Employee FAQs

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Benefits of NMHIX SHOP

What are the 10 essential health benefits covered by all health plans through SHOP?

All the health plans available through the SHOP include the following benefits:

  • Maternity and newborn care
  • Pediatric services
  • Preventive services for adults
  • Emergency services
  • Hospitalization
  • Ambulatory patient services (Outpatient care)
  • Prescription medications
  • Mental and behavioral health
  • Rehabilitative services and devices
  • Laboratory services

Manage your accountBack to Top

How do I get into my account?

NMHIX will send you an email on behalf of your employer, which will include a one-time link directly to the NMHIX system. To verify the phone number we have in our records, we will send a code either by voice or text message. Once that code has been entered, you will be asked to provide answers to two security questions and select a password.

At that point, you will be logged in to your account, and you should see a welcome greeting with your name in the upper left corner of the Dashboard screen.

How do I change my password?

To change your password, click the My Account tab on the top of the screen. Then click on the Account Settings tab in the dropdown. Click on the "Change Your Password" button then make the desired changes and click Save.

What do I do after I log in?

After you log in to your account, you must complete four main steps to enroll in a healthcare plan. These steps include:

  • Verifying your employee information
  • Adding or updating information for your dependents
  • Evaluating the available health care plans and making a selection
  • Confirming your selection and enrolling in the plan

The Dashboard walks you through these four steps and indicates which steps have already been completed.

Enrollment periodBack to Top

What is an open enrollment period?

Open enrollment is a designated period of time each year when employees can make changes to their health insurance coverage. An open enrollment period lasts for 10 days. During this time you can evaluate the available health insurance plans and make your selections. You can also make changes to your selections up to the last day of the open enrollment period. And, if desired, you can waive coverage.

On the Employee Portal, the dates of the open enrollment period are shown at the top of the Dashboard screen.

Can I make changes to my health coverage after the open enrollment period is over?

After the open enrollment period ends, you cannot make changes to your health coverage until the next open enrollment period unless you qualify for a special enrollment period due to a qualifying life event.

What is a special enrollment period?

A special enrollment period is also available to current employees who experience changes in their lives such as marriage or divorce or the birth or adoption of a baby. These changes are referred to as qualifying life events. You can let your employer know if you experience a qualifying event by clicking Report Changes on your dashboard.

Qualifying eventBack to Top

What is a qualifying event?

A qualifying event is an event that results in a life change for the employee, such as the birth of a child. These life changes can also make it necessary for an employee to make changes to their health coverage.

The following are some examples of qualifying events:

  • Birth
  • Adoption
  • Marriage
  • Divorce
  • Loss of eligibility for other coverage
  • New eligibility for other coverage
  • Death of a dependent
  • Legal Separation

If you experience a qualifying event, you have 30 days to report the event and make the change to your enrollment.

Members of federally-recognized tribes are eligible for special enrollment once every month.

Waive coverageBack to Top

What does it mean to waive coverage?

If you choose to waive coverage during the open enrollment period, it means that you give up the opportunity to enroll in the health coverage provided by your employer for the upcoming year. You will not be eligible for health coverage through your employer until the next open enrollment period.

What happens if I waive coverage?

You can choose to waive coverage during the open enrollment period by selecting the Waive Employer Coverage option. If you select this option, you will be asked to provide the reason why you want to give up employer-sponsored health coverage. For example, you may be covered under another plan or you may be eligible for a government plan such as Medicaid.

If you waive coverage, you will be asked to confirm this choice and then provide your electronic signature. Note: If you do not have any health coverage and you still choose to waive your employer coverage, you may be subject to a tax penalty.

RenewalBack to Top

If a dependent turns 26, will the dependent still be covered under the employee's health insurance?

Once enrolled, the dependent will continue to be covered under the employee's health insurance until the plan's renewal date, or until a life change event is reported that makes the dependent eligible for a Special Enrollment Period.

If I don't complete my renewal on time, will my coverage be auto-renewed or terminated?

First, it is important to note that the Employer needs to complete the renewal process for the group, or the health insurance coverage for the Employee will be cancelled.

If the group coverage has been renewed, Employees are auto-renewed when they meet both of the following conditions:

  1. The plan in which they are currently enrolled is available to them for the next coverage period.
  2. They did not complete the renewal process during Open Enrollment Period.

What can I do if I can't afford the health coverage offered by my employer?

The health insurance coverage offered by your employer is considered affordable to you if your share of the annual premium for the lowest priced self-only plan is less than 9.5% of your household's combined annual income. If the employer-sponsored coverage offered to you is considered affordable and provides "minimum essential coverage," you will not be eligible for any tax credits to reduce the cost of the monthly premiums for a plan purchased through the individual marketplace. Of course, you can still purchase a plan from the marketplace at full price.

Other issuesBack to Top

What is an Employer Contribution?

This is the amount your employer has agreed to pay toward your health and/or dental insurance plans. The Employer Contribution reduces the cost of these plans to you. This contribution may or may not also apply to the premiums for your dependents' plans.

How do I add a dependent?

You can add a dependent either during open enrollment or special enrollment by completing the Update Dependents step.

How do I purchase dental coverage for my family?

As part of the shopping experience on NMHIX, you are offered the opportunity to purchase dental coverage for your family.

Can I select different plans for different family members?

The employee and all dependents must be enrolled in the same health insurance plan. For dental insurance plan, you may choose all or a subset of family members to sign up for coverage, however all members must be enrolled into the same plan.

Where can I see a summary of my selected plans?

There are two ways to see the details of your selected plans:

  • By clicking the My Plans tab on the left-hand side of the screen.
  • By clicking the View Benefit Details button under Plan Summary.

What is an e-signature?

An e-signature is the electronic version of a handwritten signature and is a simple and legal way to give consent on electronic forms. When you enroll in the selected health care plan, you provide an e-signature by typing your name on the Enrollment screen.

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