New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 36 - STANDARDS FOR ACCIDENT-ONLY, SPECIFIED DISEASE, HOSPITAL INDEMNITY, DISABILITY INCOME, SUPPLEMENTAL, AND NON-SUBJECT WORKER EXCEPTED BENEFITS › Section 13.10.36.11 - SMALL BUSINESS HEALTH INSURANCE PREMIUM RELIEF INITIATIVE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule governs the agency's small business health
				  insurance premium relief initiative, which applies to QHPs sold through the
				  small business health options program or purchased directly from a health
				  insurance issuer selling QHPs in the small group health insurance
				  market.
A.
Premium reduction
				percentage bulletin.
Annually, based on available funding, the
				superintendent will issue a bulletin establishing a premium reduction
				percentage that will apply to all QHPs sold in the small group health insurance
				market. Health insurance issuers participating in the market shall discount
				charges to small group QHP purchasers by the percentage established by the
				superintendent and show the amount of the discount in all invoices to the
				purchaser. The superintendent may allow issuers to apply the discount directly
				or through a credit on the following month's premium. The bulletin will
				establish the percentage reduction, reporting requirements, timetable and
				process for issuer reimbursement, and other requirements. The superintendent
				may issue additional guidance, if needed.
B.
Reporting requirements and annual verification of
				accurate payments.
Health insurance issuers selling QHPs in the small
				group health insurance market must report data related to enrollment, premiums,
				and reimbursement from the health care affordability fund to the office of
				superintendent of insurance on a regular basis, based on the requirements of
				the bulletin. Following each calendar year, on a date established by the
				superintendent, issuers must report annualized data requested by the agency to
				verify the accuracy of payments made from the fund. The superintendent will
				require issuers to replenish the fund if it is determined that any overpayment
				has been issued.
C.
Payments
				to participating issuers.
On a regular basis, as established in the
				bulletin, the office of superintendent of insurance will make payments from the
				health care affordability fund to issuers for the remainder of the gross
				premium that that would otherwise by owed by small group QHP purchasers if the
				small business health insurance premium relief initiative were not in effect.
				The data received by OSI pursuant to Paragraph B of Section 10 of this rule
				serves as the basis for OSI's regular payments to issuers from the health care
				affordability fund. Issuers must invoice the agency according to the bulletin's
				instructions in order to receive payment.
D.
Notification of small group QHP purchasers.
The
				superintendent will specify a date before the initiative goes into effect by
				which health insurance issuers must notify their small group QHP purchasers
				about the premium reductions provided by the initiative. Issuers subject to the
				rule should reflect the premium reduction amount in all invoices.
E.
Treatment as third-party
				payment.
For the purposes of the federal risk adjustment program and
				federal medical loss ratio requirements, the state payment under this section
				should be considered a third-party payment that is part of the gross
				premium.