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Our affiliate New Mexico Health Insurance Agents license with many of the quality Insurance Companies in New Mexico.  When you work with one of our Health & Medical Insurance agents they will provide the most affordable low cost health insurance or New Mexico medical insurance plans for small business, self employed, families, individuals and groups.  Your needs and budget are a primary concern in choosing a quality New Mexico health care plan. More importantly, you want a company that will be easy to work with when you have a claim. For  Health Insurance plans and HSA's (Health Savings Accounts) we make your search for affordable low cost health insurance easy.



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Your Rights under New Mexico Health Insurance Law

(Copyright 2005 All Rights Reserved)

 

There are numerous state and federal laws that make getting or changing health insurance, either individual or group, easier for people with pre-existing conditions. The federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans.

Group Health Insurance for New Mexico:

In New Mexico, coverage under group health plans cannot be denied or limited, nor can you be required to pay more, because of your health status. This being called Nondiscrimination. Group health plans cannot not apply a pre-existing condition exclusion for pregnancy, newborns, newly adopted children, children placed for adoption, or genetic information (testing).

If you leave your job, like all states, you may be offered COBRA continuation coverage or state continuation coverage, at a cost to you. There are limits, though, on what you can be charged for such coverage.

If you lose coverage under fully insured group health insurance, New Mexico offers a conversion policy. This is a policy from the company that you were insured your former group. It cannot apply a new pre-existing condition exclusion period.

If you are HIPAA eligible, you are then guaranteed access to several types of individual health insurance policies. You can purchase individual coverage from New Mexico Medical Insurance Pool (NMMIP) or the New Mexico Health Alliance (the Alliance).

If you are a small employer buying a group health plan, you cannot be turned down because of the health, age, or any other factor for that matter, that might predict the use of health services by those in your group. Should you purchase a plan outside of the Alliance, you could be charged more due to the factors listed above (within limits). Health plans must be sold to you on a guaranteed issue basis.

Small employers with 2 to 50 employees, or the self-employed buying coverage for themselves and at least one other family member, may also purchase plans through the New Mexico Health Insurance Alliance. Self-employed with no other workers, however, cannot buy group plans on your own outside of the Alliance. You can, however, deduct 100% of your premium from your federal income taxes.

Individual Health Insurance for New Mexico:

In New Mexico, individual health insurance accessibility may depend on you health status. If you are HIPAA eligible, the NMMIP and the Alliance (offering HMO, PPO, and indemnity plans) are your only guaranteed access to individual health insurance. Being HIPAA eligible will also exclude you from pre-existing exclusion periods. If you are not HIPAA eligible, insurers can impose permanent elimination riders.

In New Mexico, if you have coverage through an employer’s fully insured group health plan and you leave that job for any reason, you are eligible to buy conversion coverage. Conversion coverage is an individual policy that you receive from the company that insured your employer’s group plan. To qualify, you must first use up COBRA or state continuation and cannot be eligible for Medicare or any other federal/stare insurance programs. Conversion rights also apply to surviving spouse and children, children when they reach the end of dependent coverage, and to spouse and children or divorce. HIPAA eligibility will also buy you a conversion policy.

New Mexico does have a high-risk pool program, called the New Mexico Medical Insurance Pool (NMMIP), which provides health insurance coverage to residents of New Mexico who are denied adequate health insurance, considered uninsurable and for people who are HIPAA eligible.

Under New Mexico law, newborns, adopted children and children being placed for adoption are automatically covered under the parents fully insured health plan for the first 31 days. Given the plan covers dependents. At which that time, the insurer may require that the parent enroll the child within that 31 days in order to keep coverage. Children that are disabled, are covered, fully insured, even after the age to at which most insurance’s would discontinue coverage given proof of the disability within 31 days of reaching the limiting age.

There are programs that are offered to New Mexico residents that can help if you meet certain state and federal guidelines. Medicaid is a free or subsidized health program, which is offered to families with children, pregnant women, the elderly, and people with disabilities, if marked guidelines are met. For certain categories of people, Medicaid is primarily based on the amount of your household income. Parents who receive benefits under TANF can generally stay on Medicaid for a 12-month transitional period. Children may also qualify to stay on Medicaid if your family’s income meets the standards.

The New Mexi Kids program provides health coverage to low-income New Mexico children under the age of 19 who are not eligible for Medicaid and are uninsured. You can apply at most clinics, hospitals, and schools.

Women who are diagnosed with breast or cervical cancer or a pre-cancerous condition through the New Mexico Breast and Cervical Cancer Early Detection Program (BCC) can apply for full healthcare coverage through Medicaid. This will cover the costs of treatment. If you do not qualify for Medicaid, you may be able to get financial assistance through other programs, including the Anita Salas Memorial Fund.

If you lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program, then you may be eligible for federal income tax credit from the Health Coverage Tax Credit (HCTC) to help you pay for new, qualified, health coverage. Retirees between the ages of 55-65 who are receiving pension benefits from the Pension Benefit Guarantee Corporation (PBGC) may also be HCTC eligible. These are the only two ways to obtain HCTC benefits. HCTC eligibility is not based on income. Nor is it refundable.

HCTC qualified health coverage includes: COBRA continuation, Individual health insurance in which you were enrolled for at least 30 days, spousal insurance as long as the employer contributes less than 50% of premium.

You can claim HCTC on your tax return and be reimbursed up to 65% of premium if your spouse’s employer provided your health plan. You can also choose to have your credit sent directly to your qualified health plan each month. You must register w/the HCTC Customer Service Center @ 1-866-628-4282 or TDD/TYY callers @ 1-866-626-4282. Registry must be made in advance in order for the HCTC to be paid for directly each month. Usually, the payments won’t begin until at least a month after you register w/HCTC.

To help you find the best health insurance company check out the complaint ratio. Click here for the instruction sheet on "How to find an insurance company complaint ratio".

For questions about:
Individual Health Insurance, Fully Insured Group Health Insurance, State Continuation Coverage, or Conversion Coverage - Contact: New Mexico Division of Insurance
         (800) 947-4722 (New Mexico Calls Only)
        
(505) 827-4601 or http://www.nmprc.state.nm.us/insurance/inshm.htm

You can also contact the New Mexico Comprehensive Health Insurance Pool at (505) 816-4248. They currently are open to new enrollees with a 6-month waiting period at this time.

To help you find the best health insurance company check out the complaint ratio. Click here for the instruction sheet on " How to find an insurance company complaint ratio".


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