reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23 - Group and Blanket Health Insurance Contracts › Section 59A-23-26 - Utilization review of mental health or substance use disorder services.

A. An insurer shall, at least monthly, review and update the insurer's utilization review process to reflect the most recent evidence and generally recognized standards of care.
B. When performing a utilization review of mental health or substance use disorder services, including level of care placement, continued stay, transfer and discharge, an insurer shall apply criteria in accordance with generally recognized standards of care.
C. An insurer shall provide utilization review training to staff and contractors undertaking activities related to utilization review.
D. An insurer shall:
(1) develop utilization review policies regarding quantitative and non-quantitative limitations for mental health or substance use disorder services coverage that are no more restrictive than the utilization review policies regarding quantitative and non-quantitative limitations for medical and surgical care; and
(2) make utilization review policies available to providers or plan members.
History:
Laws 2023, ch. 114, § 18.
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-23-27 - Prohibited exclusions of coverage for mental health or substance use disorder services.

An insurer shall not exclude provider prescribed coverage for mental health or substance use disorder services otherwise included in its coverage when:
A. it is available pursuant to federal or state law for individuals with disabilities;
B. it is otherwise ordered by a court or administrative agency;
C. it is available to an insured through a public benefit program; or
D. an insured has a concurrent diagnosis.
History:
Laws 2023, ch. 114, § 19.
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-23-28 - Level of care determinations for the provision of mental health or substance use disorder services.

A. An insurer shall provide coverage for all in-network mental health or substance use disorder services, consistent with generally recognized standards of care, including placing an insured into a medically necessary level of care.
B. Changes in level and duration of care shall be determined by the insured's provider in consultation with the insurer.
C. Level of care determinations shall include placement of an insured into a facility that provides detoxification services, a hospital, an inpatient rehabilitation treatment facility or an outpatient treatment program.
D. Level of care services for an insured with a mental health or substance use disorder shall be based on the mental health or substance use disorder needs of the insured rather than arbitrary time limits.
History:
Laws 2023, ch. 114, § 20.
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-23-29 - Coordination of care.

At the request of an insured, an insurer may facilitate communication between mental health or substance use disorder services providers and the insured's designated primary care provider to ensure coordination of care to prevent any conflicts of care that could be harmful to the insured.
History:
Laws 2023, ch. 114, § 21.
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-23-30 - Confidentiality provisions.

An insurer shall protect the confidentiality of an insured receiving mental health or substance use disorder services.
History:
Laws 2023, ch. 114, § 22.
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-23-31 - Exceptions.

The provisions of Sections 14 through 22 [59A-23-22 to 59A-23-30 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, § 23.
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 23A - Long-Term Care Insurance › Section 59A-23A-1 - Short title.

Chapter 59A, Article 23A NMSA 1978 may be cited as the "Long-Term Care Insurance Law".
History:
Laws 1989, ch. 136, § 1; 1993, ch. 126, § 6.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, rewrote this section, which formerly read: "This act may be cited as the 'Long-Term Care Insurance Act.'"
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-2 - Purpose.

The purpose of the Long-Term Care Insurance Law is to promote the public interest in and the availability of long-term care insurance policies, protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, establish standards for long-term care insurance, facilitate public understanding and comparison of long-term care insurance policies and facilitate flexibility and innovation in the development of long-term care insurance coverage.
History:
Laws 1989, ch. 136, § 2; 1993, ch. 126, § 7.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, substituted "Law" for "Act".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-3 - Scope.

The provisions of the Long-Term Care Insurance Law shall apply to policies, certificates or riders delivered or issued for delivery in this state on or after July 1, 1989. The Long-Term Care Insurance Law is not intended to supersede any obligations of any entity to comply with the substance of any other provision of law, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance.
History:
Laws 1989, ch. 136, § 3; 1993, ch. 126, § 8.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, in the first sentence, substituted "Law" for "Act", substituted "in this state" for "renewed or continued", and substituted "July 1, 1989" for "the effective date of that act"; substituted "Law" for "Act" in the second sentence; and deleted the former last sentence, which read: "A policy which is not marketed or offered as long term care insurance or nursing home insurance is not subject to the provisions of the Long-Term Care Insurance Act."
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-5 - Extraterritorial jurisdiction; group long-term care insurance.

