APPLICATION OF OPEN ENROLLMENT AND SPECIAL ENROLLMENT PERIODS TO INDIVIDUAL OFF-EXCHANGE PLANS

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 2023-037 December 13, 2023 TO: ALL FULLY INSURED HEALTH INSURANCE PLANS OFFEREING MAJOR MEDICAL COVERAGE IN NEW MEXICO IN THE INDIVIDUAL MARKET; ALL HEALTH INSURANCE BROKERS IN NEW MEXICO RE: APPLICATION OF OPEN ENROLLMENT AND SPECIAL ENROLLMENT PERIODS TO INDIVIDUAL OFF-EXCHANGE PLANS The New Mexico Office of Superintendent of Insurance (OSI) is issuing this bulletin to clarify the application of annual open enrollment periods (OEPs) and special enrollment periods (SEPs) to the sale of individual, fully-insured, major medical plans that meet qualified health plan standards and are sold outside the New Mexico Health Insurance Exchange (off-exchange plans). The annual OEP for off-exchange plans for individuals begins November 1 and ends on December 15 of each year. Additionally, off-exchange plans may be sold during SEPs triggered by qualifying events, which are described by the US Department of Health and Human Services (HHS) on its healthcare.gov website: https://www.healthcare.gov/coverage-outside-openenrollment/special-enrollment-period/. SEPs that are not linked to qualifying events, and which are authorized by either HHS or the New Mexico Health Insurance Exchange (beWellnm) - called “special SEPs” for the purposes of this Bulletin - do not apply to off-exchange individual plans. These special SEPs are publicized on the beWellnm website and on healthcare.gov. Carriers and brokers who sell off-exchange plans to individuals and families are not to sell these plans outside of the off-exchange annual OEP, or outside of an SEP triggered by a qualifying event. B U L L E T I N 2 0 2 3 - 0 37 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 Individuals and families inquiring about health insurance coverage during open enrollment or a qualifying-event SEP should always first be offered a plan that is sold on beWellnm, or should be referred to beWellnm so that they can take advantage of any financial assistance that may be available to them. Individuals and families seeking coverage outside of the annual off-exchange OEP, and who are not eligible for a qualifying event SEP, should be offered a plan that is sold on beWellnm if it is during either beWellnm's annual OEP (November 1 - January 15) or an HHS or beWellnm special SEP. Please note that small group plans are not subject to OEPs or SEPs. They may be purchased at any time. Questions concerning this bulletin should be directed to Viara Ianakieva at viara.ianakieva@osi.nm.gov. ISSUED this 13th day of December, 2023. __________________________________ ALICE T. KANE Superintendent of Insurance