COVID-19 Insurance Updates
April 14, 2020
On March 26, 2020, the Superintendent of Insurance issued Bulletin 2020-007, requiring insurers with an office in New Mexico to comply with orders issued by the state’s Department of Health regarding social distancing and other methods of mitigating or preventing the spread of COVID-19. The bulletin also reminds insurers that call centers in New Mexico must reduce their workforces by 100%, asks for help in fighting fraud, and reminds insurers that excepted benefit policies must include notices that state that they may not cover costs relating to the diagnosis or treatment of COVID-19.
On April 1, 2020, the Superintendent issued Bulletin 2020-008, urging all insurers licensed in New Mexico to speed up payments to hospitals and streamline administration in the following ways:
- Accelerating claim payments from 30 days to 10 or 15 days
- Reducing or eliminating prior authorization requirements, and suspending or eliminating concurrent and retrospective reviews
- Taking steps to facilitate discharging processes
- Advancing payments to hospitals
- Implementing emergency credentialing and enrollment to make sure there are providers able to care for patients
- Clarify that coverage and cost sharing decisions will be made on presenting symptoms, not a final diagnosis
- Allow members to use out of network providers as if they were in network under certain circumstances
The bulletins are primarily directed at insurers. However, employers should also be aware of these developments.
Bulletin 2020-007 »
Bulletin 2020-008 »
Medical Insurance Pool Available for Uninsured Residents Diagnosed with COVID-19
March 31, 2020
New Mexico residents who do not have health insurance and have been diagnosed with COVID-19 can enroll in the New Mexico Medical Insurance Pool (NMMIP), which is a non-profit program that enables private health insurance companies to pool resources and cover New Mexicans who have been denied health insurance.
Employers whose employees may lose their jobs and their health insurance as a result of COVID-19 should be aware of this option.
NMMIP Information »
COVID-19 Insurance Updates
March 31, 2020
In March, the Superintendent of Insurance issued an emergency rule, two orders, and two bulletins in response to the COVID-19 outbreak. These actions apply to insurance plans regulated by the state.
On March 12, 2020, the superintendent ordered that insurers providing major medical coverage and insurers providing limited benefits coverage to notify their members whether and to what extent their policies cover testing and health care services related to COVID-19. Additionally, if an insurer only offers limited coverage, they must notify their members of available full coverage options. The Superintendent also ordered limited benefit plans (such as workers’ compensation and automobile medical payment insurance) to provide notice to their members that their plans do not provide comprehensive medical coverage and to give members information on where they should go to check on their eligibility to apply for and obtain such coverage.
On March 12, 2020, the superintendent ordered an emergency amendment to an existing cost sharing rule that creates a presumption that it is unreasonable and prohibit any cost sharing requirement for the provision of health care services for COVID-19, pneumonia, influenza or any disease or condition that is the cause of, or the subject of, a public health emergency. This amendment was ordered under the authority of Gov. Grisham, who issued Executive Order 2020-004 that directed the superintendent to promulgate emergency rules maximizing the available insurance coverage for New Mexicans suffering from COVID-19, pneumonia or influenza, while simultaneously ensuring that medical costs do not create a barrier to testing and treatment. The amendment would apply to insurance policies regulated by the state.
On March 17, 2020, the superintendent issued Bulletin 2020-005. The bulletin reminds insurers that New Mexico law requires them to treat telemedicine visits and in-person visits equally. In addition, the bulletin reminds insurers that they cannot impose prior authorization requirements or cost sharing requirements upon services to person with COVID-19 and that limits or barriers to telemedicine visits may cause their plans to fail network adequacy requirements.
On March 20, 2020, the Superintendent of Insurance issued Bulletin 2020-006. The bulletin requests that all insurance companies refrain from cancelling or nonrenewing policies of businesses and individuals negatively impacted by the disruption due to the nonpayment of premiums during this public health emergency, or at a minimum, provide extended grace periods for payment of premiums. It also requests that all insurance companies work with their insureds after the public health emergency is over to allow the insureds to catch up on past due premiums in installments without loss of coverage.
Employers with policies regulated by New Mexico should be aware of these developments.
Press Release »
Emergency Rule »
Excepted Benefit Plan Order »
Bulletin 2020-005 »
Bulletin 2020-006 »
Insurance Updates Regarding COVID-19
March 17, 2020
On March 6, 2020, the Office of Superintendent of Insurance issued Bulletin 2020-004 that applies to all insurers licensed to sell health insurance in the state. The Bulletin encourages applicable insurers to educate their members regarding guidance issued by the New Mexico Department of Health and the CDC on COVID-19, as well as to let network providers know about the recommendations and protocols issued by those agencies. The Bulletin advises insurers that they and their network providers are expected to bill and process claims using codes promulgated by CMS relating to COVID-19.
The Bulletin also asks insurers to make sure that members who may be self-quarantined can obtain one-time refills of their prescriptions prior to the expiration of the normal refill waiting period.
Employers with policies regulated in New Mexico should be aware of these developments.
