Frequently Asked Questions

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How do I enroll with NMRHCA?

a. You will need to request the general enrollment packet from the RHCA office. Fill out all of the included and applicable forms in the general enrollment packet and gather supporting documents a checklist is included in the packet to guide you with the necessary documentation. Return the packet to NMRHCA by mail (4308 Carlisle Blvd. NE, Suite 104, Albuquerque, NM 87107) or in person.

Where can I get more information about how to enroll or when I can enroll?

a. You can contact our customer service toll-free number, 800-233-2576, visit our Albuquerque office at 4308 Carlisle Blvd. NE, Suite 104 or our Santa Fe office at 33 Plaza La Prensa, Suite 101, or read our Summary of Benefits booklet. Please note that there are rules and regulations in place for which you must qualify or follow as to when you can sign up for medical, dental, vision or life insurance through NMRHCA. To read more about enrollment regulations, please read Article 2.81.6 of the New Mexico Administrative Code.

How do I cancel my enrollment?

a. Cancellation must be in writing. The you can either write a letter containing your name, last four of SSN, detailed instructions as to what coverage(s) need to be cancelled, sign and date or you can fill out a change request form and return the form to NMRHCA.

b. Any cancellations will be effective the month following the date that the request is received.

How do I get my ID number(s) for prescriptions, medical, dental and vision?

a. Medical and prescription ID information is given out by the carriers. Please contact the appropriate carrier for your most current information. For the customer service phone numbers please follow this link.

b. Id information for any of our dental and vision plans are the account holder’s Social Security number. For the customer service phone numbers please click here.

Do you have my correct DOB, dependents, marital status, and gender?

Please contact RHCA (1-800-233-2576) for the most current information on your file.

Can you explain my benefits?

a. Please refer to the current summary of benefits posted here.

Who is my beneficiary and how much life insurance do I have?

a. Please contact RHCA (1-800-233-2576) for the most current information regarding the beneficiary you have listed on your account.

b. Please note: Due to HIPAA regulations release of this information is limited.

If I pass away before my spouse/dependent(s), what happens to their coverages?

a. Coverage will continue for your surviving spouses and dependents as it currently stands. Once the application for Survivor benefits has been completed a profile for the spouse/dependent will be created and there will be no interruption in coverage.

b. The benefits that are on the account at the time of the Retiree’s passing are the benefits that will continue. Dependents that are listed are not eligible to change their benefits at that time.

c. Also, if there is no life insurance associated with the dependents, none can be purchased after the Retiree has passed.

How would I go about applying for life insurance? What are the additional costs and how long does it take to process?

a. To increase or add Supplemental Life, you MUST complete an Evidence of Insurability Statement. This statement must be approved by Standard Insurance Company before we are allowed to add or increase any supplemental life insurance. Do not send any payment. Account adjustments will be made and billed after approval has been determined. Please call 1-800-233-2576 to request Evidence of Insurability Statement if one was not provided.

b. Please click here to view the most current rates regarding life insurance.

c. Processing applications for additional life insurance need approval from Standard Insurance Company. This process usually takes 4 – 6 weeks and Standard Insurance Company will be in touch with you if further information is needed.

d. Please contact Standard directly if you have any specific questions. Contact information is listed here.

How much is my monthly premium?

a. 2020 Rate Sheet

b. Please contact RHCA (1-800-233-2576) for your current monthly premium amount.

I will be going on Medicare soon; what will happen to my other coverages when I switch?

a. The only benefit we will be changing will be to the individual that is becoming Medicare eligible. Any other coverage’s that are listed on the account will remain the same.

What if I move outside of New Mexico?