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in Paragraph (4) of Subsection C of Section 59A-23A-4 NMSA 1978, unless the superintendent has determined prior to the offer that:
A. the coverage meets the requirements of Chapter 59A, Article 23A NMSA 1978 and any regulations pertaining thereto, or the insurance commissioner of another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in New Mexico has determined that such requirements have been met; and
B. the requirements of Section 59A-23-8 NMSA 1978 have been met.
History:
1978 Comp., § 59A-23A-5, enacted by Laws 1993, ch. 126, § 10.
ANNOTATIONS
Repeals and reenactments.
— Laws 1993, ch. 126, § 10 repealed former 59A-23A-5 NMSA 1978, as enacted by Laws 1989, ch. 136, § 5, and enacted a new section, effective June 18, 1993.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-7 - Preexisting condition; definition; coverage.

A. No long-term care insurance policy, certificate or rider, including a group long-term care policy or certificate shall use a definition of preexisting condition that is more restrictive than the following: "preexisting condition" means a condition for which medical advice or treatment was recommended by or received from a provider of health care services within six months preceding the effective date of coverage of an insured person.
B. No long-term care insurance policy, certificate or rider, including a group long-term care policy, certificate or rider, shall exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six months following the effective date of coverage of an insured person.
C. The definition of preexisting condition as provided in Subsection A of this section does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards.
D. In the policy, certificate or rider, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered within six months following the effective date of coverage of the insured person. No long-term care insurance policy, certificate or rider may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond six months following the effective date of coverage of the insured person.
History:
Laws 1989, ch. 136, § 7.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-8 - Incontestability period.

A. For a policy or certificate that has been in force for less than six months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
B. For a policy or certificate that has been in force for at least six months but less than two years an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.
C. After a policy or certificate has been in force for two years it is not contestable upon the grounds of misrepresentation alone. Such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
D. No long-term care insurance policy or certificate may be field issued based on medical or health status. For purposes of this subsection, "field issued" means a policy or certificate issued by an agent or a third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer.
E. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
History:
1978 Comp., § 59A-23A-8, enacted by Laws 1993, ch. 126, § 12.
ANNOTATIONS
Repeals and reenactments.
— Laws 1993, ch. 126, § 12 repealed former 59A-23A-8 NMSA 1978, as enacted by Laws 1989, ch. 136, § 8, relating to the continuation of coverage and conversion, and enacted a new section, effective June 18, 1993. For provisions of former section,
see
the 1992 NMSA 1978 on
NMOneSource.com
.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Rescission or cancellation of insurance policy for insured's misrepresentation or concealment of information concerning human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) or related health problems, 15 A.L.R.5th 92.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-9 - Authority to promulgate regulations.

The superintendent shall promulgate regulations in accordance with the provisions of Section 59A-2-9 NMSA 1978 that include minimum standards for marketing practices, agent compensation, agent testing, penalties and reporting practices for long-term care insurance.
History:
1978 Comp., § 59A-23A-9, enacted by Laws 1993, ch. 126, § 13.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-10 - Penalties.

In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or up to ten thousand dollars ($10,000), whichever is greater.
History:
1978 Comp., § 59A-23A-10, enacted by Laws 1993, ch. 126, § 14.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-11 - Filing requirements for advertising.

A. Every issuer of long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement intended for use in this state, whether through written, radio or television media, to the superintendent for review and approval. The advertisement shall comply with all applicable laws of this state and shall be retained by the insurer for at least three years from the date the advertisement was first used.
B. Persons who market long-term care insurance policies, certificates or riders in this state shall not advertise any policies or certificates unless:
(1) the issuer of the policy certificate or rider has provided the superintendent with a copy of the advertisement; and
(2) the superintendent has reviewed and approved the advertisement.
History:
1978 Comp., § 59A-23A-11, enacted by Laws 1993, ch. 126, § 15.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23A - Long-Term Care Insurance › Section 59A-23A-13 - Licensed producers; qualified state long-term care partnership program; disclosures

A. A licensed producer that sells or offers for sale an insurance plan, insurance policy, certificate of insurance or rider that is intended to qualify as qualified state long-term care partnership program insurance shall disclose the availability of qualified state long-term care insurance partnership program insurance and outline the requirements and benefits of participation in the qualified state long-term care insurance partnership program.
B. As used in this section:
(1) "licensed producer" means an agent, broker or reinsurance intermediary licensed pursuant to the applicable provisions of the Insurance Code; and
(2) "rider" means a long-term care coverage provision added to any type of insurance plan, insurance policy or certificate of insurance.
History:
Laws 2013, ch. 139, § 5.
ANNOTATIONS
Effective dates.
— Laws 2013, ch. 139 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 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-1 - Repealed.

