Benefits 101: Loss of Coverage

If you or a dependent experience a loss of coverage, you MUST report that loss within 31 days. Supportive documentation of the loss is required to include:

• Who lost coverage
• What type of coverage was lost
• When did the coverage end
• Why was the coverage lost (must be involuntary)

Be Advised: Voluntary canceling of other coverage or non-compliance to maintain other coverage is not considered a qualifying event. See page 14 of the Program Guide for details related to the Loss of Coverage Qualifying Event.

Benefits 101: Birth of a Child

Welcoming a newborn child is a joyous time in someone's life and it's also a qualifying life event to cover your newborn under NMPSIA Benefits!

Important: The Policyholder has 31 days to report the birth of a child by submitting a Change Form and proof of birth. Don't wait to inform your employer of your upcoming birth! It will be important to ask about your maternity options such as FMLA and ensure you know how to fill out the Change Form, which can be found HERE on the NMPSIA website.

Did you know: You can use the Hospital Proof of Birth/ Birth Registration to enroll your child in benefits? You do not need to wait for the Social Security card or Official State Filed Birth Certificate to enroll your newborn!

Helpful Tip: Pack your Change Form in your hospital overnight bag. When hospital registration comes to your room, you will be prepared with your Change Form, which you will provide to your employer.

NMPSIA is excited to announce new resources on our website, offering free tools and support for Behavioral Health, including suicide and self-harm prevention, mental health wellness, anxiety, substance abuse, and eating disorders.

Benefits 101: Program Guide

It’s a bird! It’s a plane! - It’s the NMPSIA Program Guide! Just like a superhero, this guide is here to help.

Enrollment Guidelines: You can find out when you are eligible, who in your family is eligible and what documents you need to provide to enroll on pages 8-17 of the Program Guide.

Smart Consumer Information: It’s no secret healthcare is costly! Check out page 18 of the Program Guide to find out how you can save yourself some time and money.

Online Benefit Access: Pages 19-21 teach you how to utilize the Online Benefit System. You can view your benefits, make changes to your personal information and beneficiary information.

Detailed Carrier Overview: Pages 27-94 offer information on each carrier. Have you ever wondered how to enroll in the Wellness Rewards through your carrier? Take advantage of gym membership discounts and more!

• Benefits 101: Health Insurance Jargon
• Employee Online Benefit System
• Digital Therapy Resource
• ‘One Week of Wellness’ Challenge
• Back to the Basics Wellness
• Longevity Series Sign-Up
• Recipe: Bang Bang Salmon Bites
• Dimensions of Wellness
• Self-Care Action Planning
• Create your Action Plan

Mark your calendar!

No cost at-home preventative health screening kits will be mailed upon request. Once received, complete the instructions, mail it back, get results.
Keep a look out for mailers regarding the program!

Benefits 101: Health Insurance Jargon

Give yourself a break, health insurance jargon can be tricky, but a quick refresh can turn confusion into confidence!

Deductible (Medical & Dental): This is the amount you must pay each year for certain medical or dental services before your insurance plan starts covering costs. Some services and procedures have a deductible that applies. Each out-of-pocket medical or dental expense is counted towards the associated deductible amount. Once you have reached the deductible amount the plan will begin to cover the services as designed. For example, with your current in-network High Option Plan, you need to pay $750 for medical expenses and $50 for dental expenses before the plan begins to contribute.

Annual Out of Pocket Maximum (Medical): This is the most you have to pay in a year for covered medical services. Once you reach this limit, your insurance plan will cover 100% of eligible costs for the rest of the year, up to the plan benefit limits. The out-of-pocket maximum includes your deductible, copayments, and coinsurance but does not include penalties, non-covered charges, or costs above Medicare’s allowed amounts. For example, with your current in-network High Option Plan, you need to pay $4,100 for covered services before the plan covers eligible services at 100% for the rest of the year.

Calendar Year Maximum (Dental): This is the most your dental plan will pay for covered services in a year. If you reach this limit, you must pay for any additional dental costs until the next year starts. The calendar year maximum benefit amount includes cleanings, exams, cavity fillings, root canals, crowns, extractions, and other surgeries

Employee Online Benefit System

Taking control of your health benefits starts here. Knowing your beneficiary and keeping your information, like addresses, updated is the first step. You will gain confidence to fully understand and use your benefits

Did you know?

You can view and change your basic information and beneficiary information any time, no forms required!

*If you have a Qualifying Event, you can also make changes to your enrollment as well as add or cancel dependents.
*Subject to Employer approval

How-To Resources

• Employee Online Enrollment Training Materials
• Add/Change Beneficiary
• Change Basic Information
• New Hire - Adding Coverage/Dependents