BCBSNM PPO Plan: Available anywhere in the world. • BCBSNM Medicare Supplemental Plan: Available anywhere in the world. •Davis Vision: Available anywhere in the USA. • United Health Care Medicare Advantage I & II Available anywhere in the USA. • Humana Medicare Advantage I & II Available anywhere in the USA. • Delta Dental: Delta Dental has more than one provider network. In New Mexico, PPO New Mexico dentists are considered In-Network. Outside New Mexico, Delta Dental PPO dentists are In-Network. Delta Dental PPO is a national network with participating dentists in every state. Coverage applies anywhere in the world treatment is received but there are no In-Network providers outside the USA. If you have dental care outside the USA, it will be necessary to pay for treatment and then submit a claim for reimbursement. All claims – whether submitted by a Delta Dental dentist, a non-participating provider, or a member – should be sent to Delta Dental of New Mexico at the Albuquerque address on the subscriber’s Reference Card. • United Concordia: You have access to the Concordia Advantage Plus network of providers. Services provided in Mexico or other countries can be submitted for claims processing at United Concordia. Claims can be mailed to the address on the back of your ID card.

If you have any questions please call us at 1-800-233-2576 to speak with a Customer Service Representative or click here to find contact numbers for Delta Dental or United Concordia.

Do plan benefits ever change?

a. From time to time, the benefit plans available through the NMRHCA may change for one of several reasons:

• As a State agency, we are required every four years to request new bids to ensure that we are paying the lowest prices for services. Also, if there were a serious deficiency in the performance of one of our carriers, we would request new bids. In either of those two cases, the NMRHCA would then substitute a different carrier and benefit plan for one previously offered.

• Once a year we renegotiate our contracts with our carriers. Based on the prior year’s claims experience, this may mean changes. Historically, many of the benefit plan changes that result from renegotiations have actually enhanced rather than detracted from the plans.

• Sometimes carriers develop new products that we believe might be more advantageous to our participants than their existing plans. Before we make these type changes, where appropriate we try to survey our participants regarding their wishes.

• Finally, occasionally questions may arise from unusual circumstances that require us to clarify or append the benefit explanations. Normal benefit plan changes take effect July 1 of any year.

Notice of Changes: You will always receive notice of change. Notice of change always appears in the newsletter (Your Benefits Messenger). Where appropriate, we may also send you a direct mailing or even hold informational meetings around the state. You will never be taken unaware if you read your newsletter. You always have the opportunity to comment on changes by emailing us, writing to us, calling us, or attending a Board of Directors meeting.

What is the process to make changes to my account?

a. If there is a change in your name, address, phone number or marital status, please contact the RHCA (1-800-233-2576) or complete a Change Request Form click here to be directly linked to the form.

b. If you would like to change the beneficiary for your life insurance or your method of premium contribution payment please contact the RHCA (1-800-233-2576) or complete a Change Request Form click here to be directly linked to the form.

c. Once your change request is processed, we will communicate the changes to the appropriate carriers. Premium refunds will be calculated from the first of the month following either (a) our receipt of your Change Request Form or (b) the date of the event causing the change in status, whichever is later. Premiums are calculated on a per-month basis, and cannot be changed or terminated mid-month. Premium refunds are not prorated. We will refund amounts less than $5.00 only if you request it within 90 days of the first day of the month that was overpaid.

d. Marital/Dependent Changes: You may request at any time to drop one or more dependents from your NMRHCA program of benefits. If a dependent becomes ineligible through marriage, death, divorce, annulment, or legal separation, age or because he/she recovers from a mental or physical disability, coverage ceases at the end of the month in which the event occurred. The dependent may be able to elect to continue coverage under the Continuation of Coverage provision, COBRA. Click here for more information on Continuation of Coverage.

e. You may add a new dependent only under one of the following circumstances: (1) There is a change in status which makes someone newly eligible as your dependent (e.g., marriage, birth); (2) an un-enrolled eligible dependent involuntarily loses his or her medical coverage; or (3) upon submission and approval of a Change Request Form and an NMRHCA Plan Health Statement certifying the state of your dependent’s health. For newly eligible dependents, you must apply for dependent coverage within 31 days of the event that caused the new eligibility. Late enrollment approvals will be decided by the underwriter’s evaluation of the applicant’s medical history. Remember, it is your responsibility to notify us of dependent status changes.

