Deductibles

Deductibles and Out-of-Pocket Expenses

The Individual deductible you chose is indicated on your ID card. The table below lists the deductible and the out-of-pocket limits that apply to your Policy — based on the Individual deductible amount selected by you and printed on your ID card. While NMMIP does not offer a "Family" Policy, if you have three or more qualified family members on NMMIP Policies with the same deductible you may receive reduced deductible and out-of-pocket limits as indicated on the table below.

Note: Amounts applied to the annual deductible and to member coinsurance are not used to calculate benefit limitations that are based on a dollar amount (e.g., $1,500 per calendar year). Such limits are based on amounts actually paid out by the NMMIP. However, when a limitation is based on a maximum number of days, visits, or benefit periods (e.g., 30 days per calendar year), the maximum benefit may be reached even if all covered charges were applied to the deductible.

Plan Deductible - See your ID card for your individual deductible amount

Deductible — The deductible you chose is indicated on your ID card (see table, above). You must pay your deductible amount before NMMIP will begin paying its share of your covered charges. Only covered charges are applied toward the deductible.

Family Deductible — An entire family meets an annual deductible when the total deductible amount for all family members reaches two times the Individual deductible amount chosen (see table, above). Note: If a member’s Individual deductible is met, no more charges incurred by that member may be used to satisfy the Family deductible.

Change in Deductible Plan — NMMIP members can change from a lower to a higher deductible plan at any time upon written notice to the Administrator. The effective date of the change is the next premium due date following the request date.

If you increase your deductible amount, the new deductible amount must be met for all services received as of the change effective date. This means that if you had met your lower deductible and then change to a higher deductible, for services received as of the change effective date, you do not receive benefit payments until the increase in deductible is met.

NMMIP members can change from a higher to a lower deductible plan on or before October 1 each year. The effective date will be January 1 the following year. Requests for such changes must be made in writing to the Administrator. If you decrease your deductible amount, you do not receive a refund for any deductible amounts applied for services before the change effective date.

Out-of-Pocket Limit Changes — Changing your deductible plan also affects your out-of-pocket limit provisions. This means that if you had met your lower out-of-pocket limit and then you change to a higher out-of-pocket limit, for services received as of the change effective date, you do not receive the 100 percent payment until the increase in out-of-pocket is met.