reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-3.1 - Group insurance reports required.

A. At least quarterly, upon request by the employer, each insurer who has delivered or issued for delivery a policy of group insurance covering twenty-six or more employees, all or a portion of the premiums for which is paid by the employer of the insureds, shall submit to the employer a financial summary report by coverage of expenses incurred by or on behalf of the employees of that employer since the last report. The report shall include the number and amount of monthly paid claims, monthly covered lives and an accounting of reserves and retention costs.
B. Upon request by the employer, each insurer shall provide to the employer claims information that provides sufficient detail, subject to state and federal privacy laws, to enable the employer to obtain and compare group health insurance rates from multiple insurers or establish a plan of self-insurance.
C. The report and claims information required by this section shall be provided within thirty days from the date of request.
History:
1978 Comp., § 59A-23-3.1, enacted by Laws 1985, ch. 167, § 1; 1987, ch. 281, § 2; 1993, ch. 164, § 1; 2007, ch. 53, § 1.
ANNOTATIONS
The 2007 amendment,
effective June 15, 2007, required insurers to provide claims experience information to employers to permit the employer to obtain and compare group health care rates and coverage from other carriers.
The 1993 amendment,
effective June 18, 1993, substituted "twenty-six" for "fifty" in the first sentence, inserted "and amount" in the second sentence, and deleted former Subsection B, relating to submission to the employer of premium and claim data 180 days after expiration of a policy covering more than 24 but less than 50 employees for which all or a portion of the premium is paid by the employer.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-5 - Extended disability benefit.

Any group health insurance policy may provide for payment not exceeding one thousand dollars ($1,000) as an extended disability benefit upon the insured's death from any cause, which benefit shall not be construed as life insurance.
History:
Laws 1984, ch. 127, § 464.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-6.1 - Coverage of alpha-fetoprotein IV screening test.

A blanket or group health policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for an alpha-fetoprotein IV screening test for pregnant women, generally between sixteen and twenty weeks of pregnancy, to screen for certain genetic abnormalities in the fetus.
History:
Laws 2004, ch. 122, § 5.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 122, § 13 made Laws 2004, ch. 122, § 5 effective July 1, 2004.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-6.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.
B. Nothing in this section shall be construed to require payment for a gynecological or obstetrical ultrasound that is not:
(1) medically necessary; or
(2) a covered benefit.
C. As used in this section, "prior authorization" means advance approval that is required by blanket or group health insurance policy or contract as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits.
History:
Laws 2019, ch. 182, § 4.
ANNOTATIONS
Emergency clauses.
— Laws 2019, ch. 182, § 7 contained an emergency clause and was approved April 3, 2019.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.3 - Maximum age of dependent.

Each blanket or group health policy or certificate of insurance delivered, issued for delivery or renewed in New Mexico on or after July 1, 2003 that provides coverage for an insured's dependent shall not terminate coverage of an unmarried dependent by reason of the dependent's age before the dependent's twenty-sixth birthday, regardless of whether the dependent is enrolled in an educational institution.
History:
Laws 2003, ch. 391, § 3; 2021, ch. 108, § 24.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, after "before the dependent's", changed "twenty-fifth" to "twenty-sixth".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.4 - Coverage of circumcision for newborn males.

A blanket or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for circumcision for newborn males.
History:
Laws 2004, ch. 122, § 6.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 122, § 13 made Laws 2004, ch. 122, § 6 effective July 1, 2004.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.5 - Coverage of part-time employees.

An insurer that provides group health insurance pursuant to Chapter 59A, Article 23 NMSA 1978 shall make available, upon an employer's request prior to issuance, delivery or renewal, coverage for regular part-time employees who work or are expected to work an average of at least twenty hours per week over a six-month period. Nothing in this section shall be construed to require an employer to offer or provide coverage for regular part-time employees.
History:
Laws 2005, ch. 42, § 2.
ANNOTATIONS
Effective dates.
— Laws 2005, ch. 42, § 5 made Laws 2005, ch. 42, § 2 effective July 1, 2005.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.6 - Coverage of colorectal cancer screening.

A. A blanket or group health policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for colorectal screening for determining the presence of precancerous or cancerous conditions and other health problems. The coverage shall make available colorectal cancer screening, as determined by the health care provider in accordance with the evidence-based recommendations established by the United States preventive services task force.
B. Coverage for colorectal screening may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies.
History:
Laws 2007, ch. 17, § 2.
ANNOTATIONS
Effective dates.
— Laws 2007, ch. 17, contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 15, 2007, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.7 - General anesthesia and hospitalization for dental surgery.

