reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 46 - Health Maintenance Organizations › Section 59A-46-70 - Exceptions.

The provisions of Sections 25 through 33 [59A-46-61 to 59A-46-69 NMSA 1978] of this 2023 act do not apply to short-term plans subject to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978].
History:
Laws 2023, ch. 114, § 34.
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 47 - Nonprofit Health Care Plans › Section 59A-47-1 - Short title.

Chapter 59A, Article 47 NMSA 1978 may be cited as the "Nonprofit Health Care Plan Law".
History:
Laws 1984, ch. 127, § 878; 2003, ch. 391, § 6.
ANNOTATIONS
The 2003 amendment,
effective June 20, 2003, substituted "Chapter 59A, Article 47 NMSA 1978" for "This article" at the beginning.
Law reviews.
— For note, "Nonprofit Health Care Corporations Are Not Insurance Providers," see 10 N.M.L. Rev. 481 (1980).
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Nonprofit purposes and character which warrant creation of nonprofit organization, 16 A.L.R.2d 1345.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-2 - Purpose; exemptions.

A. The purpose of this article is to provide for the reasonable regulation of membership corporations organized for the purpose of making health care expense payments on a service benefit basis or on an indemnity benefit basis, or both, for persons who become subscribers under contracts with such corporation.
B. Nothing in this article shall apply to any professional or hospital association which accepts health care expense payments for health care on a service basis or on an indemnity basis, or both, which are underwritten by any authorized insurer.
History:
Laws 1984, ch. 127, § 879.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-4 - Organization; profit corporations prohibited; merger and consolidation of health care plans.

A. A corporation may be organized under the laws of this state which provide for the organization of nonprofit corporations, as a nonprofit corporation organized for making health care expense payments on a service benefit basis or an indemnity basis, or both, for subscribers under contract with such corporation.
B. The articles of incorporation of each domestic health care plan shall have endorsed thereon or annexed thereto the consent of the superintendent prior to filing. The amendment of the articles of incorporation of any domestic health care plan shall have endorsed thereon or annexed thereto the consent of the superintendent prior to filing.
C. The directors of a domestic health care plan shall be chosen in accordance with the bylaws of the corporation, subject to the following:
(1) at least twenty-five percent of the directors shall be members of the general public; and
(2) the balance of the directors shall be either representatives of purveyors or members of the general public.
D. No domestic health care plan shall be converted into a corporation organized for pecuniary profit; and any such plan shall be maintained and operated primarily for the benefit of its subscribers.
E. A domestic health care plan may merge only with another domestic health care plan in accordance with applicable provisions of the Insurance Holding Company Law [Chapter 59A, Article 37 NMSA 1978] and the Nonprofit Corporation Act [Chapter 53, Article 8 NMSA 1978].
History:
Laws 1984, ch. 127, § 879.2; 1999, ch. 133, § 2.
ANNOTATIONS
The 1999 amendment,
effective June 18, 1999, added "Merger and Consolidation of Health Care Plans" in the section heading; inserted "domestic" throughout the section; rewrote former Subsection E which read: "No health care plan shall furnish or contract to furnish health care expense payments in this state unless organized under the laws of this state as above provided and so authorized to operate under the provisions of this article. No foreign health care plan may be authorized to conduct business in this state".
Law reviews.
— For note, "Nonprofit Health Care Corporations Are Not Insurance Providers," see 10 N.M.L. Rev. 481 (1980).
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-5 - Qualifications for health care plan authority.

