reglab/housing_qa huggingface dataset:
NM Stat § 59A-23-7.16 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-7.16 - Heart artery calcium scan coverage.

A. A group health plan, other than a small group health plan or a blanket health insurance policy or contract that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible insureds to receive a heart artery calcium scan.B. Coverage provided pursuant to this section shall:(1) be limited to the provision of a heart artery calcium scan to an eligible insured to be used as a clinical management tool;(2) be provided every five years if an eligible insured has previously received a heart artery calcium score of zero; and(3) not be required for future heart artery calcium scans if an eligible insured receives a heart artery calcium score greater than zero.C. At its discretion or as required by law, an insurer may offer or refuse coverage for further cardiac testing or procedures for eligible insureds based upon the results of a heart artery calcium scan.D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.E. As used in this section:(1) "eligible insured" means an insured who:(a) is a person between the ages of forty-five and sixty-five; and(b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence-based algorithm widely used in the medical community to assess a person's ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;(2) "health care provider" means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional's license; and(3) "heart artery calcium scan" means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function.History: Laws 2020, ch. 79, § 3.ANNOTATIONSEffective dates. — Laws 2020, ch. 79 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 20, 2020, 90 days after adjournment of the legislature.Applicability. — Laws 2020, ch. 79, § 6 provided that the provisions of Laws 2020, ch. 79, are applicable to group health insurance policies, health care plans or certificates of health insurance, other than small group health plans, that are delivered, issued for delivery or renewed in this state on or after January 1, 2021.
NM Stat § 59A-23-8 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-8 - Group formed to purchase health insurance; limitations.

A. No policy or certificate of group health insurance may be renewed, delivered or issued for delivery in this state to a group formed for the purpose of purchasing one or more policies of group health insurance unless the superintendent has approved the issuance. The superintendent shall not grant his approval unless he finds that: (1) the benefits of the policy are reasonable in relation to the premium charged; and (2) the group to which the policy is issued is organized and operated in a fiscally sound manner. B. An insurer may exclude or limit the coverage in a policy issued pursuant to this section for any person as to whom evidence of insurability is not satisfactory to the insurer. C. The provisions of this section apply to the offering in this state of a policy issued in another state or its certificates. History: Laws 1991, ch. 125, § 28.
NM Stat § 59A-23-9 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-9 - Repealed.

History: Laws 1997, ch. 243, § 20; repealed by Laws 2021, ch. 108, § 37. ANNOTATIONSRepeals. — Laws 2021, ch. 108, § 37 repealed 59A-23-9 NMSA 1978, as enacted by Laws 1997, ch. 243, § 20, relating to out-of-state associations and trusts, effective July 1, 2021. For provisions of former section, see the 2020 NMSA 1978 on NMOneSource.com.
NM Stat § 59A-23-10 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-10 - Employer utilization and loss data availability.

Claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 23 NMSA 1978 shall be made available only upon the request of and to employers of employees with such coverage within sixty days of an employer's written request for such information, provided the employer's coverage extends to no less than twenty-five individual employees, regardless of whether family coverage is included. In providing such utilization data, carriers shall not reveal information that allows identification of an individual employee or the employee's family or the specific conditions for which coverage was provided. History: Laws 2003, ch. 252, § 1. ANNOTATIONSEffective dates. — Laws 2003, ch. 252 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 20, 2003, 90 days after adjournment of the legislature.
NM Stat § 59A-23-12 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-12 - Prescription drug prior authorization protocols.

A. After January 1, 2014, an insurer shall accept the uniform prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request prior authorization for prescription drug benefits. B. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability. C. If an insurer fails to use or accept the uniform prior authorization form or fails to respond within three business days upon receipt of a uniform prior authorization form, the prior authorization request shall be deemed to have been granted. D. As used in this section, "insurer": (1) means: (a) an insurer; (b) a nonprofit health service provider; (c) a health maintenance organization; (d) a managed care organization; or (e) a provider service organization; and (2) does not include: (a) a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy; (b) a physician or a physician group to which a health insurer has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or (c) an insurer or its affiliated providers, if the insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs. History: Laws 2013, ch. 170, § 6. ANNOTATIONSEffective dates. — Laws 2013, ch. 170 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2013, 90 days after the adjournment of the legislature.
NM Stat § 59A-23-12.2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-12.2 - Pharmacist prescriptive authority services; reimbursement parity.

