THE 2024 HEALTH INSURANCE MARKETPLACE AFFORDABILITY PROGRAM; DATA REPORTING PROCESS; PAYMENT PROCESS AND TIMELINE

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 2024-001 January 3, 2024 TO: HEALTH INSURANCE ISSUERS SELLING INDIVIDUAL MARKET QUALIFIED HEALTH PLANS ON THE NEW MEXICO HEALTH INSURANCE EXCHANGE RE: THE 2024 HEALTH INSURANCE MARKETPLACE AFFORDABILITY PROGRAM; DATA REPORTING PROCESS; PAYMENT PROCESS AND TIMELINE FOR THE 2024 PLAN YEAR THIS BULLETIN is issued pursuant to NMSA 1978, Section 59A-23F-11, which established the Health Care Affordability Fund (HCAF) to “reduce health care premiums and cost sharing for New Mexico residents who purchase health care coverage on the New Mexico health insurance exchange” and 13.10.36 NMAC. This Bulletin sets forth requirements for individual market health insurance issuers under the Health Insurance Marketplace Affordability Program, the process for payments under the program, and the payment timeline. The affordability and income criteria for the 2024 Plan Year was established in the “Health Insurance Marketplace Affordability Program Policy and Procedures Manual,” which can be found at final_2024-health-insurance-marketplace-affordability-programpolicy-and-procedures-manual_230412.pdf (storyblok.com). In 2024, the New Mexico Office of Superintendent of Insurance (OSI) will continue making payments under the Health Insurance Marketplace Affordability Program to lower costs for qualifying individuals and families enrolled in a Qualified Health Plan offered on the New Mexico Health Insurance Exchange (NMHIX). Payments for the following programs will be made monthly: • New Mexico Premium Assistance (NMPA) B U L L E T I N 2 0 2 4 - 0 0 1 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 • Native American Premium Assistance (NAPA) • State Out-of-Pocket Assistance (SOPA) Primary Issuer Contact for Matters Related to the Health Insurance Marketplace Affordability Program By January 12, 2024, all issuers subject to this Bulletin shall select a primary contact familiar to all matters related to the Health Insurance Marketplace Affordability Program. Issuers should submit the selected contact’s name, title, email address, and phone number to Shannon.Chapman@osi.nm.gov or Sahar.Hassanin@osi.nm.gov If the contact changes at any point during the year, the issuer should notify the agency promptly. Data Reporting and Payment Process Each month during the 2024 Plan Year, NMHIX will submit data to OSI indicating the payment amounts owed to each health insurance issuer subject to this Bulletin. This data will include payment amounts for the NMPA, NAPA, and advanced SOPA programs according to the schedule in TABLE 1. OSI will validate the data and issue a Notice of Payment with the validated data to issuers before the payment deadline in TABLE 2. Retroactive adjustments for premium assistance may be incorporated into subsequent data reports. TABLE 1: Monthly NMHIX Reporting Deadlines for Plan Year 2024 Coverage Month NMHIX Premium Reporting Deadline NMHIX SOPA Reporting Deadline January 2024 January 2, 2024 January 31, 2024 February 2024 February 2, 2024 February 29, 2024 March 2024 March 4, 2024 March 29, 2024 April 2024 April 2, 2024 April 30, 2024 May 2024 May 2, 2024 May 31, 2024 June 2024 June 4, 2024 June 28, 2024 July 2024 July 2, 2024 July 31, 2024 August 2024 August 2, 2024 August 30, 2024 September 2024 September 3, 2024 September 30, 2024 October 2024 October 2, 2024 October 31, 2024 November 2024 November 4, 2024 November 29, 2024 December 2024 December 3, 2024 December 31, 2024 B U L L E T I N 2 0 2 4 - 0 0 1 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 TABLE 2: Monthly Payment Deadlines for Plan Year 2024 Coverage Month OSI Premium Assistance Payment Deadline OSI Advance SOPA Payment Deadline January 2024 January 31, 2024 February 29, 2024 February 2024 February 29, 2024 March 29, 2024 March 2024 March 29, 2024 April 30, 2024 April 2024 April 30, 2024 May 31, 2024 May 2024 May 31, 2024 June 28, 2024 June 2024 June 28, 2024 July 31, 2024 July 2024 July 31, 2024 August 30, 2024 August 2024 August 30, 2024 September 30, 2024 September 2024 September 30, 2024 October 31, 2024 October 2024 October 31, 2024 November 29, 2024 November 2024 November 29, 2024 December 31, 2024 December 2024 December 31, 2024 January 31, 2025 Example of Reporting and Payment Process • Data Reporting for October 2024 Payments o On September 30th, NMHIX will submit SOPA data for the September Coverage Month to OSI. o On October 2nd, NMHIX will submit NMPA, and NAPA data for the October Coverage to OSI. • Payments in October 2024 o The Notice of Payment will include payment amounts for October NMPA, NAPA and payment amounts for September SOPA. o By October 31st, the October payments described above will be made to issuers. SOPA Reconciliation Following the 2024 Plan Year, all health insurance issuers must adhere to forthcoming guidance on the reconciliation of SOPA payments. Appeals and Disputes If a consumer or health insurance issuer believes a NMPA, or NAPA, payment amount to be B U L L E T I N 2 0 2 4 - 0 0 1 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 inaccurate, appeals and disputes shall be resolved in accordance with the NMHIX’s internal policies and procedures. OSI’s SOPA Reconciliation Reporting Guidance for the 2024 Plan Year addresses all matters regarding SOPA appeals and disputes from issuers. Additional elements are in development and will be added before the guidance is finalized for the 2024 Plan Year. ISSUED this 3rd day of January 2024. __________________________________ ALICE T. KANE Superintendent of Insurance