History:
Laws 1991, ch. 111, § 1; 2010, ch. 95, § 2; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-1 NMSA 1978, as enacted by Laws 1991, ch. 111, § 1, relating to short title, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-2 - Repealed.

History:
Laws 1991, ch. 111, § 2; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-2 NMSA 1978, as enacted by Laws 1991, ch. 111, § 2, relating to purpose, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-3 - Repealed.

History:
Laws 1991, ch. 111, § 3; 1994, ch. 60, § 1; 1997, ch. 249, § 3; 1997, ch. 250, § 3; 2003, ch. 337, § 3; 2008, ch. 87, § 2; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-3 NMSA 1978, as enacted by Laws 1991, ch. 111, § 3, relating to policy or plan, definition, criteria, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-4 - Repealed.

History:
Laws 1991, ch. 111, § 4; 1994, ch. 60, § 2; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-4 NMSA 1978, as enacted by Laws 1991, ch. 111, § 4, relating to mandated and optional offering of policy or plan, exemption from certain requirements, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-5 - Repealed.

History:
Laws 1991, ch. 111, § 5; 2017, ch. 130, § 16; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-5 NMSA 1978, as enacted by Laws 1991, ch. 111, § 5, relating to policy or plan disclosure requirements, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-6 - Repealed.

History:
Laws 1991, ch. 111, § 6; 1994, ch. 60, § 3; 1997, ch. 22, § 2; 1997, ch. 243, § 21; 1998, ch. 41, § 3; 2010, ch. 95, § 3; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-6 NMSA 1978, as enacted by Laws 1991, ch. 111, § 6, relating to forms and rates, approval of the superintendent, adjusted community rating, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-7 - Repealed.

History:
Laws 1991, ch. 111, § 7; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-7 NMSA 1978, as enacted by Laws 1991, ch. 111, § 7, relating to recordkeeping and reporting requirements, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-8 - Repealed.

History:
Laws 1991, ch. 111, § 8; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-8 NMSA 1978, as enacted by Laws 1991, ch. 111, § 8, relating to continuation of coverage and conversion rights, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-9 - Repealed.

History:
Laws 1991, ch. 111, § 9; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-9 NMSA 1978, as enacted by Laws 1991, ch. 111, § 9, relating to premium tax exemption, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-10 - Repealed.

History:
Laws 1991, ch. 111, § 10; 1994, ch. 64, § 6; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-10 NMSA 1978, as enacted by Laws 1991, ch. 111, § 10, relating to individuals eligible for medicaid benefits, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-10.2 - Repealed.

History:
1978 Comp., § 59A-23B-10.2, enacted by Laws 1994, ch. 64, § 7; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-10.2 NMSA 1978, as enacted by Laws 1994, ch. 64, § 7, relating to coverage of children, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-11 - Repealed.

History:
Laws 1991, ch. 111, § 11; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-11 NMSA 1978, as enacted by Laws 1991, ch. 111, § 11, relating to rules and regulations, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23B - Minimum Healthcare Protection (Repealed.) › Section 59A-23B-12 - Repealed.

History:
Laws 2003, ch. 252, § 2; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23B-12 NMSA 1978, as enacted by Laws 2003, ch. 252, § 2, relating to employer utilization and loss data availability, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-1 - Short title.

Chapter 59A, Article 23C NMSA 1978 may be cited as the "Small Group Rate and Renewability Act".
History:
Laws 1991, ch. 153, § 1; 1994, ch. 75, § 29.
ANNOTATIONS
The 1994 amendment,
effective January 1, 1995, substituted "Chapter 59A, Article 23C NMSA 1978" for "Sections 1 through 9 of this act".
Applicability.
— Laws 1994, ch. 75, § 36 made the provisions of §§ 26 to 34 of the act applicable to all plans and policies delivered, issued for delivery or renewed on or after January 1, 1995.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-2 - Purpose of act.

The purpose of the Small Group Rate and Renewability Act is to promote the continuing availability of health insurance coverage to small employers, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules for continuity of coverage for employers and covered individuals and to improve the efficiency and fairness of the small group health insurance marketplace.
History:
Laws 1991, ch. 153, § 2.
ANNOTATIONS
Applicability.
— Laws 1991, ch. 153, § 11 made the provisions of the act applicable to each health benefit plan for a small employer under the Small Group Rate and Renewability Act that is delivered, issued for delivery, renewed or continued in this state after July 1, 1991 and provided that the date a plan is continued or renewed is the first rating period that commences after June 14, 1991.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-4 - Health insurance plans subject to the Small Group Rate and Renewability Act.