When and how can I make changes to my enrollments?

a. The NMRHCA holds a Switch Enrollment Period once a year. This allows our members to make any changes to their benefits (medical, dental and/or vision).

b. If you switch or add coverage, your new benefits will go into effect on the following January 1. You can cancel your coverage at any time, but you must wait until the next Open Enrollment Period, which takes place every two years, to rejoin NMRHCA. Open Enrollment Periods take place during a portion of October-November before odd-numbered years. You can apply to rejoin NMRHCA in October-November of 2018 with your new benefits going into effect on January 1, 2019. The next Open Enrollment would be a period in October-November of 2020 with benefits going into effect on January 1, 2021.

c. If you enroll in an NMRHCA dental or vision plan and later terminate it, you must wait four years before enrolling again during the subsequent Switch Enrollment Period. You need not wait until the Switch Enrollment Period to apply for life insurance.

d. Life insurance changes may be done at any time by submitting a Change Request Form and/or an Evidence of Insurability Statement. Please contact RHCA to obtain the correct form(s).

Notice of the Annual Switch Enrollment Period appears in the newsletter prior to its commencement, along with instructions and a schedule of informational meetings around the state. At these meetings, representatives of all the carriers available in your area will give presentations regarding their benefit plans so that you may have an opportunity to compare the plans and assess which is best for you. You may also ask any questions you have about your plan(s) or your NMRHCA program, but you do not have to wait for these meetings to do so — you are welcome to call or write to the carriers or the NMRHCA at any time to comment or ask questions.

What should a survivor do upon the death of a participant?

a. When someone passes away, those who are left behind must take care of practical matters at a time when their thoughts are elsewhere. Health care and life insurance may not be at the top of the list. However, there are several actions that must be taken with regard to NMRHCA insurance in order to avoid problems later. Following are the steps survivors should take:

1. Call the NMRHCA to report the death of a retiree or enrolled dependent.

2. Review the packet of information the NMRHCA sends in response to the death report. You may be required to take action regarding health care coverage and/or life insurance.

3. In the case of a retiree’s death, benefits to the surviving spouse and/or dependent(s) listed on the account will continue. A survivor benefit application will be sent out and should be completed and returned as soon as possible; if we do not receive it, the survivor’s coverage will subsequently be terminated. If we receive the form, the survivor’s benefits will be continued as they were under the retiree, but the premium will be reduced effective the first of the month following the retiree’s death, and the survivor will be assessed the applicable Spouse or Dependent Rate for medical coverage. In the case of a dependent’s death, the retiree’s health care coverage will automatically continue as before, but the premium will be reduced effective the first of the month following the dependent’s death. We will send a Change Request Form so the retiree may request a change in the level of coverage (e.g., from Two-Party to Single) and name a new beneficiary if the deceased dependent was named. In either case, arrangements for subsequent premium contribution payments will depend in part on whether we have already taken a deduction for the next month’s coverage; refunds, amounts due, and subsequent payment arrangements will be determined on a case-by-case basis.

4. If the retiree carried life insurance on the deceased dependent through the NMRHCA, and for any deceased retiree, the survivor must complete a claim form and follow the instructions to make a claim.

The NMRHCA recognizes that this is a difficult time for survivors. However, the worst thing you can do is to ignore the matter; survivor coverage may be canceled if we do not hear from you. For that reason, we encourage survivors to call us for assistance.

How long can I keep my child(ren) on my plan?

a. You can keep your dependents under your health care plan and voluntary coverage (dental and vision) until age 26.

When and how are premium changes made?

a. From time to time, to ensure the stability of the NMRHCA fund and/or to offer our participants the lowest possible rates based on the previous year’s claims history, we may increase or decrease the amount of your monthly premium contributions. This can also arise from renegotiation of our carrier contracts each year. It is usually done on the recommendation of our Benefits Consultant and only at the direction of our Board of Directors.

Normal premium contribution rate changes take effect January 1 of any year.

Notice of Changes: You will always receive notice of change. Notice of change always appears in the newsletter (Your Benefits Messenger). Where appropriate, we may also send you a direct mailing or even hold informational meetings around the state. You will never be taken unaware if you read your newsletter. You always have the opportunity to comment on changes by emailing us, writing to us, calling us, or attending a Board of Directors meeting.