An insurer shall reimburse a participating provider that is a certified pharmacist clinician or pharmacist certified to provide a prescriptive authority service who provides a service pursuant to a health insurance plan, policy or certificate of health insurance at the standard contracted rate that the health insurance policy, health care plan or certificate of health insurance reimburses, for the same service pursuant to that policy, plan or certificate, any licensed physician or physician assistant licensed pursuant to the Medical Practice Act [Chapter 41, Article 5 NMSA 1978] or any advanced practice certified nurse practitioner licensed pursuant to the Nursing Practice Act [Chapter 61, Article 3 NMSA 1978]. History: Laws 2020, ch. 58, § 4; 2021, ch. 54, § 12. ANNOTATIONSThe 2021 amendment, effective June 18, 2021, after "Medical Practice Act", deleted "or the Osteopathic Medicine Act".
NM Stat § 59A-23-13 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-13 - Pharmacy benefits; prescription synchronization.

A. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides a prescription drug or device benefit shall allow an insured to fill or refill a prescription for less than a thirty-day supply of the prescription drug, and apply a prorated daily copayment or coinsurance for the fill or refill, if: (1) the prescribing practitioner or the pharmacist determines the fill or refill to be in the best interest of the insured; (2) the insured requests or agrees to receive less than a thirty-day supply of the prescription drug; and (3) the reduced fill or refill is made for the purpose of synchronizing the insured's prescription drug fills. B. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides a prescription drug or device benefit shall not: (1) deny coverage for the filling of a chronic medication when the fill is made in accordance with a plan to synchronize multiple prescriptions for the insured pursuant to Subsection A of this section established among the insurer, the prescribing practitioner and a pharmacist. The insurer shall allow a pharmacy to override any denial indicating that a prescription is being refilled too soon for the purposes of medication synchronization; and (2) prorate a dispensing fee to a pharmacy that fills a prescription with less than a thirty-day supply of prescription drug pursuant to Subsection A of this section. The insurer shall pay in full a dispensing fee for a partially filled or refilled prescription for each prescription dispensed, regardless of any pro-rated copayment or coinsurance that the insured may pay for prescription synchronization services. History: Laws 2015, ch. 65, § 4. ANNOTATIONSEffective dates. — Laws 2015, ch. 65 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 19, 2015, 90 days after the adjournment of the legislature.
NM Stat § 59A-23-15 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-15 - Physical rehabilitation services; limits on cost sharing.

A. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied.B. As used in this section:(1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech therapist; and(2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate. History: Laws 2019, ch. 188, § 3. ANNOTATIONSEffective dates. — Laws 2019, ch. 188, § 6 made Laws 2019, ch. 188 effective January 1, 2020.
NM Stat § 59A-23-16 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23 - Group and Blanket Health Insurance Contracts|Section 59A-23-16 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)

A. Until January 1, 2027, a group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health services.B. For the purposes of this section:(1) "behavioral health services" means professional and ancillary services for the treatment, habilitation, prevention and identification of mental illnesses, substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient and all medications, including brand-name pharmacy drugs when generics are unavailable;(2) "coinsurance" means a cost-sharing method that requires a covered person to pay a stated percentage of medical expenses after any deductible amount is paid; provided that coinsurance rates may differ for different types of services under the same group or blanket health insurance policy, health care plan or certificate of health insurance;(3) "copayment" means a cost-sharing method that requires a covered person to pay a fixed dollar amount when health care services are received, with the insurer paying the balance of the allowable amount; provided that there may be different copayment requirements for different types of services under the same group or blanket health insurance policy, health care plan or certificate of health insurance; and(4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of a covered person other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of a group or blanket health insurance policy, health care plan or certificate of health insurance.History: Laws 2021, ch. 136, § 7. ANNOTATIONSEffective dates. — Laws 2021, ch. 136, § 11 made Laws 2021, ch. 136, § 7 effective January 1, 2022.
NM Stat § 59A-23A-1 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-1 - Short title.

Chapter 59A, Article 23A NMSA 1978 may be cited as the "Long-Term Care Insurance Law". History: Laws 1989, ch. 136, § 1; 1993, ch. 126, § 6. ANNOTATIONSThe 1993 amendment, effective June 18, 1993, rewrote this section, which formerly read: "This act may be cited as the 'Long-Term Care Insurance Act.'"
NM Stat § 59A-23A-2 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-2 - Purpose.

The purpose of the Long-Term Care Insurance Law is to promote the public interest in and the availability of long-term care insurance policies, protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, establish standards for long-term care insurance, facilitate public understanding and comparison of long-term care insurance policies and facilitate flexibility and innovation in the development of long-term care insurance coverage. History: Laws 1989, ch. 136, § 2; 1993, ch. 126, § 7. ANNOTATIONSThe 1993 amendment, effective June 18, 1993, substituted "Law" for "Act".
NM Stat § 59A-23A-3 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-3 - Scope.

