State Employee Health Insurance Reforms

SENATE BILL 376 IMPLEMENTATION JUNE 10, 2025 INVESTING FOR TOMORROW, DELIVERING TODAY.

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SENATE BILL 376 IMPLEMENTATION RATE AND CONTRIBUTION CHANGES

SENATE BILL 376 IMPLEMENTATION Major reforms for FY26 Minimum 80% state contribution to medical, dental, and vision insurance Program for lower-income state employees funded by Health Care Affordability Fund Actuarially sound rates Hospital savings initiatives and patient protections Even with needed rate increases, overall employee premiums will drop significantly due to state contribution increases Investing for tomorrow, delivering today.

BASELINE CONTRIBUTION SCHEDULE CHANGES Current State/Employee Contribution Schedule Under $50,000 $50,000-$60,000 Over $60,000 80/20 70/30 60/40 New Minimum State/Employee Contribution Minimum 80/20 Investing for tomorrow, delivering today.

FY26 RATE CHANGES Rate changes FY26 20% increase in medical insurance rates 10% decrease in dental and vision insurance rates Employee-only Rates in FY25 and FY26 Plan FY25 Gross Rate FY26 Gross Rate Presbyterian HMO $300.06 $360.36 Blue Cross HMO $300.06 $360.36 Blue Cross PPO $348.95 $419.10 Delta Dental $18.05 $16.25 EyeMed Vision $3.36 $3.02 Investing for tomorrow, delivering today.

STATE EMPLOYEE PREMIUM ASSISTANCE (SEPA) SEPA is the additional premium assistance program for lower income state employees SEPA Eligibility Either Under 250% FPL or Between $37,650 and $50,000 if purchasing employee-only coverage Ineligible for Medicaid 2025 Coverage Year Federal Poverty Levels Family Size 1 2 3 4 5 6 7 8 138% FPL $20,783 $28,207 $35,632 $43,912 $50,480 $57,905 $65,329 $72,754 250% FPL $37,650 $51,100 $64,550 $79,550 $91,450 $104,900 $118,350 $131,800 Investing for tomorrow, delivering today.

EMPLOYEE CONTRIBUTION LEVELS UNDER SEPA FY26 Employee Premium Contribution Schedule with SEPA SEPA Group 1 138-175% FPL 0% SEPA Group 2 175-212% FPL 5% SEPA Group 3 212-250% FPL 10% $37,650-$50,000 Employee Only 10% Coverage Category All Others 20% Employee Only 0% 5% 10% N/A 20% Employee + Partner 5% 10% 15% N/A 20% Employee + Children 5% 10% 15% N/A 20% Family Investing for tomorrow, delivering today.

9 HOW TO APPLY FOR SEPA Step 1: Check your state email to see if you received an automatic eligibility determination from SEPA@easitpa.com NOTE: If you are on an Employee- only plan and your state salary is between $37,650 and $50,000, you will be automatically enrolled at the beginning of July when FY26 salaries are initiated. Step 2: If you did not receive an automatic eligibility determination, visit https://www.mybenefitsnm.com/S EPA.html and fill out the SEPA application. Applications must be submitted with all supporting documentation to SEPA@easitpa.com or faxed to 505-244-6009 no later than June 30. Investing for tomorrow, delivering today.

10 WHAT COUNTS AS INCOME? You should use your Adjusted Gross Income, which is your gross income after certain deductions have been subtracted. These deductions can include things like contributions to retirement accounts, student loan interest payments, or self- employment expenses. You can find this number on your tax forms. The annual household income in the most recent available tax return. The projected annual household income during the upcoming benefits year with a letter of attestation explaining the household circumstances. You can also submit documentation of your monthly household income during the month before the employee submits a SEPA application. Investing for tomorrow, delivering today.

11 WHAT CAN I SUBMIT AS PROOF OF INCOME? 1040 federal or state tax return. Must contain your first and last name, income amount, and tax year. If you file Schedule 1, you must submit it with your 1040. Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to- date profit and loss statement, or a self- employment ledger). Must contain your first and last name, company name, and income amount. If you re submitting a self-employment ledger, include the dates covered by the ledger, and the net income from profit/loss. Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT). Must contain your first and last name, income amount, tax year, and employer name (if applicable). Pay stub. Must contain your first and last name, income amount, and pay period or frequency of pay with the date of payment. If a pay stub includes overtime, tell us the average overtime amount per paycheck. Social Security Administration Statements (Social Security Benefits Letter). Must contain first and last name, benefit amount, and frequency of pay. Unemployment Benefits Letter. Must contain your first and last name, source/agency, benefits amount, and duration (start and end date, if applicable). Investing for tomorrow, delivering today.

12 WHAT IF I QUALIFY FOR MEDICAID? If you qualify for Medicaid, you can significantly reduce your costs by switching to Medicaid. As an adult, if you qualify for Medicaid, you do not qualify for SEPA. Visit yes.nm.gov to apply for Medicaid. Investing for tomorrow, delivering today.

13 EXCEPTIONS REQUESTS If you have unique circumstances that you believe could qualify for an exception, please submit the request to EASI Gov. Investing for tomorrow, delivering today.

14 WHEN DO CHANGES TAKE EFFECT? All changes to contributions will take effect during the first pay period of the new fiscal year. The changes will be reflected on paychecks received on July 25. Investing for tomorrow, delivering today.

15 CONTACT EASI GOV IF YOU HAVE QUESTIONS If you have any questions or need help with your application: Email EASI Gov at SEPA@easitpa.com Call EASI Gov at (855) 618-1800 Investing for tomorrow, delivering today.

THANK YOU! FOR MORE RESOURCES, VISIT HTTPS://WWW.MYBENEFITSNM.COM/SEPA.HTML