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 Timothy Vigil SANTA FE LOCATION (MAIN OFFICE) (OVERNIGHT/SECOND DAY MAIL ONLY) 1120 Paseo De Peralta, 4th Floor Santa Fe, New Mexico 87501 (USPS MAIL ONLY) P O Box 1689 Santa Fe, New Mexico 87504 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2025-014 November 13, 2025 TO: ALL FULLY INSURED HEALTH INSURANCE PLANS OFFERING 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 This bulletin repeals and replaces Bulletin No. 2023-037 issued on December 13, 2023. 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). Currently, the annual OEP for off-exchange plans for individuals begins November 1 and ends on December 15 of each year. To support off-exchange enrollment, OSI is revising the offexchange OEP to begin on November 1 and end on January 15 of each year. Additionally, offexchange 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-open-enrollment/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 (BeWell) - called “special SEPs” for the purposes of this Bulletin - do not apply to off-exchange individual plans. These special SEPs are publicized on the BeWell website and on healthcare.gov. Carriers and brokers who sell off-exchange plans to B U L L E T I N 2 0 2 5 - 0 1 4 P a g e | 2 SANTA FE LOCATION (MAIN OFFICE) (OVERNIGHT/SECOND DAY MAIL ONLY) 1120 Paseo De Peralta, 4th Floor Santa Fe, New Mexico 87501 (USPS MAIL ONLY) P O Box 1689 Santa Fe, New Mexico 87504 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us __________________________________ ALICE T. KANE Superintendent of Insurance 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. 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 BeWell, or should be referred to BeWell 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 BeWell if it is during either BeWell’s annual OEP (November 1 - January 15) or an HHS or BeWell 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 the Life and Health bureau at life.health@osi.nm.gov ISSUED this 13th day of November, 2025. _______________________ __ _ _______ LICE T KANE