The provisions of the Long-Term Care Insurance Law shall apply to policies, certificates or riders delivered or issued for delivery in this state on or after July 1, 1989. The Long-Term Care Insurance Law is not intended to supersede any obligations of any entity to comply with the substance of any other provision of law, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance. History: Laws 1989, ch. 136, § 3; 1993, ch. 126, § 8. ANNOTATIONSThe 1993 amendment, effective June 18, 1993, in the first sentence, substituted "Law" for "Act", substituted "in this state" for "renewed or continued", and substituted "July 1, 1989" for "the effective date of that act"; substituted "Law" for "Act" in the second sentence; and deleted the former last sentence, which read: "A policy which is not marketed or offered as long term care insurance or nursing home insurance is not subject to the provisions of the Long-Term Care Insurance Act."
NM Stat § 59A-23A-5 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-5 - Extraterritorial jurisdiction; group long-term care insurance.

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in Paragraph (4) of Subsection C of Section 59A-23A-4 NMSA 1978, unless the superintendent has determined prior to the offer that: A. the coverage meets the requirements of Chapter 59A, Article 23A NMSA 1978 and any regulations pertaining thereto, or the insurance commissioner of another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in New Mexico has determined that such requirements have been met; and B. the requirements of Section 59A-23-8 NMSA 1978 have been met. History: 1978 Comp., § 59A-23A-5, enacted by Laws 1993, ch. 126, § 10. ANNOTATIONSRepeals and reenactments. — Laws 1993, ch. 126, § 10 repealed former 59A-23A-5 NMSA 1978, as enacted by Laws 1989, ch. 136, § 5, and enacted a new section, effective June 18, 1993.
NM Stat § 59A-23A-7 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-7 - Preexisting condition; definition; coverage.

A. No long-term care insurance policy, certificate or rider, including a group long-term care policy or certificate shall use a definition of preexisting condition that is more restrictive than the following: "preexisting condition" means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within six months preceding the effective date of coverage of an insured person. B. No long-term care insurance policy, certificate or rider, including a group long-term care policy, certificate or rider, shall exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six months following the effective date of coverage of an insured person. C. The definition of preexisting condition as provided in Subsection A of this section does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. D. In the policy, certificate or rider, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered within six months following the effective date of coverage of the insured person. No long-term care insurance policy, certificate or rider may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond six months following the effective date of coverage of the insured person. History: Laws 1989, ch. 136, § 7.
NM Stat § 59A-23A-8 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-8 - Incontestability period.

A. For a policy or certificate that has been in force for less than six months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage. B. For a policy or certificate that has been in force for at least six months but less than two years an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought. C. After a policy or certificate has been in force for two years it is not contestable upon the grounds of misrepresentation alone. Such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health. D. No long-term care insurance policy or certificate may be field issued based on medical or health status. For purposes of this subsection, "field issued" means a policy or certificate issued by an agent or a third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer. E. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded. History: 1978 Comp., § 59A-23A-8, enacted by Laws 1993, ch. 126, § 12. ANNOTATIONSRepeals and reenactments. — Laws 1993, ch. 126, § 12 repealed former 59A-23A-8 NMSA 1978, as enacted by Laws 1989, ch. 136, § 8, relating to the continuation of coverage and conversion, and enacted a new section, effective June 18, 1993. For provisions of former section, see the 1992 NMSA 1978 on NMOneSource.com. Am. Jur. 2d, A.L.R. and C.J.S. references. — Rescission or cancellation of insurance policy for insured's misrepresentation or concealment of information concerning human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) or related health problems, 15 A.L.R.5th 92.
NM Stat § 59A-23A-9 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-9 - Authority to promulgate regulations.

The superintendent shall promulgate regulations in accordance with the provisions of Section 59A-2-9 NMSA 1978 that include minimum standards for marketing practices, agent compensation, agent testing, penalties and reporting practices for long-term care insurance. History: 1978 Comp., § 59A-23A-9, enacted by Laws 1993, ch. 126, § 13.
NM Stat § 59A-23A-10 (2021)
2021 New Mexico Statutes|Chapter 59A - Insurance Code|Article 23A - Long-Term Care Insurance|Section 59A-23A-10 - Penalties.

In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or up to ten thousand dollars ($10,000), whichever is greater. History: 1978 Comp., § 59A-23A-10, enacted by Laws 1993, ch. 126, § 14.