The superintendent shall not authorize any proposed health care plan to solicit preliminary applications from subscribers or to transact business as a health care plan unless he finds after such investigation and hearings as he deems advisable that the proposed health care plan is qualified therefor as follows:
A. it shall be duly incorporated as a health care plan under the laws of a state governing incorporation of nonprofit corporations;
B. its sponsors shall have financial stability and its directors and officers shall be individuals of good personal and business reputation and integrity;
C. its proposed management shall possess experience and competence as to the business in which to engage;
D. it shall have ready access to health care facilities in this state reasonably sufficient to provide the health care services to be covered by its subscriber contracts, whether on service or indemnity bases;
E. it shall actually or prospectively have sufficient funds to finance preliminary solicitation of subscribers and to conduct its operations with reasonable margin of financial safety;
F. its proposed contracts to be offered subscribers shall be well drafted and provide substantial health care coverage and benefits at reasonable premium rates;
G. operation of the health care plan in the area of this state proposed to be served would be in the public interest and of convenience to its residents; and
H. if it [is] a newly formed health care plan, prior to being granted an initial certificate of authority to engage in business, it shall have applied for and received from the superintendent a preliminary permit to solicit subscribers' applications for health care contracts as proposed to be offered, and thereunder have solicited and received, within one year from date of the preliminary permit, applications for coverage of not less than one thousand individuals under such contracts together with payment in advance of one month's premium therefor or if it is a foreign health care plan with a certificate of authority from its state of domicile, it must already cover not less than one thousand individuals.
History:
Laws 1984, ch. 127, § 879.3; 1987, ch. 259, § 30; 1999, ch. 133, § 3.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and it is not part of the law.
The 1999 amendment,
effective June 18, 1999, substituted "shall" for "must" throughout the section; substituted "a" for "this" in Subsection A; inserted "if it a newly formed health care plan" at the beginning of Subsection H and added the language following "premium therefor" at the end of Subsection H.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-6 - Preliminary permit for solicitations.

A. A newly-formed health care plan shall not solicit any subscriber or enter into any proposed contract for health care expense payments unless and until it obtains from the superintendent a preliminary permit to do so. The proposed health care plan shall file with the superintendent its application in writing for the permit in form as prescribed and furnished by the superintendent and calling for information as follows:
(1) name and business address of applicant;
(2) area of this state proposed to be served;
(3) names, residence addresses, occupations, business experience, biographical data, and such proof of identity as the superintendent may require of the incorporators, sponsors, directors, officers and proposed management personnel;
(4) health care coverage proposed to be provided and premium rates therefor, as shown by two (2) copies of proposed subscribers' contracts and premium rate schedules filed with the application;
(5) financial resources, present or prospective, of applicant; and
(6) such other information as to applicant's qualifications as the superintendent may reasonably require.
The application shall be accompanied by a copy of applicant's articles of incorporation and its bylaws, its current financial statement, and such other documentation as the form of application may require. Upon filing the application the applicant shall pay to the superintendent the filing fee specified therefor in Section 101 [59A-6-1 NMSA 1978] (fee schedule) of the Insurance Code.
B. If after such investigation of the applicant and its sponsors and personnel, and hearings held, as he deems advisable the superintendent finds that the applicant meets the qualifications stated in Section 879.3 [59A-47-5 NMSA 1978] of this article and is otherwise in compliance with this article, he shall issue a preliminary permit in appropriate terms; otherwise he shall deny the permit by his written order stating the reasons for the denial.
History:
Laws 1984, ch. 127, § 879.4.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-7 - Escrow of preliminary premiums.

With its application for a preliminary permit as provided for in Section 879.4 [59A-47-6 NMSA 1978] of this article the applicant shall file with the superintendent documentation of an escrow arrangement made by applicant and satisfactory to the superintendent adequate to insure return to applicants for subscribers' health care contracts of advance premium payments made, if within one year from date of issuance of the preliminary permit an initial certificate of authority to do business as a health care plan has not been issued to the applicant by the superintendent.
History:
Laws 1984, ch. 127, § 879.5.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-8 - Certificate of authority required; application and conditions; exceptions.

