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 13.10.36.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Terms are as defined in the Insurance Code, and as
				  supplemented below.
A.
"Advance state payments"
means marketplace affordability program
				payments by the fund to a participating health insurance issuer on a monthly
				basis to lower premium and state out-of-pocket assistance for
				consumers.
B.
"Affordability
				criteria"
means the factors used to determine the amount of premium
				assistance or state out-of-pocket assistance that will be provided from the
				fund on behalf of an eligible individual.
C.
"Eligible plan"
means a
				health plan sold on the New Mexico health insurance exchange (the "exchange" or
				"marketplace") that meets the requirements for the state premium assistance
				program.
D.
"Federal poverty
				level or FPL"
means the federal poverty level issued annually by the U.S
				department of health and human services at
				aspe.hhs.gov/poverty-guidelines/.
E.
"Income criteria"
means parameters to establish eligibility for
				marketplace affordability programs.
F.
"Modified adjusted gross income or
				MAGI"
means modified adjusted gross income as defined in 42 CFR §
				435.60.
G.
"Marketplace
				affordability program"
means a fund program that reduces premiums and
				OOP costs for individuals and families who purchase individual or family
				coverage on the exchange.
H.
"OOP"
means out-of-pocket.
I.
"Participating health insurance
				issuer"
means a health insurance issuer who is authorized to sell a QHP
				on the exchange or in the fully-insured small group market who has confirmed in
				writing its intention to participate in a specified fund program prior to the
				commencement of the plan year.
J.
"Plan year"
means the year for which a participating health
				insurance issuer underwrites qualifying health insurance coverage.
K.
"Premium assistance"
means
				a fund program that pays a participating health insurance issuer to cover a
				portion of the premium obligation of a person who meets premium assistance
				affordability criteria.
L.
"QHP"
means a qualified health plan.
M.
"Small business health insurance
				premium relief initiative"
means a program to reduce premiums for small
				businesses that purchase QHPs in the small group health insurance
				market.
N.
"Small group QHP
				purchaser"
means an employer who purchases one or more QHPs for any of
				its employees or owners through the small business health options program or
				directly from a health insurance issuer selling QHPs in the small group health
				insurance market.
O.
"State
				benchmark plan"
means a qualified health plan that has been approved for
				sale on the exchange and that is identified by the superintendent as the plan
				to be used in developing affordability criteria.
P.
"State out-of-pocket assistance
				program"
means a fund program that reduces OOP costs for households that
				meet eligibility and income criteria established by the
				superintendent.