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Have Questions?

Frequently Asked Questions

What is the New Mexico Health Insurance Alliance?
How do I qualify for a Health Insurance Policy through the NMHIA?
Who is considered an “eligible” employee?
What if I am self-employed and have no insurance?
How do we apply for health insurance thru the NMHIA?
Can I get an individual policy for my child?
Do you provide insurance outside of New Mexico?
If I drop/lose NMHIA coverage can I re-enroll?
If I have a pre-existing condition can I still qualify for insurance with NMHIA?
Does NHMIA offer dental or vision coverage?
Can I keep my current Agent or carrier if I apply for insurance with NMHIA?
How can I compare my current or previous coverage and rates to those offered by NMHIA?
How do I make changes to my existing NMHIA account?
What forms of payment do you accept?
What other options are available to me if I do not qualify for insurance through NMHIA?

What is the New Mexico Health Insurance Alliance?

We are a nonprofit organization that is not federally or state funded, but is funded in part by an alliance of insurance carriers operating in New Mexico. The mission of NMHIA is to provide access to small businesses and individuals for health coverage not available in the commercial market. We offer a choice of insurance plans and carriers (including HMO, HMO Hybrid and PPO plans).

How do I qualify for a Health Insurance Policy through the NMHIA?

Individuals who qualify:

• Must have previous coverage being a group health plan, church plan, or government plan, and have exhausted either State Continuation Insurance or COBRA, if offered. (Please note: Government plan refers to plans established for government employees therefore Medicare, Medicaid or Salud are not considered government plans.)
• Must not have more than a 95 day lapse in coverage. This is 95 days from last date of group coverage to the date of application.
• Must have 18 months of prior creditable coverage.
• Do not have an employer health plan available.

Groups who qualify:

• Employers with 50 or fewer eligible employees;
• Groups as small as one, the employer must have an enrolled dependent; or a group of two that can have one employee waiving coverage for other coverage.
• Must have at least 50% of net eligible employees enroll.
• They must be headquartered in New Mexico and at least 50% of all employees (eligible & ineligible) must live in the state of New Mexico.

Who is considered an “eligible” employee?

An employee is eligible to enroll in an approved health plan if:

• They have completed the employer’s waiting period.
• They are working at least 20 hours per week on a regular basis (other than as a volunteer).

What if I am self-employed and have no insurance?

• You may qualify as a self-employed person if you have at least one dependent. A dependent could be a spouse or child (children unmarried or married qualify as dependents up to age 26).

How do we apply for health insurance thru the NMHIA?

State law requires that a licensed and NMHIA certified Agent sign the application. We provide the names of certified Agents listed by county. Our Agents will be able to meet with you to discuss the different medical plans we offer and prepare a current rate quote. The Agents can also look to the commercial market for other available options, so that you know you are getting the best plan and rates available to you. There is no cost to you for our Agents to do the legwork.

Can I get an individual policy for my child?

In certain circumstances we can take children; however, they will have to meet the NMHIA underwriting criteria for individuals to be able to obtain insurance. Our underwriting department or a certified Agent can provide further information specific to your situation.

Do you provide insurance outside of New Mexico?

No, but if you are insured in New Mexico and are traveling out of state there are benefits that may be available depending on what insurance policy and carrier you have.

If I drop/lose NMHIA coverage can I re-enroll?

If you voluntarily leave the NMHIA program, you will not be eligible to re-apply for 12 months. You may re-apply at any time if you come back working for a different employer group.

If you are terminated for non-payment, fraud, or non-submission of required renewal documentation (groups only) you will have to wait 3 years before you can return to the NMHIA.

If I have a pre-existing condition can I still qualify for insurance with NMHIA?

Yes, we have no medical screening or industry underwriting.

Does NHMIA offer dental or vision coverage?

No, we offer medical coverage only. However, a certified Agent may be able to help you with your additional insurance needs.

Can I keep my current Agent or carrier if I apply for insurance with NMHIA?

If your Agent is certified through NMHIA you may continue working with him/her. To find an Agent CLICK HERE. If you don’t find your current insurance Agent listed on the website, you can call them direct or call NMHIA to confirm if they are certified. Our carriers are BCBS of NM, Lovelace, Presbyterian, and UnitedHealthcare.

How can I compare my current or previous coverage and rates to those offered by NMHIA?

For a Summary of Benefits of the currently offered plans CLICK HERE. For a rate quote, contact one of our certified Agents. To find an Agent near you CLICK HERE.

How do I make changes to my existing NMHIA account?

You may download a Group/Individual Change Request Form, print the form, and fax or mail it to us. Contact your Agent for assistance. You may make the following changes to your account:

• Address changes
• Name changes (must also submit appropriate documentation [i.e. divorce decree, court order, etc.])
• Dependent additions or deletions (must list a requested effective date)
• Cancellation of coverage (must list a requested effective date)

For Individual changes CLICK HERE. For Group changes CLICK HERE.

What forms of payment do you accept?

First time premium payments must be paid by check along with your application:

• Business check for group application
• Personal checks for individual applications
• Sole Proprietor Groups may submit either business check or personal checks

Premium payments for existing accounts may pay by:

• Check
• Electronic Fund Transfer. (EFT) will be withdrawn monthly from your checking account. If you wish to set up EFT payments, CLICK HERE to download the form. This form must be printed, and either faxed or mailed to our office.
• Please note: We cannot set up EFT payments verbally over the phone. An EFT form must be submitted.
• Credit card. To pay your premium by Credit Card (Visa, MasterCard, Discover, American Express, Diners, or JCB) please call
  1-800-204-4700 ext. 1017. There is a $25.00 convenience fee each time.
• Please note: Credit card payments cannot be set up for automatic payments, as we do not keep that information on file.

What other options are available to me if I do not qualify for insurance through NMHIA?

Please contact one of our certified Agents even if you think you do not qualify with NMHIA, they are there to help you find the right plan at the most affordable cost possible. Our Agents are provided at no cost to you. Additional options where you may be qualified to apply are:

If you are a Santa Fe County resident you may also consider Santa Fe PROJECT ACCESS. You may contact them at 505-795-2356 or online at www.sfaccess.org.