A. No health care plan shall make health care expense payments unless and until it has obtained from the superintendent a certificate of authority to do business. Violation of this provision shall constitute a misdemeanor punishable upon conviction by a fine of not to exceed one thousand dollars ($1,000).
B. A newly formed health care plan's application for initial certificate of authority must be filed with the superintendent prior to expiration of one year from date of issuance of the preliminary permit referred to in Section 59A-47-6 NMSA 1978.
C. The application for certificate of authority shall be in the form prescribed and furnished by the superintendent consistent with Chapter 59A, Article 47 NMSA 1978, and be verified by two of the applicant's officers. The application shall include or be accompanied by such proof as the superintendent may reasonably require that the applicant is qualified for the certificate of authority under this article. At filing of the application the applicant shall pay to the superintendent the applicable filing fee as specified in Section 59A-6-1 NMSA 1978. The filing fee shall not be refundable.
D. No such certificate of authority shall be required for a health care plan formerly so authorized, to enable it to investigate and settle losses under its contracts lawfully written in New Mexico, or to liquidate assets and liabilities (other than collection of new premiums) resulting from its former authorized operations in this state. A health care plan not transacting new business in this state but continuing collection of premiums on and servicing contracts remaining in force as to residents of or risks located in this state, is transacting business in New Mexico for the purpose of premium tax requirements only and is not required to have a certificate of authority.
History:
Laws 1984, ch. 127, § 879.6; 1999, ch. 133, § 4.
ANNOTATIONS
The 1999 amendment,
effective June 18, 1999, subdivided former Subsection B into Subsections B and C; substituted "A newly formed" for "The" and "Section 59A-47-6 NMSA 1978" for "Section 879.4 of this article" in Subsection B; inserted "for certificate of authority", substituted "Chapter 59A, Article 47 NMSA 1978" for "this article", inserted "the" preceding "applicant's", and substituted "Section 59A-6-1 NMSA 1978" for "Section 101 (fee schedule) of the Insurance Code" in Subsection C, and redesignated former Subsection C as Subsection D.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-9 - Issuance and denial of initial certificate of authority.

A. If after such investigation as he deems advisable the superintendent finds that the applicant is in sound financial condition and is otherwise qualified therefor, he shall issue to the applicant a certificate of authority as a health care plan.
B. If the superintendent does not so find, he shall deny issuance of the certificate of authority and notify the applicant thereof in writing stating the reasons for such denial.
History:
Laws 1984, ch. 127, § 879.7; 1999, ch. 133, § 5.
ANNOTATIONS
The 1999 amendment,
effective June 18, 1999, inserted "and" in the section heading; deleted "prior to expiration of one year from date of issuance of the preliminary permit referred to in Section 879.4 of this article the newly-formed health care plan has filed and completed its application to the superintendent for an initial certificate of authority as required under Section 879.6 of this article, and" following "If", and substituted "a" for "an initial" in Subsection A; and substituted "the certificate" for "an initial certificate" in Subsection B.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-10 - Trust deposit.

A. Every health care plan shall make and thereafter maintain a deposit in trust with the state treasurer through the superintendent for the benefit and protection of all of its subscribers, as a condition to being authorized to transact business. The deposit shall consist of United States treasury bonds or other securities of the United States government or agency thereof, or in bonds or obligations of any state, county or other political subdivision in the United States, or in certificates of deposit of solvent financial institutions located in New Mexico, purchased within this state and having at all times a market value of not less than one hundred thousand dollars ($100,000).
B. Any such trust deposit shall be released in the following instances only:
(1) upon extinguishment of all liabilities of the health care plan for the security of which the deposit is held;
(2) upon the health care plan ceasing to transact business in New Mexico, and all fixed or contingent liabilities for which the deposit was a security have been satisfied or terminated, or have been assumed by some other company authorized to transact business in New Mexico; or
(3) upon proper order of a court of competent jurisdiction, the trust deposit may be released to the receiver, conservator, rehabilitator or liquidator of the health care plan for whose account the deposit is held.
No such release shall be made except on application and written order of the superintendent made upon proof satisfactory to him of the existence of one or more of such grounds. Before directing the release of any securities the superintendent may require such evidence as he deems satisfactory that the health care plan is entitled to the release and return of the securities or a part thereof. The superintendent shall have no personal liability for any such release of any trust deposit or any part thereof so made in good faith.
History:
Laws 1984, ch. 127, § 879.8.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-11 - Expiration, continuance of certificate of authority.

