SMALL BUSINESS HEALTH INSURANCE PREMIUM RELIEF INITIATIVE PREMIUM REDUCTION PERCENTAGE FOR COVERAGE

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE DEPUTY SUPERINTENDENT Alice T. Kane Colin Baillio Main Office: 1120 Paseo de Peralta, Fourth Floor, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2023-036 December 1, 2023 TO: HEALTH INSURANCE ISSUERS SELLING HEALTH BENEFIT PLANS IN THE SMALL GROUP MARKET THAT MEET QHP STANDARDS RE: SMALL BUSINESS HEALTH INSURANCE PREMIUM RELIEF INITIATIVE PREMIUM REDUCTION PERCENTAGE FOR COVERAGE ACTIVE JANUARY 1, 2024, UNTIL JUNE 30, 2024; PAYMENT TIMELINE AND RECONCILIATION FOR THE 2024 PROGRAM YEAR THIS BULLETIN is issued pursuant to NMSA 1978, Section 59A-23F-11, which established the Health Care Affordability Fund to “reduce premiums for small businesses and their employees.” This Bulletin sets forth program parameters, requirements for issuers, and the Office of Superintendent of Insurance’s (OSI’s) responsibilities under the Small Business Health Insurance Premium Relief Initiative established in 13.10.36.11 NMAC. Premium Reduction Percentage All issuers subject to this Bulletin must reduce premium charges to small group Qualified Health Plan (QHP) purchasers by the credit amount of 10% for coverage active on January 1, 2024, on or off-exchange. The Premium Reduction Credit described in this bulletin will be effective from January 1, 2024, through June 30, 2024. This period of time will be referred to as “the first half of the 2024 Program Year.” The 10% premium reduction shall be applied by providing a credit for coverage in the invoice to small group QHP purchasers following the applicable coverage month. B U L L E T I N 2 0 2 3 - 0 3 6 P a g e | 2 Main Office: 1120 Paseo de Peralta, Fourth Floor, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us Monthly Issuer Reporting Issuers must submit data to OSI on a monthly basis in order to receive payment for the discount/credit provided. Issuers should not report retroactive adjustments/restatements from previous months on this template. These will be handled during the annual reconciliation period. No later than the third business day following each applicable coverage month, using the secure online data-sharing portal provided to the issuer’s primary contact by OSI, issuers must submit to OSI: 1. A completed version of the Monthly Reporting Template is posted on the initiative’s webpage: https://www.osi.state.nm.us/pages/misc/small-business-health-insurancepremium-relief-initiative. 2. An invoice specifying the amounts owed by OSI for the applicable coverage month. This invoice should include the date, the issuer’s contact information, a unique invoice number, and a note that the invoice is related to the New Mexico Small Business Health Insurance Premium Relief Initiative. Monthly Payments to Issuers Upon verification of the submitted data and invoice described above, OSI will issue monthly electronic payments to issuers no later than 15 business days after receiving the necessary documentation. TABLE 1 shows the reporting and payment deadlines for the 2024 Program Year. TABLE 1: Monthly Reporting and Payment Deadlines for the 2024 Program Year Coverage Month Issuer Reporting Deadline OSI Payment Deadline January 2024 February 5, 2024 February 26, 2024 February 2024 March 5, 2024 March 26, 2024 March 2024 April 3, 2024 April 24, 2024 April 2024 May 3, 2024 May 24, 2024 May 2024 June 5, 2024 June 27, 2024 June 2024 July 3, 2024 July 25, 2024 July 2024 August 5, 2024 August 26, 2024 August 2024 September 5, 2024 September 26, 2024 September 2024 October 3, 2024 October 24, 2024 October 2024 November 5, 2024 November 26, 2024 November 2024 December 4, 2024 December 25, 2024 December 2024 January 6, 2025 January 27, 2025 B U L L E T I N 2 0 2 3 - 0 3 6 P a g e | 3 Main Office: 1120 Paseo de Peralta, Fourth Floor, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us Annual Issuer Reporting and Reconciliation By March 3, 2025, all issuers subject to this Bulletin must submit the following documents to OSI using the secure online data-sharing portal provided to the issuer’s primary contact: 1. A completed version of the Annual Reporting Template can be found on the initiative’s webpage: https://www.osi.state.nm.us/pages/misc/small-business-health-insurancepremium-relief-initiative. 2. An attestation to the accuracy of the submission, signed by a senior executive. No later than May 5, 2025, OSI will inform issuers of reconciliation amounts. All reconciliation amounts owed to OSI or the issuer shall be included in the issuer’s invoice submitted during June 2025. If an issuer wishes to dispute reconciliation amounts after OSI notification, it must submit the dispute to Shannon.Chapman@osi.nm.gov no later than May 12, 2025. TABLE 2: Reconciliation Deadlines Reconciliation Activity Deadline Submission of Annual Data March 3, 2025 OSI Notice of Reconciliation Amounts May 5, 2025 Submission of Reconciliation Disputes May 12, 2025 Reconciliation Payments Due June 30, 2025 Small Business Notification All issuers subject to this Bulletin must notify small group QHP purchasers of the premium reduction credit. All letters must be approved by OSI. The following language must be sent to all active small groups prior to January 2, 2024. A version of this letter should also be included in enrollment packets for all new groups that enroll after January 2, 2024. During the 2021 legislative session, the New Mexico Legislature worked with Governor Michelle Lujan Grisham to pass legislation establishing a Health Care Affordability Fund. On April 8, 2021, Governor Lujan Grisham signed Section 59A-23F-11 NMSA 1978 into law, which allows the New Mexico Office of Superintendent of Insurance (OSI) to reduce B U L L E T I N 2 0 2 3 - 0 3 6 P a g e | 4 Main Office: 1120 Paseo de Peralta, Fourth Floor, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us health insurance premiums for small businesses. Under the program, you will receive a credit on your invoice that reduces your premium by 10%. This premium reduction is part of OSI’s Small Business Health Insurance Premium Relief Initiative. You will see the credit applied to your premium on all invoices received after February 1, 2024, through August 1, 2024. You do not need to take any action to receive this credit. Please note that the initiative is subject to legislative appropriation, and the reduction percentage could change from year to year. Should the reduction percentage change, [ISSUER NAME] will notify you in advance. If you have any questions about the initiative, please visit https://bit.ly/3HmMKRr. Advertising of Discounted/Credited Premiums To ensure transparency, any advertising materials that display premiums at the discounted/credited price must make clear that the discount/credit is applied to the premium and results from New Mexico’s Small Business Health Insurance Premium Relief Initiative. The materials should also provide a link to OSI’s Initiative webpage and OSI’s phone number. All marketing materials must be approved by OSI. Please direct any questions regarding this bulletin to Shannon Chapman at (505) 527-1651, or via e-mail at Shannon.Chapman@osi.nm.gov. ISSUED this 1st day of December, 2023. __________________________________ ALICE T. KANE Superintendent of Insurance