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New Mexico Health Insurance Information

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Updated January 04, 2009

New Mexico Insurance Division

The New Mexico Insurance Division is responsible for regulating all types of insurance sold in the state of New Mexico - including health insurance policies.

If you are looking for health insurance coverage, the Insurance Division can help you find an insurance agent or insurance company that is licensed to do business in New Mexico. You can contact them at the phone number listed below.

If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Insurance Division. There are separate complaint forms for those who have managed care plans (HMO/PPO) and those who have indemnity insurance. If you are not sure whether you have managed care or an indemnity plan, contact the Insurance Division for help.

New Mexico Insurance Division
P.E.R.A. Bldg., 4th Floor
1120 Paseo de Peralta
Santa Fe, NM 87501
Phone: 505-827-4601 or 800-947-4722

U.S. Department of Labor

If you get your insurance through your job, your plan is also regulated by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees - for example, your employer cannot single out an individual employee to exclude her from the plan because she (or one of her dependents) has a costly illness. Also, if there are 20 or more employees at your job, you should be offered COBRA continuation coverage when you leave your job. The EBSA works to make sure that all of this happens and your rights are protected.

If you have concerns about your employer's practices in administering your job-based health coverage - for example, if you think you should have been offered COBRA continuation coverage, but were not, or if you feel that you were wrongly terminated from your health plan - contact your regional EBSA office.

U.S. Department of Labor Employee Benefits Security Administration
Dallas Regional Office
525 South Griffin Street, Room 900
Dallas, TX 75202-5025
Roger Hilburn - Director
Phone: 972-850-4500
Fax: 214-767-1055

Buying Individual Policies in New Mexico

As a general rule, insurers in New Mexico are allowed to reject your application for coverage based on your health status. However, you may qualify for coverage as a "HIPAA-eligible" individual if you:

  • had at least 18 months of continuous creditable coverage, the last day of which was under a group plan AND
  • you have exhausted all COBRA continuation coverage which was available to you.

People who are HIPAA-eligible are guaranteed the right to buy insurance through the New Mexico Medical Insurance Pool (described below). If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Insurance Division can help you find out.

New Mexico Medical Insurance Pool (NMMIP)

NMMIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers "HIPAA-eligible" individuals as described above. The NMMIP website has information on their eligibility requirements, as well as current premium rates and benefit packages.

New Mexico Medical Insurance Pool
P.O. Box 1594
Roswell, NM, 88201
Phone: 505-622-4711

New MexiKids - the State Children's Health Insurance Program

NewMexiKids provides health insurance coverage for children under age 19 whose family income is between 185% and 235% of the federal poverty level.

New MexiKids
New Mexico Human Services Department
2009 S. Pacheco, Pollon Plaza
Santa Fe, NM 87504
Phone: 888-997-2583

New Mexico Benefits Counseling Program

The New Mexico Benefits Counseling Program provides free one-on-one counseling for Medicare beneficiaries with questions about any aspect of Medicare, including the Medicare Part D prescription drug benefit, or Medigap coverage.

New Mexico Benefits Counseling Program
Phone: 866-451-2901

New Mexico Medicaid

Medicaid is a government program designed to help the poor and indigent obtain health care services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals. For more information about New Mexico Medicaid, including eligibility requirements, contact the New Mexico Medical Assistance Division at the number listed below.

New Mexico Medical Assistance Division
P.O. Box 2348
Santa Fe, NM 87504-2348
Phone: 888-997-2583
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