A. A blanket or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center for dental surgery for the following:
(1) insureds exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results;
(2) insureds for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy;
(3) insured children or adolescents who are extremely uncooperative, fearful, anxious or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised; or
(5) other procedures for which hospitalization or general anesthesia in a hospital or ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies.
C. Coverage for dental surgery may be subject to copayments, deductibles and coinsurance subject to network and prior authorization requirements consistent with those imposed on other benefits under the same policy, plan or certificate.
History:
Laws 2007, ch. 218, § 3.
ANNOTATIONS
Effective dates.
— Laws 2007, ch. 218, § 6 made Laws 2007, ch. 218, § 3 effective July 1, 2007.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.8 - Hearing aid coverage for children required.

A. A blanket or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for a hearing aid and any related service for the full cost of one hearing aid per hearing-impaired ear up to two thousand two hundred dollars ($2,200) every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery or renews in this state a blanket or group health insurance policy, health care plan or certificate of health insurance may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.
C. Hearing aid coverage offered shall include fitting and dispensing services, including providing ear molds as necessary to maintain optimal fit, provided by an audiologist, a hearing aid dispenser or a physician, licensed in New Mexico.
D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies.
E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid" means durable medical equipment that is of a design and circuitry to optimize audibility and listening skills in the environment commonly experienced by children.
History:
Laws 2007, ch. 356, § 3.
ANNOTATIONS
Effective dates.
— Laws 2007, ch. 356, § 6 made Laws 2007, ch. 356, § 3 effective July 1, 2007.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.10 - Coverage for orally administered anticancer medications; limits on patient costs.

A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state and that provides coverage for cancer treatment shall provide coverage for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits by the plan.
B. An insurer shall not increase patient cost-sharing for anticancer medications in order to achieve compliance with the provisions of this section.
C. Coverage of orally administered anticancer medication shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medication used to kill or slow the growth of cancerous cells.
D. As used in this section, "insurer" or "blanket or group health insurance plan":
(1) means:
(a) a health 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 blanket or large group policies 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 policies.
History:
Laws 2011, ch. 55, § 3.
ANNOTATIONS
Effective dates.
— Laws 2011, ch. 55, § 7 made Laws 2011, ch. 55, § 3 effective June 17, 2011.
Applicability.
— Laws 2011, ch. 55, § 6 provided that the provisions of this act apply to insurance policies that provide coverage for cancer treatment and that are delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2012.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.11 - Coverage of prescription eye drop refills.

A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state and that provides coverage for prescription eye drops shall not deny coverage for a renewal of prescription eye drops when:
(1) the renewal is requested by the insured at least twenty-three days for a thirty-day supply of eye drops, forty-five days for a sixty-day supply of eye drops or sixty-eight days for a ninety-day supply of eye drops from the later of the date that the original prescription was dispensed to the insured or the date that the last renewal of the prescription was dispensed to the insured; and
(2) the prescriber indicates on the original prescription that additional quantities are needed and that the renewal requested by the insured does not exceed the number of additional quantities needed.
B. As used in this section, "prescriber" means a person who is authorized pursuant to the New Mexico Drug, Device and Cosmetic Act [Chapter 26, Article 1 NMSA 1978] to prescribe prescription eye drops.
History:
Laws 2012, ch. 27, § 3.
ANNOTATIONS
Effective dates.
— Laws 2012, ch. 27, § 7 provided that Laws 2012, ch. 27, § 3 was effective January 1, 2013.
Applicability.
— Laws 2012, ch. 27, § 6 provided that the provisions of Laws 2012, ch. 27, §§ 1 to 5 apply to insurance policies that provide coverage for prescription eye drops and that are delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2013.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-7.15 - Coverage exclusion. (Contingent repeal. See note.)

Coverage of vasectomy and male condoms pursuant to Section 5 [59A-23-7.14 NMSA 1978] of this 2019 act is excluded for high-deductible individual or group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met.
History:
Laws 2019, ch. 263, § 6.
ANNOTATIONS
Contingent repeal. —
Laws 2019, ch. 263, § 11 provided that upon certification by the superintendent of insurance to the director of the legislative council service and the New Mexico compilation commission that federal law permits coverage of vasectomies and male condoms under high-deductible health benefits plans with health savings accounts, 59A-23-7.15 NMSA 1978 is repealed.
Effective dates.
— Laws 2019, ch. 263 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 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.
ANNOTATIONS
Effective 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.
2023 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.
2023 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.
ANNOTATIONS
Repeals.
— 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
.
2023 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.
ANNOTATIONS
Effective 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.
2023 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.
ANNOTATIONS
Effective 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.
2023 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.
ANNOTATIONS
The 2021 amendment,
effective June 18, 2021, after "Medical Practice Act", deleted "or the Osteopathic Medicine Act".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-12.3 - Calculating an insured's cost-sharing obligation for prescription drug coverage.