The certificate of authority of a health care plan issued under this article shall be subject to continuation or expiration upon the same applicable procedures and time periods as provided in Article 5 [Chapter 59A, Article 5 NMSA 1978] (authorization of insurers and general requirements) of the Insurance Code with respect to authorized insurers, and upon payment of the applicable fees specified in Section 101 [59A-6-1 NMSA 1978] (fee schedule) of the Insurance Code.
History:
Laws 1984, ch. 127, § 879.9.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-12 - Suspension, revocation or refusal to continue certificate of authority.

The superintendent may suspend, revoke or refuse to continue the certificate of authority of any health care plan if the health care plan no longer fulfills the qualifications therefor as stated in this article or on any applicable ground, procedure and conditions on which he could suspend, revoke or refuse continuance of the certificate of authority of an insurer under Article 5 [Chapter 59A, Article 5 NMSA 1978] (authorization of insurers and general requirements) of the Insurance Code.
History:
Laws 1984, ch. 127, § 879.10.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-13 - Service of process; superintendent as attorney.

Prior to issuance of its initial certificate of authority, the health care plan shall appoint the superintendent and his successors as its true and lawful attorney upon whom may be served all lawful process in any action or legal proceedings against it by a resident of New Mexico or where the cause of action arises in this state. In the appointment the health care plan shall agree that any such process so served shall be of the same effect and validity as if served on the health care plan direct. The appointment shall continue in force irrevocably so long as any liability of the health care plan under a subscriber's contract in this state remains outstanding. Process shall be served upon the superintendent in the same manner and subject to the same conditions as provided in Section 99 [59A-5-32 NMSA 1978] of the Insurance Code as for service of process against insurers.
History:
Laws 1984, ch. 127, § 879.11.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-14 - Annual statement.

As prerequisite to continuance of its certificate of authority, each health care plan shall on or before March 1 each year file with the superintendent and with the national association of insurance commissioners an annual statement in accordance with the requirements of Section 59A-5-29 NMSA 1978 and a risk-based capital report in accordance with the requirements of Section 59A-5A-3 NMSA 1978.
History:
Laws 1984, ch. 127, § 879.12; 2014, ch. 59, § 52.
ANNOTATIONS
The 2014 amendment,
effective July 1, 2014, required insurers to annually file a statement of financial condition and transactions and a risk-based capital report; after "national association of insurance", deleted "superintendents its financial statement for the year ending December 31 immediately preceding on form as prescribed and furnished without charge by the superintendent" and added the remainder of the sentence; deleted the former second sentence, which required the form to correspond to the form adopted by the national association of insurance superintendents; and deleted the former third sentence, which required the statement to be verified by the president and secretary of the health care plan.
Severability.
— Laws 2014, ch. 59, § 54 provided that if any part or application of the provisions of Laws 2014, ch. 59 is held invalid, the remainder or its application to other situations or persons shall not be affected.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-15 - Assets.

In determining the financial condition of a health care plan there shall be allowed as assets only such assets allowed as to life or health insurers under Sections 118 [59A-8-1 NMSA 1978] ("assets" defined) and 119 [59A-8-2 NMSA 1978] (assets not allowed) of the Insurance Code.
History:
Laws 1984, ch. 127, § 879.13.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-17 - Examination.

A health care plan, or organizaion [organization] proposing or purporting to be a health care plan, shall be subject to investigation and examination by the superintendent upon the same bases, in the same manner and subject to the same provisions as to conduct of the examination, payment of expense or costs of the examination, making, approval and filing of examination report, and all related provisions, as apply as to investigation or examination of insurers under Article 4 [Chapter 59A, Article 4 NMSA 1978] (examinations, hearings and appeals) of the Insurance Code.
History:
Laws 1984, ch. 127, § 879.15.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and it is not a part of the law.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-18 - Investments.

A health care plan shall invest its funds only in such securities and assets as are eligible for investment of the funds of health insurers under Article 9 [Chapter 59A, Article 9 NMSA 1978] (investments) of the Insurance Code, and subject to the provisions of that article as to investments and assets of such insurers.
History:
Laws 1984, ch. 127, § 879.16.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-19 - Limitation upon acquisition and administration expenses.

