New Mexico Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
New Mexico Medical Insurance Pool / NMMIP
Insurance Regulation Establishing Risk Pool
New Mexico State Legislature
Chapter 59A - Article 54
New Mexico Medical Insurance Pool (NMMIP)
The New Mexico Medical Insurance Pool (NMMIP) was established by the 1987 New Mexico State Legislature to provide access to health insurance coverage to residents of New Mexico who are denied health insurance by the private health insurers and considered uninsurable. NMMIP also provides health benefit portability coverage to New Mexicans who have exhausted COBRA benefits and have no other portability options available to them.
Funding
NMMIP receives funding from the insurance premiums paid by plan members and assessments to insurance carriers and HMO's operating in New Mexico. There is a partial tax credit offset provided against the premium taxes paid by the insurance companies.
Plans Offered
NMMIP offers three 80 percent PPO plans and three 100 percent PPO plans, each with different deductibles and out-of-pocket maximums.
Plan Benefits
The 80 percent PPO plans offer deductibles of $500, $1,000 and $2,000. For most in-patient covered medical services, the NMMIP member is required to pay 20% coinsurance. For most out-patient services, the NMMIP member is required to pay 20% coinsurance. The maximum out-of-pocket limit, including deductible, is $2,500 for the $500 deductible, $3,500 for the $1,000 deductible and $5,000 for the $2,000 deductible. The 100 percent PPO plans offer deductibles of $5,000, $7,500 and $10,000. The Pool pays 100% of covered charges after the deductible is met.
Maximum Benefit Limits
There is no overall lifetime maximum payment limit. However, there are specific lifetime maximums for certain benefits. Please refer to Summary of Benefits and Plan Options for more details.
Eligibility
There are two categories of eligibility for the New Mexico Medical Insurance Pool
Standard Eligibility
- You are a resident of New Mexico
- You have received a notice of rejection for health insurance coverage from at least one insurance company providing comprehensive coverage
- Or, you were approved for other medical insurance but the premium for coverage exceeds the rate of the $500 deductible NMMIP plan for the same age and gender
- Or, you were approved for other medical insurance but the premium for coverage exceeds the rate of the $500 deductible NMMIP plan for the same age and gender
- Or, you were approved for coverage with another insurance company but received a reduction or exclusion in your coverage, including a restrictive rider for a pre-existing medical condition for longer more than 12 months
- Or, you lost your individual health plan because the insurance carrier stopped selling any health insurance in New Mexico
- Or, have received a letter from your physician stating that you have been diagnosed with one of the medical conditions specifically outlined in the plan brochure
Portability Eligibility
- You are and continue to be a resident of the state of New Mexico
- You have had a minimum 18 months of continuous coverage, the last of which must be group coverage
- You have received notice of termination of group health coverage, including COBRA continuation, that terminated within 95 days prior to the initial application date
Enrollment Periods
You may apply for coverage under the New Mexico Medical Insurance Plan at anytime. Coverage will become effective on the first day of the month following approval of your application, provided that your application is received and approved before the cut-off day of each month.
Premium Payments
Premiums for NMMIP are based on your plan selection, your gender and your age.
Premium Calculations
NNMIP premiums are capped at 125% of the standard rate for similar coverage available from insurance companies offering health insurance in New Mexico.
Pre-Existing Condition Waiting Periods
NMMIP standard eligibility plans have a 6 month waiting period before you may receive benefits on pre-existing medical conditions. Under federal HIPAA eligibility, the exclusionary period for pre-existing conditions may be waived.
New Mexico Comprehensive Health Insurance Pool Contact Information
NMMIP Contact Info
New Mexico Medical Insurance Pool
P.O. Box 6726
Santa Fe, New Mexico 87502
Phone: 866-622-4711
NMMIP Website
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