A. When calculating an insured's cost-sharing obligation for covered prescription drugs, pursuant to 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, the insurer shall credit the insured for the full value of any discounts provided or payments made by third parties at the time of the prescription drug claim.
B. Beginning on or after January 1, 2024, an insurer shall not charge a different cost-sharing amount for:
(1) prescription drugs or pharmacy services obtained at a non-affiliated pharmacy; or
(2) administration of prescription drugs at different infusion sites; provided that an insurer may communicate with an insured regarding lower-cost sites of service.
C. Beginning on or after January 1, 2024, an insurer shall not require an insured to make a payment at the point of sale for a covered prescription drug in an amount greater than the least of the:
(1) applicable cost-sharing amount for the prescription drug;
(2) amount an insured would pay for the prescription drug if the insured purchased the prescription drug without using a health benefits plan or any other source of prescription drug benefits or discounts;
(3) total amount the pharmacy will be reimbursed for the prescription drug from the insurer, including the cost-sharing amount paid by an insurer; or
(4) value of the rebate from the manufacturer provided to the insurer or its pharmacy benefits manager for the prescribed drug.
D. Beginning on or after January 1, 2024, if a prescription drug rebate is more than the amount needed to reduce the insured's copayment to zero on a particular drug, the remainder shall be credited to the insurer.
E. Beginning on or after January 1, 2024, any rebate amount shall be counted toward the insured's out-of-pocket prescription drug costs.
F. For purposes of this section, "cost sharing" means any:
(1) copayment;
(2) coinsurance;
(3) deductible;
(4) out-of-pocket maximum;
(5) other financial obligation, other than a premium or share of a premium; or
(6) combination thereof.
G. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans, tax-favored plans or high-deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law.
History:
Laws 2023, ch. 206, § 4.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 206 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
2023 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.
ANNOTATIONS
Effective 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.
2023 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.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 188, § 6 made Laws 2019, ch. 188 effective January 1, 2020.
2023 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.

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.
ANNOTATIONS
Effective dates.
— Laws 2021, ch. 136, § 11 made Laws 2021, ch. 136, § 7 effective January 1, 2022.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-17 - Anatomical gift nondiscrimination.

A. For purposes of this section:
(1) "covered person" means a policyholder or other person covered by a health benefit plan; and
(2) "organ transplant" includes parts or the whole of organs, eyes or tissue.
B. All individual and group health insurance policies delivered or issued for delivery in this state that provide coverage for organ transplants or associated care shall not:
(1) deny that coverage solely on the basis of a covered person's physical or mental disability;
(2) deny to a covered person with a physical or mental disability eligibility or continued eligibility to enroll or to renew coverage under the terms of the health benefit policy or plan solely for the purpose of avoiding the requirements of this section;
(3) penalize or otherwise reduce or limit the reimbursement or provide monetary or nonmonetary incentives to a health care provider to induce that health care provider not to provide an organ transplant or associated care to a covered person with a physical or mental disability; or
(4) reduce or limit coverage benefits to a covered person with a physical or mental disability for the associated care related to organ transplantation as determined in consultation with the physician and patient.
History:
Laws 2023, ch. 171, § 4.
ANNOTATIONS
Emergency clauses.
— Laws 2023, ch. 171, § 7 contained an emergency clause and was approved April 5, 2023.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-18 - Diagnostic and supplemental breast examinations.

A. A blanket or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing for diagnostic and supplemental breast examinations.
B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law.
C. As used in this section:
(1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;
(2) "diagnostic breast examination" means a medically necessary and clinically appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a medically necessary and clinically appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer.
History:
Laws 2023, ch. 12, § 3.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 12 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 12, § 8 provided that Laws 2023, ch. 12 apply to health insurance policies, health care plans, certificates of health insurance and health maintenance organization contracts that are delivered, issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-19 - Chiropractic physician services; limits on cost sharing and coinsurance. (Effective January 1, 2024.)

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 that offers coverage of the services of a chiropractic physician shall not impose a copayment or coinsurance on those chiropractic physician services that exceeds the copayment or coinsurance imposed for primary care services.
B. As used in this section, "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.
C. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies.
History:
Laws 2023, ch. 51, § 3.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 51, § 6 made Laws 2023, ch. 51, § 3 effective January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-21 - Sexually transmitted infection care; cost sharing eliminated.