No health care plan shall during any one calendar year incur expense for acquisition of its business more than ten percent of its premium income earned during that year; nor incur during any such year for expense of administration more than twenty percent of such earned premiums.
History:
Laws 1984, ch. 127, § 879.17.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-20 - Conflicts of interest as to certain transactions.

A. No director or officer of any health care plan, or employee of such plan having authority for investment or expenditure of funds, shall accept except for the health care plan or be beneficiary of any fee, brokerage, gift or other emolument in addition to his fixed salary or compensation, because of any investment, loan, deposit, purchase, sale, exchange, reinsurance or other similar transaction made by or for the health care plan, or be pecuniarily interested therein in any capacity except on behalf of the health care plan.
B. No health care plan shall guarantee the financial obligation of any of its officers, directors or employees.
C. This section shall not prohibit such a director, officer or employee from becoming a subscriber of the health care plan and enjoying thereunder the rights customarily provided to such subscribers, nor shall it prevent any director, officer or employee from being a purveyor or from being associated with or employed by a purveyor, who receives in ordinary course of business health care expense payments made by the health care plan for services or materials furnished to subscribers.
History:
Laws 1984, ch. 127, § 879.18.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-21 - Joint coverage, reinsurance.

Two (2) or more health care plans may enter into and carry out cooperative agreements under which subscribers may subscribe jointly to and receive the benefits of all such plans; and any health care plan may enter into and carry out reinsurance agreements.
History:
Laws 1984, ch. 127, § 879.19.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-22 - Transfer of subscribership.

A. A health care plan may enter into agreements with another health care plan or mutual company similarly engaged in this state or another state or country for transfer of subscribers from one such plan to the other, subject to prior approval of any such agreement by the superintendent. The superintendent shall disapprove any such agreement if he finds on basis of such investigation as he deems advisable that the agreement in reasonable probability would result in loss to the health care plan authorized to do business in this state or is otherwise unfair or inequitable. The superintendent shall approve the agreement if he finds that the transfer of subscribership is to be accompanied by transfer of funds representing reserves in amount adequate to cover all liabilities to be incurred by the assuming health care plan through such transfer, that the transfer meets the applicable requirements of Chapter 59A, Article 34 NMSA 1978 and of the Nonprofit Corporation Act [Chapter 53, Article 8 NMSA 1978] for disposition or distribution of assets and that the agreement is otherwise fair and equitable to the insurers and subscribers involved.
B. The superintendent shall ensure, by imposition of conditions, if necessary, that New Mexico charitable assets are protected and preserved for the benefit of the people of New Mexico.
History:
Laws 1984, ch. 127, § 879.20; 1999, ch. 133, § 6.
ANNOTATIONS
The 1999 amendment,
effective June 18, 1999, in Subsection A, substituted "another health care plan or mutual company" for "a similar corporation" and inserted "this state or" preceding "another state" in the first sentence, and inserted "that the transfer meets the applicable requirements of Chapter 59A, Article 34 NMSA 1978 and of the Nonprofit Corporation Act for disposition or distribution of assets" and substituted "insurers" for "health care plans" in the last sentence, and added Subsection B.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-23 - Subscriber contracts; coverage period.

Every health care expense payments contract made by a health care plan under this article shall provide coverage for the subscribers thereunder for a period of not less than one month; and no such contract shall be made which provides for an effective date which is more than six (6) months prior to or after the date when the contract was actually issued by the health care plan.
History:
Laws 1984, ch. 127, § 879.21.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-25 - Subscriber contracts; filing, approval.

