NM Small Business Health Insurance Plans
New Mexico Small Business Health Insurance Plans 2022. The following is an overview of the rules that govern small group health insurance plans in the State of New Mexico.
The information that is discussed below includes the laws that have been mandated by the Affordable Care Act (ACA or "Obamacare"), as well as the laws that are required by New Mexico State government.
If you own and operate a NM small business and you already offer small group health insurance or you're thinking about offering small group health insurance - this guide can help you better understand the regulations, requirements and available New Mexico small business health insurance plans available.
Learn how to get New Mexico small business health insurance plans for 1 to 50 employees. The best small business health insurance providers in NM offer affordable rates, flexible coverage options and access to a large network of medical providers.
Below are some answers to commonly asked NM small business health insurance plan questions:
- How Much Does New Mexico Small Business Health Insurance Cost?
- What Are The Small Business Health Insurance Regulations In New Mexico?
- Does New Mexico Participate In The Affordable Care Act?
- What Are The Affordable Care Act Requirements For New Mexico Small Businesses?
- How Are NM Health Insurance Premiums Are Determined?
- What Types Of Health Insurance Plans Are Available For New Mexico Small Businesses?
How Much Does New Mexico Small Business Health Insurance Cost?
The average price of a standard New Mexico small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.
What Are The Small Business Health Insurance Regulations In New Mexico?
There are fewer health insurance regulations in New Mexico than there are in many other states. Nevertheless, it is important for small business owners to familiarize themselves with the laws that do exist so that they can provide their employees with the right coverage.
In New Mexico, insurance companies can include provisions that exclude pre-existing health conditions from coverage, but only for 6 months. Pre-existing conditions are those that individuals have been diagnosed with 6 months prior to the effective date of the health insurance policy.
If you are changing New Mexico small business health insurance plans, new pre-existing condition exclusion periods cannot be applied to the new policy, so long as there haven't been any breaks in the coverage of the previous policy.
In this scenario, the exclusion period of the old policy will credit the exclusion period that is required by the new policy. In other words, if the exclusion period for the old policy was met, you do not have to wait for the new policy to take effect.
According to The State of New Mexico website, The New Mexico Medicaid Program, beWellnm (New Mexico's Health Insurance Exchange), and the New Mexico Medical Insurance Pool are working together to help you find health coverage during this unprecedented and challenging time. If you have had a recent change in employment or income, have lost your current plan or wish to become insured for the first time, we may have a good option for you.
All three programs cover comprehensive benefits like doctor's visits, hospitalizations, prescriptions, mental health services and more. All testing and treatment related to COVID-19 will be covered at no cost to you.
Does New Mexico Participate In The Affordable Care Act?
In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.
If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".
The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.
Qualifying Exemptions For The Individual Mandate
Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in NM:
- Illegal aliens
- Jailed individuals
- Religious objections
- The cost of health insurance coverage is higher than 8% of your household income
- Those who aren't covered for less than three months during the calendar year
- Those who have hardship waivers
- Your income level is blow the 100% poverty level
What Are The Affordable Care Act Requirements For New Mexico Small Businesses?
If you're a small business owner in New Mexico, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.
Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant New Mexico small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.
New Mexico small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.
Affordable Care Act Standardized Essential Health Benefits
As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.
Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:
- Ambulatory patient services (medical care that is offered without being admitted to a hospital)
- Emergency services
- Hospitalizations, such as overnight stays and surgical procedures
- Lab services
- Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
- Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
- Pregnancy, maternity, and newborn care, including before and after birth
- Prescription pharmaceuticals
- Preventative and wellness services, as well as management for chronic diseases
- Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions
Additional Health Benefits Mandated In New Mexico
In New Mexico, health insurance policies must cover the benefits outlined by the ACA, as well as the following benefits that have been mandated by the state government:
- Costs incurred in cancer clinical trials
- Diabetes care management
- Maternity emergency transportation/ambulance services
- Hearing aids for children
- Outpatient surgery coverage for newborn baby boy circumcisions
- Post-mastectomy care
- TMJ and craniomandibular treatment
Standardized New Mexico Small Business Health Insurance Plans
In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying New Mexico small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.
Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.
All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold New Mexico small business health insurance plans.
All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:
|Metal Plan||Insurer Pays / Insured Pays|
|Bronze||60% / 40%|
|Silver||70% / 30%|
|Gold||80% / 20%|
|Platinum||90% / 10%|
As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.
Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.
However, plans can be canceled if the individual fails to pay their premiums or commits fraud.
How Are NM Health Insurance Premiums Determined?
A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:
- Age of the individual
- Whether or not the individual uses tobacco
- Where the individual lives, based on a rating area
- The number of family members who will be enrolling
What Types Of Health Insurance Plans Are Available For New Mexico Small Businesses?
While there are several types of health insurance plans to choose from, the following plans are the most popular among NM small business owners:
Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.
Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among New Mexico small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.
Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.
Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.
Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.
