New Mexico (NM)
Individual Health Insurance Regulations

Learn more about New Mexico Individual Health Insurance

Individual medical insurance plans in New Mexico are not guarantee issue. New Mexico law permits all individual health insurance plans to be medically underwritten, allowing the health insurance carrier an opportunity to review your past and current health history. Based upon information provided to the health insurance carrier, the insurance company may opt to deny coverage, approve coverage or approve a modified version of coverage with specific limitations or exclusions. Each health insurance carrier can impose a 6 month exclusionary period limit on pre-existing medical conditions. If you have prior creditable coverage, it must be recognized and applied to the 6 month exclusionary period. New Mexico law also permits the use of elimination riders which may temporarily or permanently eliminate coverage of specific health conditions. Insurance premiums are not regulated in New Mexico.

Request New Mexico Individual Health Insurance Quotes from any of our multiple providers.

New Mexico (NM)
Small Group Health Insurance Regulations

Defined as any company with 2-50 employees, small group health insurance coverage in New Mexico is guaranteed issue. Guarantee issued coverage assures that the group may not be declined coverage based on past or current health history of the group or its individual members. Health insurance carriers may impose a 6 month maximum exclusionary period on pre-existing medical conditions on all applicants lacking prior creditable coverage. The look back period is limited to 6 months. Each qualified employee may be required to satisfy an employer imposed waiting period prior to joining the group health plan. New Mexico provides for the medical underwriting of group rates. Small groups with an unfavorable health history may be charged a maximum premium no more than 125% of the standard small group rate.

Small business owners can request quotes for New Mexico group health insurance from any of our listed providers.

New Mexico COBRA and Continuation Coverage

New Mexico has its own mini-COBRA law similar to the federal COBRA law. The state regulated COBRA program offers continuation of group health benefits to qualifying employees for a period of six months. To qualify for mini-COBRA, an employee must have been covered under the group health plan for at least 6 months and must be eligible through a qualifying event. A COBRA qualified individual must elect their COBRA coverage within 30 days of the loss of their eligibility for group health coverage. Monthly premiums under the mini-COBRA program are the sole responsibility of the employee. Groups with more than 19 employees must also offer COBRA under federal law. Conversion plans are available to any person that elects to convert their COBRA coverage into an individual health plan. For those that are exhausting their COBRA coverage, the state high-risk pool offers guaranteed individual health insurance if accepted within 63 days of the COBRA termination date.

Title 13, Chapter 10, Part 11.31 states that persons insured under a group plan with 2-19 employees can qualify for 6 months of continuation coverage.