No health care plan shall make or issue any health care expense payments contract or certificate therefor unless it has first filed with the superintendent a copy of the form of the proposed contract or certificate and a copy of all applications, riders and endorsements to be used in connection with or for renewal thereof, and the same have been approved by the superintendent. If the superintendent finds that the proposed forms are in compliance with applicable requirements of this article and are not to be disapproved by him as stated below, he shall approve the forms. The superintendent may disapprove any such form on any of the grounds for disapproval of a health insurance policy under Section 344 [59A-18-14 NMSA 1978] of the Insurance Code. The superintendent shall notify the health care plan of his approval or disapproval within thirty (30) days after such filing, or within sixty (60) days after such filing if he so extends the time; and if the superintendent fails to act within such period the form shall be deemed approved.
History:
Laws 1984, ch. 127, § 879.23.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-26 - Premium rates; filing and approval.

A. No health care plan shall enter into any contract with a subscriber unless it has first filed with the superintendent a full schedule of premium rates to be paid by the subscribers. The superintendent shall notify the health care plan of his approval or disapproval of such rates within fifteen (15) days after the filing thereof, or within thirty (30) days after such filing if he shall so extend the time, and if the superintendent fails to act within such period, the rates shall be deemed approved.
B. At the time the health care plan files such rates with the superintendent, it shall also file a full schedule of all health care expense payments to be made under the contracts.
C. The superintendent may disapprove any such rate found by him to be excessive, inadequate or unfairly discriminatory, considering the health care expense payments to be made.
History:
Laws 1984, ch. 127, § 879.24.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-27 - Coverage for newly born children, maternity transport, home health care.

Subscriber contracts of a health care plan shall also be subject to coverage as required of health insurers under Sections 59A-22-34 through 59A-22-36 NMSA 1978.
History:
Laws 1984, ch. 127, § 879.25; 1987, ch. 259, § 31.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Unborn child as insured or injured person within meaning of insurance policy, 15 A.L.R.4th 548.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-27.1 - Coverage of circumcision for newborn males.

An individual 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, § 10.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 122, § 13 made Laws 2004, ch. 122, § 10 effective July 1, 2004.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-28 - Coverage for service of chiropractor.

All individual and group subscriber contracts delivered or issued for delivery in New Mexico, which, on a service basis or on an indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall include coverage for the services of a chiropractor.
History:
Laws 1984, ch. 127, § 879.26.
ANNOTATIONS
Compiler's notes.
— Laws 1984, ch. 127, § 879.27, read "The provisions of this section shall be repealed effective July 1, 1987." However, Laws 1984, ch. 127, § 879.27, contained no provisions other than those quoted above and as such has not been codified.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-28.1 - Coverage for service of certified nurse-midwives and registered lay midwives.

A. Any individual and group subscriber contracts delivered in New Mexico which provide for obstetrical and/or maternity benefits on a service basis or an indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall include coverage for the services of a certified nurse-midwife or registered lay midwife as defined in Subsection B of this section. Deductibles, limits of coverage or other terms and conditions of coverage for such services shall not differ substantially from coverage for the same or similar services provided by other practitioners.
B. As used in this section:
(1) "certified nurse-midwife" means any person who is licensed by the board of nursing as a registered nurse and who is registered with the health services division of the health and environment department [department of health] as a certified nurse-midwife; and
(2) "registered lay midwife" means any person who practices lay midwifery and who is registered as a registered lay midwife by the health services division of the health and environment department [department of health].
History:
1978 Comp., § 59A-47-28.1, enacted by Laws 1985, ch. 192, § 2.
ANNOTATIONS
Cross references.
— For freedom of choice of hospital and practitioner,
see
59A-22-32 NMSA 1978.
Bracketed material.
— The bracketed material was inserted by the compiler and it is not part of the law. Laws 1991, ch. 25, § 16 repealed former 9-7-4 NMSA 1978, relating to the health and environment department, and enacted a new 9-7-4 NMSA 1978, creating the department of health.
Applicability.
— Laws 1985, ch. 192, § 3 made the provisions of Laws 1985, ch. 192, § 2 applicable to any policy or contract which was delivered or issued for delivery in this state on or after July 1, 1985, and to any existing policy, contract or plan on its anniversary or renewal date after June 30, 1985, or at the expiration of the applicable collective bargaining contract, if any, whichever is later.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-28.2 - Doctor of oriental medicine discrimination prohibited.

