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New Mexico Risk Pool - Health Insurance Provided for the Uninsurable

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FAQ

Acronym or name of the risk pool: New Mexico Medical Insurance Pool or NMMIP.

Regulation establishing risk pool: New Mexico state legislature under chapter 59a, article 54.

Funding: NMMIP receives funds from insurance premiums paid by members of the plan and also from tax assessments on companies operating in the state. A partial tax credit offset is provided for the premium taxes paid by the companies.

Plans offered: 80% and 100% PPO plans are offered. Each has separate deductibles and out of pocket limits.

Plan benefit: The 80% PPO plans offer deductibles of $500, $1000 and $2000. The in network medical covers are offered at a coinsurance level of 20%. The member is expected to pay 20% coinsurance rates for out of network services. The out of pocket maximum is $2500 on a deductible of $500 and it is $3500 on a deductible of $1000. The $2000 deductible has an out of pocket limit of $5000. The PPO plans offer deductibles of $5000, $7500 and $10000. 100% charges are covered after the payment of deductibles.

NMMIP plan details: http://www.nmmip.com/deductibles.htm

Maximum benefit limits: There is no limit on the lifetime maximum that is payable however, particular maximums apply for certain benefits. Look up the plan brochure for details.

Eligibility: There are two sets of eligibility conditions that are to be satisfied.

Standard eligibility requirements - (1) The person must be a resident of New Mexico for at least 6 months. (2) The person must have received a notice rejecting his application for insurance from an admitted company in the state within the last 6 months. (3) You are not receiving benefits from any other plans, state or federal. (4) No other health coverage is being provided to the individual. (5) You are paying premiums at a rate that is more than the rate for NMMIP. (6) The person has one of the conditions specified under NMMIP brochure as is evident in a letter provided by the physician. (7) You lost your cover as the company stopped selling health insurance in the state.

Portability eligibility: (1) You are a resident of New Mexico and are continuing as such. (2) You have had at least 10 months of coverage and the last was group coverage. (3) The group plan has been terminated and you have ended coverage under COBRA. (4) The plans have ended within the last 63 days of filing of application.

Enrollment periods: You can apply for the plans at any time. NMMIP covers become effective on the first of the month following approval. This is true if the application is received within the cutoff date for a month.

Premium payments: The rates of premium are determined by your age, gender and your plan.

Premium calculations: The rate assigned is 107% of the standard rate charged by insurance companies in the state.

Pre existing condition waiting period: There is a 6 month waiting period for pre existing conditions under these plans. There is also a waiver for persons having HIPAA eligibility.

Contact information: New Mexico Medical Insurance Pool. P.O box 1594 Roswell, New Mexico 882021594. NMMIP Website.

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