2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 46 - Health Maintenance Organizations › Section 59A-46-32 - Continuation of coverage and conversion rights; health care plans.

A. Every individual or group contract entered into by a health maintenance organization and that is delivered, issued for delivery or renewed in this state on or after January 1, 1985 shall provide covered family members of subscribers the right to continue such coverage through a converted or separate contract upon the death of the subscriber or upon the divorce, annulment or dissolution of marriage or legal separation of the spouse from the subscriber. Where a continuation of coverage or conversion is made in the name of the spouse of the subscriber, such coverage may, at the option of the spouse, include coverage to dependent children for whom the spouse has responsibility for care and support.
B. The right to a continuation of coverage or conversion pursuant to this section shall not exist with respect to any covered family member of a subscriber in the event the coverage terminates for nonpayment of premium, nonrenewal of the contract or the expiration of the term for which the contract is issued. With respect to any covered family member who is eligible for medicare or any other similar federal or state health insurance program, the right to a continuation of coverage or conversion shall be limited to coverage under a medicare supplement insurance contract as defined by the rules and regulations adopted by the superintendent of insurance.
C. Coverage continued through the issuance of a converted or separate contract shall be provided at a reasonable, nondiscriminatory rate to the insured and shall consist of a form of coverage then being offered by the health maintenance organization as a conversion contract. Continued and converted coverages shall contain renewal provisions that are not less favorable to the subscriber than those contained in the contract from which the conversion is made, except that the person who exercises the right of conversion is entitled only to have included a right to coverage under a medicare supplement insurance contract, as defined by the rules and regulations adopted by the superintendent of insurance, after the attainment of the age of eligibility for medicare or any other similar federal or state health insurance program.
D. At the time of inception of coverage, the health maintenance organization shall provide each covered family member eighteen years of age or older a statement setting forth in summary form the continuation of coverage and conversion provisions of the subscriber's contract.
E. The eligible covered family member exercising the continuation or conversion right must notify the health maintenance organization and make payment of the applicable premium within thirty days following the date such coverage otherwise terminates as specified in the contract from which continuation or conversion is being exercised.
F. Coverage shall be provided through continuation or conversion without additional evidence of insurability and shall not impose any preexisting condition, limitations or other contractual time limitations.
G. Any probationary or waiting period set forth in the converted or separate contract is deemed to commence on the effective date of the applicant's coverage under the original contract.
History:
Laws 1984, ch. 127, § 876.1; 1978 Comp., § 59A-46-30, recompiled as 1978 Comp., § 59A-46-32 by Laws 1993, ch. 266, § 31; 2019, ch. 259, § 18.
ANNOTATIONS
Recompilations.
— Laws 1993, ch. 266, § 31, recompiled former 59A-46-32 NMSA 1978, as amended by Laws 1989, ch. 55, § 1, relating to the prohibition of provider discrimination, as 59A-46-35 NMSA 1978, effective January 1, 1994.
The 2019 amendment,
effective June 14, 2019, further limited pre-existing condition limitations or other contractual time limitations when an insurance contract is continued or converted due to death or divorce; and in Subsection F, after "time limitations", deleted "other than those remaining unexpired under the contract from which continuation or conversion is exercised".