All individual and group subscriber contracts delivered or issued for delivery in New Mexico by a nonprofit health care plan that, on a service or indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall not contain any provisions that exclude a licensed doctor of oriental medicine as a provider of oriental medical services and shall not discriminate in the reimbursement levels for such services between types of licensed health care providers.
History:
1978 Comp., § 59A-47-28.2, enacted by Laws 1991, ch. 145, § 1; 1993, ch. 158, § 6.
ANNOTATIONS
Cross references.
— For prohibition against discrimination against acupuncture practitioner,
see
59A-46-36 NMSA 1978.
For Acupuncture Practice Act,
see
Chapter 61, Article 14A NMSA 1978.
The 1993 amendment,
effective June 18, 1993, substituted "Doctor of Oriental Medicine" for "Oriental Medical Doctor" in the section heading and substituted "licensed doctor of oriental medicine" for "licensed oriental medical doctor" near the end of the section.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-28.3 - Provider discrimination prohibited.

All individual and group subscriber contracts delivered or issued for delivery in New Mexico that, on a prepaid, service or indemnity basis, or all of them, provide for treatment of persons for the prevention, cure or correction of an illness or physical or mental condition shall include coverage for the services of a physician assistant and a certified nurse practitioner. Deductibles, limits of coverage or other terms and conditions of coverage for certified nurse practitioners and physician assistants shall not differ substantially from coverage for the same or similar services provided by other practitioners. Nothing in this section shall restrict a health care plan from including in the terms of its coverage any benefit differences based on differences in the scope of practice of health care practitioners.
History:
1978 Comp., § 59A-47-28.3, enacted by Laws 1998, ch. 39, § 2; 2008, ch. 9, § 6.
ANNOTATIONS
The 2008 amendment,
effective May 14, 2008, added "physician assistant".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-28.4 - Coverage for collaborative practice; dental therapists; dental hygienists.

An individual or group subscriber contract delivered or issued for delivery in New Mexico that, on a prepaid, service or indemnity basis, provides for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall include coverage for the services of a dental therapist and a dental hygienist in a collaborative practice pursuant to the Dental Health Care Act [Chapter 61, Article 5A NMSA 1978].
History:
Laws 2003, ch. 343, § 4; 2019, ch. 107, § 16.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, required subscriber contracts of a health plan to include the services of dental therapists; in the section heading, added "dental therapists", and after "coverage for the services of a", added "dental therapist".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-29 - Settlement of disputes; appeal.

The parties to a dispute between a health care plan and a purveyor arising out of a health care expense payments contract may submit the dispute to the superintendent for his final decision and his final decision shall then be binding upon the parties to the contract. A party to the contract may seek review of the superintendent's decision by filing an appeal in the district court pursuant to the provisions of Section 39-3-1.1 NMSA 1978.
History:
Laws 1984, ch. 127, § 879.28; 1998, ch. 55, § 68; 1999, ch. 265, § 71.
ANNOTATIONS
The 1999 amendment,
effective July 1, 1999, substituted "Section 39-3-1.1" for "Section 12-8A-1" in the last sentence.
The 1998 amendment,
effective September 1, 1998, rewrote this section to the extent that a detailed comparison is impracticable.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-31 - Rehabilitation, liquidation or dissolution.

If the superintendent finds that expenses incurred by a health care plan for acquisition of business or administration exceed the limits prescribed under Section 879.17 [59A-47-19 NMSA 1978] of this article, or that the health care plan is at any time unable or prospectively unable to fulfill its outstanding contracts and also to meet the requirements of this article as to expenses, reserves, deposit and surplus funds, or is otherwise insolvent or likely to become insolvent, the superintendent may institute and maintain proceedings to conserve, rehabilitate, liquidate or dissolve such health care plan pursuant to the provisions of Article 41 [Chapter 59A, Article 41 NMSA 1978] (conservation, rehabilitation, liquidation) of the Insurance Code as applicable to insurers.
History:
Laws 1984, ch. 127, § 879.30.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-32 - Unauthorized contract or adjustment transactions; penalty.

