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Q.
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What are the eligibility requirements for PAK?
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A.
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Children under the age of 12 (and up to 18 if they have an eligible sibling) who
meet the following requirements:
- Uninsured and ineligible for Medicaid and SCHIP based on income;
- New Mexico resident;
- United States Citizen or a Legal Permanent Resident (LPR) and
- Must not have dropped health insurance in the past six months
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Q.
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How do I apply for PAK?
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A.
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You may request an application by calling 1-888-997-2583 or you may download an
application from this website. Once the application is complete, it can either be
mailed with requested documentation to Insure New Mexico! Solutions Center, P.O.
Box 27117, Santa Fe, NM 87502 or faxed to 505-827-7200.
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Q.
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What documentation is required to complete a PAK application?
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A.
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The PAK application is completed if you have signed and initialed the appropriate
pages, selected a
PAK health plan, and submitted copies of the following documents:
- Copies of social security cards and birth certificates for all children applying
- Copies of household income, such as pay stubs, for the past 30 days
- Proof of child care (i.e. receipts for the past 30 days or letter signed by the
care giver).
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Q.
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Can I apply for PAK if my children qualify for Medicaid?
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A.
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If your child(ren) are eligible for Medicaid, you must apply for Medicaid. If you
are denied Medicaid due to income, you may submit a PAK application.
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Q.
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I have voluntarily dropped health insurance for my child(ren) in the last 6 months,
can I apply for PAK for my child(ren)?
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A.
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No, if you have voluntarily dropped health insurance for your children, there is
a 6 month waiting period for PAK.
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Q.
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How will I know if I am enrolled?
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A.
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Once the PAK enrollment application is approved by the health plan, parents pay
their portion of the premium to begin the enrollment process. Health plan approval
is dependent on the outcome of the medical underwriting process.
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Q.
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How much will my premium be?
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A.
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The PAK program
pays a portion of the child’s full monthly premium
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Q.
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When is my premium due?
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A.
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Once your child(ren) are deemed eligible for PAK, we will send you a letter providing
you with information about how to enroll with the PAK health plan that you selected.
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Q.
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What doctors will accept PAK?
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A.
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Once you receive your insurance card, you will be given a list of providers that
accept PAK.
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Q.
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How much will my deductable be?
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A.
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The deductable is $500 per year per child. This deductable resets at the beginning
of each calendar year (January 1– December 31). There is no carryover regardless
of the renewal date.
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Q.
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Will I have co-pay?
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A.
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Yes, there are co-pays for the PAK program.
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Q.
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How much will the co-pays be?
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A.
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Your co-pay can range from $15 to $50 depending on the service.
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Q.
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What are the PAK benefits?
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A.
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The PAK benefits of a comprehensive health insurance product for children includes
preventive,
primary and specialty care, inpatient and outpatient hospitalization, pharmacy,
lab, x-ray, physical, occupational and speech therapy.
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Q.
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How long is my child covered?
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A.
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Once your child is enrolled with the PAK program, they will be eligible for a year
unless you stop premium payments or obtain other insurance.
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Q.
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Do I have to recertify for PAK?
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A.
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Yes, with the PAK program, it is required that you recertify every 12 months.
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Q.
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If I decide that I don’t need this insurance, is my premium refunded?
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A.
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Should you decide that PAK is not for you or you acquire another insurance, any
premiums paid are non refundable.
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Q.
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Does this program cover dental and vision?
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A.
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It may- please refer to the PAK health plans for benefit information
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Q.
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My child was denied by the PAK health plan I selected, who can insure me now?
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A.
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Children who do not qualify for the PAK program because of health issues will be
referred back to Insure New Mexico! for other coverage options, including the New
Mexico Medical Insurance Pool.
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Premium Assistance for Maternity (PAM) Frequently Asked Questions
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Q.
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What are the eligibility requirements for PAM?
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A.
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- Must be ineligible for Medicaid due to income.
- Must be pregnant, a resident of New Mexico and a U.S. citizen or Legal Permanent
Resident
- Must be uninsured or have insurance that does not include maternity coverage
- Must not have voluntarily dropped health insurance with maternity coverage in the
past 6 months.
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Q.
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How do I apply for PAM?
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A.
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To request an application for PAM, please call the Insure New Mexico Solutions Center
at 1-888-997-2583. You may also download the application from this website. Once
the application is complete, it can either be mailed with requested documentation
to Insure New Mexico! Solutions Center, P.O. Box 27117, Santa Fe, NM 87502 or faxed
to 505-827-7200.
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Q.
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What documentation is required to complete the PAM application?
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A.
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The PAM application is complete if you have signed and initialed the appropriate
pages, and if you have submitted copies of the following documents:
- A doctor’s statement as proof of pregnancy
- Proof of identity (e.g. driver’s license and Social Security card, etc.)
- Proof of citizenship (e.g. U.S. passport, U.S. birth certificate, certificate of
U.S. citizenship or naturalization)
- Proof of household income (e.g. copy of pay stubs) for the past 30 days
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Q.
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What will I pay for PAM?
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A.
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There is a one-time enrollment fee – if you enroll during the first 20 weeks
of pregnancy (months 1-5), you pay $500; if you enroll during the second 20 weeks
(months 6-9), your payment is $1000. There are no additional fees, deductibles or
co-payments in the PAM program.
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Q.
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I sent my PAM application to Insure New Mexico – what happens now?
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A.
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Your application will be processed shortly after it is received. If approved, you
will be sent an approval letter which instructs you to make your one-time payment.
Once your payment is received, your enrollment will start the beginning of the current
month. If you do not qualify for PAM, you will receive notification.
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Q.
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What services does PAM cover?
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A.
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PAM covers pregnancy-related health services, including pre-natal exams, ultrasounds,
delivery, and post-natal care for the mother. PAM does not cover health care services
provided to the newborn child immediately following the delivery.
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Q.
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What doctors will accept PAM?
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A.
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Currently, the PAM provider network is any New Mexico medical provider that accepts
Medicaid reimbursement.
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Q.
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How will my doctor know I am covered under this program? Will I receive a card?
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A.
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Your doctor can access the Medicaid database to view your eligibility status. If
you do not receive an eligibility card, it is recommended that you bring your PAM
enrollment letter to your appointments as proof of coverage.
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Q.
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My doctor is telling me I am not covered under PAM. What does this mean?
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A.
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This could mean that your PAM payment has not yet been received or processed, or
there has been a delay in transmitting your information into the Medicaid database.
Please call 505-827-7288 for assistance.
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Q.
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Can I use a midwife with my PAM coverage?
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A.
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Yes, you may use a midwife who accepts New Mexico Medicaid reimbursement. For more
information on birthing options, you can click on the “Birthing Options Program”
brochure.
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