New Mexico Small Business Health Insurance Plans - The Bottom Line
We strongly advise business owners to speak with a CPA and a NM health insurance broker before jumping in and getting any type of the New Mexico small business health insurance plans available.
Make sure that you know exactly what each option can do for your company and the potential drawbacks associated with it.
New Mexico Economic Data, Regulations And Limits On Commercial Insurance
Owning and operating a business can prove to be financially and personally rewarding. However, if you want to have as much success as possible, it's essential that you choose the best possible location for your company.
After all, it doesn't matter how exceptional your products are and how top-notch your products and/or services are, if the location isn't favorable for your specific business, chances are you won't reap the success you are hoping for.
When considering where to start a business, it's important to consider the economic trends of a state. These trends provide insight into the health of a state's economy, which can help prospective business owners determine whether or not a specific location is favorable for their particular operation. Additionally, it's important to understand what type of commercial insurance policies you'll need to invest in to properly protect your business.
If you're thinking about starting a business in the state of New Mexico, read on to find an overview of the economy and the commercial insurance requirements of the Land of Enchantment.
Economic Trends For Business Owners In New Mexico
A state's unemployment rate is an important factor to consider when assessing the economy, as it illustrates whether or not the area offers a favorable environment for businesses.
According to the Bureau of Labor Statistics, as of December, 2019, the unemployment rate in New Mexico was 4.7%, which is 1.2% higher than the national average. However, the rate has fallen; in July of 2019, for example, the unemployment rate was 4.9% and in November of the same year, it was 4.8%.
This rapid decrease shows promise for the Land of Enchantment. Furthermore, economists predict that the jobless rate of the state will continue to decrease moving forward.
New Mexico is a large state with varied topography and demographics. As such, the best locations prospective business owners can expect to see the most success include urban areas and the surrounding regions. Examples include:
- Las Cruces
- Rio Rancho
- Santa Fe
The industries that are seeing the most economic growth in the Land of Enchantment include:
- Administrative and federal government
- Advanced manufacturing
- Aerospace and defense
- Digital media and film production
- Distribution, logistics, and transportation
- Hospitality and tourism
Commercial Insurance Requirements In New Mexico
The New Mexico Office of Superintendent of Insurance regulates insurance in NM. New Mexico mandates very few forms of insurance coverage by law. They enforce worker's compensation.
New Mexico requires you to have worker's compensation insurance if you hire 3 or employees on a regular basis in the construction industry, businesses with even one employee must provide workers compensation insurance. This includes part-time employees, family members, minors, and immigrant employees. It is not required for independent contractors or domestic employees, though you should check to make sure any contractors you have are true contractors, and not employees.
New Mexico also requires all business-owned vehicles to be covered by commercial auto insurance. Other types of business insurance that business owners should carry depend on the specific industry.
Request a free New Mexico small business health insurance plans quote in these other NM cities: Agua Fria, Alamogordo, Albuquerque, Anthony, Arenas Valley, Artesia, Aztec, Bayard, Belen, Bernalillo, Bloomfield, Boles Acres, Bosque Farms, Cannon AFB, Carlsbad, Carnuel, Chaparral, Chimayo, Clayton, Clovis, Corrales, Crownpoint, Deming, Dulce, Edgewood, El Cerro, El Cerro Mission, El Valle de Arroyo Seco, Eldorado at Santa Fe, Espanola, Eunice, Farmington, Flora Vista, Gallup, Grants, Hobbs, Holloman AFB, Jal, Jarales, Jemez Pueblo, Keeler Farm, La Cienega, La Mesilla, Las Cruces, Las Maravillas, Las Vegas, Lee Acres, Lordsburg, Los Alamos, Los Chaves, Los Lunas, Los Ranchos de Albuquerque, Lovington, Meadow Lake, Mesilla, Milan, Monterey Park, Moriarty, Nambe, Navajo, North Hobbs, North Valley, Paradise Hills, Peralta, Placitas, Pojoaque, Portales, Questa, Ranchos de Taos, Raton, Rio Communities, Rio Rancho, Roswell, Ruidoso, San Felipe Pueblo, San Ysidro, Sandia Heights, Santa Clara, Santa Fe, Santa Rosa, Santa Teresa, Santo Domingo Pueblo and Ruidoso Downs, Sausal, Shiprock, Silver City, Socorro, South Valley, Sunland Park, Taos, Tome, Truth or Consequences, Tucumcari, Tularosa, University Park, Vado, Valencia, Waterflow, West Hammond, White Rock, Zuni Pueblo and all other NM cities & New Mexico counties near me in The Land of Enchantment.
Also find NM local small businesses by General Liability Class Code and learn about New Mexico small business insurance requirements for general liability, business property, commercial auto & workers compensation including NM business insurance costs. Call us (505) 349-0657.
Small Business Health Insurance Plans By State
You can find more state specific small business health insurance information including requirments and coverage by clicking on the state below:
- North Carolina
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- Washington D.C.
- West Virginia