A. Any person writing or attempting to write, solicit or procure health care plan contracts within this state without a certificate of authority or license duly issued in accordance with the Insurance Code and then required and subsisting, and any person adjusting, settling or knowingly accepting adjustment or settlement of any loss covered by a contract written or issued by any health care plan not holding a subsisting certificate of authority issued by the superintendent, shall be guilty of a misdemeanor, and upon conviction thereof shall be fined not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000), or imprisoned in the county jail for not less than thirty (30) nor more than sixty (60) days, or both such fine and imprisonment in the court's discretion.
B. The exemptions from certificate of authority requirements of insurers as provided in Section 78 [59A-5-11 NMSA 1978] of the Insurance Code shall to the extent applicable also apply as to health care plans and their contracts under this section.
History:
Laws 1984, ch. 127, § 879.31.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-37.1 - Hearing aid coverage for children required.

A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery 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 an individual 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, § 5.
ANNOTATIONS
Effective dates.
— Laws 2007, ch. 356, § 6 made Laws 2007, ch. 356, § 5 effective July 1, 2007.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-38 - Coverage for medical diets for genetic inborn errors of metabolism.

As of July 1, 2003, subscriber contracts of a health care plan shall also be subject to coverage for special medical diets for genetic inborn errors of metabolism as required of health insurers in Chapter 59A, Article 22 NMSA 1978.
History:
Laws 2003, ch. 192, § 3.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 192 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 47 - Nonprofit Health Care Plans › Section 59A-47-39 - Employer utilization and loss experience availability.

Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 47 NMSA 1978 shall be made available by the carrier only upon the written request of and to employers of subscribers with such coverage within thirty days of an employer's written request to the carrier for such information, provided the employer's coverage extends to no less than twenty-five individual subscribers, regardless of whether family coverage is included. Each carrier 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 rates from multiple carriers or establish a plan of self-insurance.
History:
Laws 2003, ch. 252, § 5; 2007, ch. 53, § 3.
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.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-40 - Maximum age of dependent.

An individual or group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers coverage of 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, § 7; 2005, ch. 41, § 3; 2021, ch. 108, § 30.
ANNOTATIONS
Cross references.
— For age of dependents,
see
59A-22-2 and 59A-22-34.2 NMSA 1978.
The 2021 amendment,
effective July 1, 2021, after "before the dependent's", changed "twenty-fifth" to "twenty-sixth".
The 2005 amendment,
effective July 1, 2005, provided that an individual or group health care coverage under the Health Care Purchasing Act shall not terminate coverage of unmarried dependents by reason of age before the twenty-fifth birthday.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-41 - Coverage of alpha-fetoprotein IV screening test.

An individual 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 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, § 9.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 122, § 13 made Laws 2004, ch. 122, § 9 effective July 1, 2004.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 47 - Nonprofit Health Care Plans › Section 59A-47-41.1 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

A. An individual or group 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 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:
(1) "health care plan" means an organization that demonstrates to the office of superintendent of insurance that it has been granted exemption from the federal income tax by the United States commissioner of internal revenue as an organization described in Section 501(c)(3) of the United States Internal Revenue Code of 1986, as that section may be amended or renumbered, and is authorized by the office of superintendent of insurance to enter into contracts with subscribers and make health care expense payments; and
(2) "prior authorization" means advance approval that is required by a health care plan 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, § 6.
ANNOTATIONS
Cross references.
— For Section 501(c)(3) of the Internal Revenue Code of 1986,
see
26 U.S.C. § 501(c)(3).
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 47 - Nonprofit Health Care Plans › Section 59A-47-42 - Coverage of part-time employees.

A health care plan that provides coverage for health care pursuant to the Nonprofit Health Care Plan Law 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, § 4.
ANNOTATIONS
Effective dates.
— Laws 2005, ch. 42, § 5 made Laws 2005, ch. 42, § 4 effective July 1, 2005.