Health Benefits Committee

In an effort to lower costs, streamline benefits, and simplify the consumer shopping experience on beWellnm.com, the New Mexico state legislature authorized the beWellnm Board of Directors to develop and approve standardized plan designs for out-of-pocket costs. Each insurer selling health plans on beWellnm is required to offer these standardized plan designs in addition to their other offerings. beWellnm established the Health Benefits Committee to research and design standardized plan options. The Committee met regularly throughout 2021 and 2022 and adopted the following priorities:

1. Creating apples-to-apples plan comparisons for consumers.
2. Improving cost predictability by only using co-pays (fixed dollar amounts) instead of coinsurance (a percentage of the service cost).
3. Categorizing co-pay levels by lower, medium, and higher amounts, with high value services like primary care and generic medications having the lowest out-of-pocket costs.
4. Minimizing deductibles and out-of-pocket maximum limits.
5. Minimizing the number of services subject to a deductible.
6. Ensuring reasonable costs for hospital visits so that rural residents who have limited access to services in their area aren’t priced out of care.
7. Lowering out-of-pocket costs for specialty medications, which are typically used to treat complex, chronic conditions like cancer, multiple sclerosis, and rheumatoid arthritis.
8. Focusing on income-based out-of-pocket designs as part of the state’s new out-of-pocket assistance programs.

The Committee held a series of meetings gather input from stakeholders and the public, present the Committee’s work, and finalize recommendations to the Board for approval. The New Mexico Office of Superintendent of Insurance (OSI) assisted the Committee with its development of plan designs that met the Committee’s overarching priorities. Under beWellnm’s Plan of Operations, the Board of Directors must approve any standardized health plans at the January board meeting for the following plan year. For example, the Board must approve standardized health plans for the 2024 Plan Year in January of 2023.

In January of 2023, the Board of Directors adopted standardized health plan requirements for the 2024 Plan Year. To ensure compliance with state and federal requirements, the Committee made minor adjustments to the plans with the authorization of the Board. Click here to view the final standardized health plan requirements. Click here to view actuarial value screenshots.