The State Coverage Insurance Program is a program offered by private insurers in partnership with the state of New Mexico that makes available low-cost (subsidized) health insurance for small employers, self-employed and individuals.
When can I get State Coverage Insurance (SCI)?
- If you are an employer with 2 to 50 eligible employees or self employed and meet certain qualifications, you can buy health insurance through the SCI program
- As a small employer participant, you must not have voluntarily cancelled insurance for your employees within the last 12 months (6 months for self-employed individuals).
- To be eligible for SCI benefits, employees of participating small employers and self-employed individuals must be uninsured, low-income (<200% FPL) and between 19 and 64. In addition, they cannot have voluntarily canceled health insurance coverage in the last 6 months.
- All other individuals, regardless of employment status, that are low income, uninsured and between the age of 19 and 64, may be eligible for individual coverage through the SCI program (see page 38).
WHAT WILL SCI COVER?
- SCI provides basic coverage to eligible individuals. Coverage includes physician services, hospital, prescription drugs, X-rays, and mental health services. All individuals are subject to a $100,000 annual cap. Services may vary depending on the plan. No dental or vision services.
- Currently, three health plans participate in SCI, Lovelace, Molina, and Presbyterian.
WHAT ABOUT PRE-EXISTING CONDITIONS?
- There are no pre-existing condition exclusion periods when you buy health insurance through SCI.
WHAT CAN I BE CHARGED FOR SCI COVERAGE?
- If you work for a participating small employer, your employer will pay $75 per month and you will have to pay up to $35 per month, based on your income. If you are self-employed, you will have to pay the $75 employer contribution in addition to the monthly premium (up to $35 per month). You may also be responsible for co-payments.
- For more information about SCI, contact the New Mexico Health Insurance Solutions Center at 866-901-4538 or visit them on the web at www.insurenewmexico.state.nm.us.