A. A blanket or group 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 for preventive care or treatment of sexually transmitted infections shall not impose cost sharing on eligible insureds.
B. Pursuant to this section, preventive care or treatment of sexually transmitted infections shall not be conditioned upon the gender identity of the insured.
C. The provisions of Subsection A of this section do not apply to high-deductible health care plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law.
D. For the purposes of this section:
(1) "cost sharing" means policy deductibles, copayments or coinsurance;
(2) "preventive care" means screening, testing, examination or counseling and the administration, dispensing or prescribing of preventive drugs, devices or supplies incidental to the prevention of a sexually transmitted infection;
(3) "sexually transmitted infection" means chlamydia, syphilis, gonorrhea, HIV and relevant types of hepatitis, as well as any other sexually transmitted infection regardless of mode of transportation, as designated by rule upon making a finding that the particular sexually transmitted infection is contagious; and
(4) "treatment" means medically necessary care for the management of an existing sexually transmitted infection.
History:
Laws 2023, ch. 99, § 3.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 99 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 99, § 7 provided that the provisions of Laws 2023, ch. 99 apply to health insurance policies, health care plans, certificates of health insurance or health maintenance organization contracts that are delivered, issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-22 - Definitions.

As used in Sections 14 through 22 [59A-23-22 to 59A-23-30 NMSA 1978] of this 2023 act:
A. "generally recognized standards" means standards of care and clinical practice established by evidence-based sources, including clinical practice guidelines and recommendations from mental health and substance use disorder care provider professional associations and relevant federal government agencies, that are generally recognized by providers practicing in relevant clinical specialties, including:
(1) psychiatry;
(2) psychology;
(3) social work;
(4) clinical counseling;
(5) addiction medicine and counseling; or
(6) family and marriage counseling; and
B. "mental health or substance use disorder services" means:
(1) professional services, including inpatient and outpatient services and prescription drugs, provided in accordance with generally recognized standards of care for the identification, prevention, treatment, minimization of progression, habilitation and rehabilitation of conditions or disorders listed in the current edition of the American psychiatric association's Diagnostic and Statistical Manual of Mental Disorders, including substance use disorder; or
(2) professional talk therapy services, provided in accordance with generally recognized standards of care, provided by a marriage and family therapist licensed pursuant to the Counseling and Therapy Practice Act [Chapter 61, Article 9A NMSA 1978].
History:
Laws 2023, ch. 114, § 14.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 114 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. 114 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, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-23 - Benefits required.

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 all mental health or substance use disorder services required by generally recognized standards of care.
History:
Laws 2023, ch. 114, § 15.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 114 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. 114 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, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-24 - Parity for coverage of mental health or substance use disorder services.

A. The office of superintendent of insurance shall ensure that an insurer complies with federal and state laws, rules and regulations applicable to coverage for mental health or substance use disorder services.
B. An insurer shall not impose quantitative treatment limitations, financial restrictions, limitations or requirements on the provision of mental health or substance use disorder services that are more restrictive than the predominant restrictions, limitations or requirements that are imposed on substantially all of the coverage of benefits for other conditions.
C. An insurer shall not impose non-quantitative treatment limitations for the treatment of mental health or substance use disorders or conditions unless factors, including the processes, strategies or evidentiary standards used in applying the non-quantitative treatment limitation, as written and in operation, are comparable to and are applied no more restrictively than the factors used in applying the limitation with respect to medical or surgical benefits in the classification.
History:
Laws 2023, ch. 114, § 16.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 114 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. 114 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, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-25 - Provider network adequacy.

A. An insurer shall maintain an adequate provider network to provide mental health or substance use disorder services.
B. The superintendent shall ensure access to mental health or substance use disorder services providers, including parity with medical and surgical services provider access, through regulation and review of claims processing, provider reimbursement procedures, network adequacy and provider reimbursement rate adequacy.
C. An insurer shall ensure that the process by which reimbursement rates for mental health and substance use disorder services are determined is comparable to and no more stringent than the process for reimbursement of medical or surgical benefits. In developing provider reimbursement rates, an insurer shall demonstrate that it has performed a comparability analysis of provider:
(1) reimbursement rates in surrounding states;
(2) reimbursement rates between mental health and substance use disorder providers and medical or surgical providers; and
(3) credentialing processes for mental health and substance use disorder providers and medical or surgical providers.
D. An insurer shall undertake all efforts, including increasing provider reimbursement rates through the processes and strategies described in Subsection C of this section, to ensure state-mandated network adequacy for the provision of mental health or substance use disorder services.
E. When in-network access to mental health or substance use disorder services is not reasonably available, an insurer shall provide access to out-of-network services with the same cost-sharing obligations to the insured as those required for in-network services.
History:
Laws 2023, ch. 114, § 17.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 114 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 114, § 46 provided that the provisions of Laws 2023, ch. 114 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, 2024.