The New Mexico Medical Insurance Pool

The New Mexico Medical Insurance Pool (NMMIP) was established by the 1987 New Mexico State Legislature.  The Pool was created to provide access to health insurance coverage to residents of New Mexico who are denied health insurance and considered uninsurable.  Financing of the Pool is a four-way partnership: premiums from individuals, assessment of losses to health insurance carriers, State premium tax credits for health insurance carriers (to help offset assessments) and a Federal grant.

The Board of Directors, with approval of the Superintendent of Insurance, is responsible for setting the premium rates. By state law, those rates cannot be above 150% of the “standard risk rate” (the average premium rate charged for healthy individuals in the private market). Premium rates are reviewed at least annually and, currently, the premiums are set at less than 135% of the standard rate.

There are a couple basic categories of eligibility. The first major category is if you have a qualifying medical condition or have either been rejected for individual coverage or offered insurance with a rate above the Pool’s qualifying rate or with restrictions and limits in coverage due to a health condition. The second major category is if you meet State or Federal criteria under HIPAA (Health Insurance Portability and Accountability Act) of having at least 18 months of previous group coverage that ended within the last 95 days and now you need an individual policy.

You must be a resident of New Mexico to be eligible for Pool coverage. However, there is no minimum time limit for residency. But, you must have a physical street address in New Mexico and, if you currently live elsewhere, coverage cannot become effective prior to moving to the state.