Bulletin 2020-004 »
Excepted Benefit Form Filings Not Approved Until Rules in Place
March 03, 2020
On February 25, 2020, the Office of Superintendent of Insurance issued a statement that the office will not approve excepted form filings until rules and standards are in place to protect the public from purchasing insurance products that may not provide benefits or protections required under the ACA. Excepted benefits, such as limited health benefits and accident and sickness coverage, are not intended to replace major medical plans. However, the office has become aware that some excepted benefit plans are being packaged and sold as replacements.
The Short-Term Health Plan and Excepted Benefit Act, effective June 14, 2019, requires the office to promulgate rules to establish permissible content and terms of those plans. In the meantime, the office will not approve excepted plan filings.
Employers should be aware of these developments and alert to attempts to sell excepted benefit plans as medical plans.
Press Release »
State Law Amended to Provide Certain ACA Protections
October 29, 2019
On April 4, 2019, Gov. Lujan Grisham signed HB0436 into law. The law aligns provisions relating to accessibility of health care coverage to federal law, including protections for persons with pre-existing conditions and a requirement that health care plans provide essential health benefits such as emergency services, hospitalization, prescription drugs, and maternity and newborn care. The state passed this law in order to make sure that residents of the state would not lose coverage in the event that the Affordable Care Act is struck down in the courts.
New Mexico is one of several states that are passing state-level solutions in the event the ACA is struck down in the courts, in order to make sure that their residents are covered. Employers should keep an eye on these efforts in their own states, and be prepared to make any adjustments in the way they provide health coverage to their employees in light of any state-level changes.
New Mexico HB0436 »
Bernalillo County Paid Time-Off Ordinance
October 29, 2019
On October 15, 2019, Bernalillo County, New Mexico’s Board of County Commissioners approved a paid-leave ordinance that will become effective January 1, 2020. Under the ordinance, all employees can accrue or use up to 28 hours of paid leave a year starting on July 1, 2020. All employees of employers with at least 11 employees can accrue or use up to 44 hours of paid leave a year starting on July 1, 2021, and all employees of employers with at least 35 employees can accrue or use up to 56 hours of paid leave a year starting on July 1, 2022.
This is a good example of how local jurisdictions are mandating paid leave through local ordinances. Employers in Bernalillo County should consult with their employment law advisors to comply with this law.
Bernalillo County New Mexico Paid-Leave Ordinance »
Surprise Billing Protection Act Signed
October 15, 2019
On April 4, 2019, Gov. Grisham signed SB 337, also known as the Surprise Billing Protection Act, effective January 1, 2020. The Surprise Billing Protection Act may apply when an insured person receives out-of-network emergency care or receives non-emergency care from a nonparticipating provider at a participating facility. Under these circumstances, the Act provides that the insured person is responsible only for the amount that would have been paid for services from a participating facility or provider. The Act also establishes a system whereby the provider is reimbursed for the difference between what the provider charged and what the insurer paid, applying a reimbursement rate set by the Act and informed by benchmarking data.
SB 337 »
Sick Leave Rules Extended to Family
May 14, 2019
On April 3, 2019, Gov. Grisham signed SB 123 into law. The law is effective June 14, 2019. It applies to all sized employers who have at least one employee performing work in New Mexico. The new law requires employers who are already providing sick leave to permit NM-based employees to use that time for an absence related to the illness of a spouse, domestic partner, or a family member by blood, marriage, or legal adoption (a parent, grandparent, great-grandparent, child, foster child, grandchild, great-grandchild, brother, sister, niece, nephew, aunt or uncle of an eligible employee).
An employer is not required to create a new bank of accrued leave. The law simply applies to sick leave already provided by an employer. Sick leave is defined as accrued paid time off that an employee is provided for an absence related to their own injury or illness. Thus, an employer with a leave program which does not require the employee to give a reason for the leave would align with the new requirement. Employers should work with outside counsel to update their leave policies and handbook, as appropriate.
SB 123 »
Transgender Non-Discrimination in Health Benefits
September 05, 2018
On Aug. 23, 2018, Superintendent of Insurance Franchini issued Bulletin 2018-013. This bulletin outlines the nondiscrimination rules for the coverage of transgender benefits under New Mexico law. As background, the ACA, the New Mexico Human Rights Act and the New Mexico Insurance Code all have provisions that prohibit discrimination against transgender persons. In accordance with those laws, the New Mexico Office of the Superintendent of Insurance considers exclusions for gender identity or dysphoria-related treatment to be prohibited discrimination on the basis of sex.
As a result, insurers in New Mexico may not:
- Deny coverage to an individual because they are a transgender person
- Require different or additional payment from an individual on the basis that they are a transgender person
- Designate a person’s perceived gender identity as a pre-existing condition for which coverage will be denied or limited
- Deny or limit coverage for services because the person is transgender, including:
- Health care services related to gender transition if those services are available to others who are not transitioning gender (such as hormone therapy, counseling, hysterectomy, mastectomy and vocal training)
- Health care services that are ordinarily or exclusively available to individuals of one sex
This bulletin essentially confirms that New Mexico law seeks to mirror the requirements under the ACA’s Section 1557. Although insurers are ultimately responsible for complying with these requirements, employer plan sponsors should familiarize themselves with these requirements as well.
John G. Franchini. “Bulletin 2018-13.” Bulletins, Office of Superintendent of Insurance, osi.state.nm.us »