life insurance contracts (policies), rates, advertisements and other forms for compliance with all applicable laws and regulations. We must approve all of these prior to the marketing of the insurance product. The Division also ensures that commercial health insurers comply with laws and regulations concerning the adequacy of provider networks, utilization management policies and prior authorization processes, member and provider grievance practices, quality improvement plans, cultural competency training, and behavioral health parity laws. 

In addition, the Life and Health Division oversees prescription benefit managers’ (PBMs) compliance with laws and regulations, and we administer aspects of the Vaccine Purchasing Act (VPA) in cooperation with the New Mexico Department of Health. The Division also supports OSI’s goal of increasing access to affordable health insurance coverage through policy innovation, the implementation of legislative initiatives, and ongoing economic and demographic research concerning health insurance coverage and affordability.