A. Except as provided in Subsections B and C of this section, the provisions of the Small Group Rate and Renewability Act apply to any health benefit plan that provides coverage to one or more employees of a small employer.
B. The provisions of the Small Group Rate and Renewability Act shall not apply to individual health insurance policies that are subject to policy form and premium rate approval as provided in Section 59A-18-12, 59A-18-13, 59A-44-16, 59A-46-8, 59A-47-25 or 59A-47-26 NMSA 1978.
C. Any policies or certificates of a master policy that because of solicitation by agents or through the mail or mass media advertising are treated as individual policies and subject to the approvals stated in Subsection B of this section.
History:
Laws 1991, ch. 153, § 4.
ANNOTATIONS
Applicability.
— Laws 1991, ch. 153, § 11 made the provisions of the act applicable to each health benefit plan for a small employer under the Small Group Rate and Renewability Act that is delivered, issued for delivery, renewed or continued in this state after July 1, 1991 and provided that the date a plan is continued or renewed is the first rating period that commences after June 14, 1991.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-5 - Repealed.

History:
Laws 1991, ch. 153, § 5; 1994, ch. 75, § 31; 1997, ch. 243, § 23; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23C-5 NMSA 1978, as enacted by Laws 1991, ch. 153, § 5, relating to restrictions relating to premium rates, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-6 - Provisions on renewability of coverage.

A. Except as provided in Subsection B of this section, a health benefit plan subject to the Small Group Rate and Renewability Act shall be renewable to all eligible employees and dependents at the option of the small employer, except for the following reasons:
(1) nonpayment of required premiums;
(2) fraud or misrepresentation of the small employer, or with respect to coverage of an insured individual, fraud or misrepresentation by the insured individual or that individual's representative;
(3) noncompliance with plan provisions;
(4) the number of individuals covered under the plan is less than the number or percentage of eligible individuals required by percentage requirements under the plan; or
(5) the small employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan.
Eligibility classifications may not be changed if any individual is eliminated, due to the change, who was insured immediately prior to the change without first receiving the approval of the superintendent.
B. A small employer carrier may cease to renew all plans under a class of business. The carrier shall provide notice to all affected health benefit plans and to the superintendent in each state in which an affected insured individual is known to reside at least ninety days prior to termination of coverage. A carrier which exercises its right to cease to renew all plans in a class of business shall not:
(1) establish a new class of business for a period of five years after the nonrenewal of the plans without prior approval of the superintendent; or
(2) transfer or otherwise provide coverage to any of the employers from the nonrenewed class of business unless the insurer offers to transfer or provide coverage to all affected employers and eligible employees and dependents without regard to case characteristics, claim experience, health status or duration of coverage.
C. A small employer carrier may not change eligibility classifications upon renewal or replacement within twelve months of its termination of its own coverage if the change in classification eliminates from coverage any individual who was insured previous to the change and would have continued to be insured if the change in eligibility had not occurred.
History:
Laws 1991, ch. 153, § 6.
ANNOTATIONS
Applicability.
— Laws 1991, ch. 153, § 11 made the provisions of the act applicable to each health benefit plan for a small employer under the Small Group Rate and Renewability Act that is delivered, issued for delivery, renewed or continued in this state after July 1, 1991 and provided that the date a plan is continued or renewed is the first rating period that commences after June 14, 1991.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-7 - Disclosure of rating practices and renewability provisions.

Each small employer carrier shall make reasonable disclosure in solicitation and sales materials provided to small employers of the following:
A. the provisions concerning the carriers' right to change premium rates and the factors that affect changes in premium rates; and
B. the provisions relating to renewability of coverage.
History:
Laws 1991, ch. 153, § 7; 2019, ch. 259, § 6.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, revised provisions related to a small employer's duty to make reasonable disclosures, and removed language related to premium setting by claim experience, health status or class of business; deleted former Subsection A and redesignated former Subsection B as Subsection A; in Subsection A, after "factors", deleted "including case characteristics"; and deleted former Subsection C and redesignated former Subsection D as Subsection B.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-7.1 - Repealed.

History:
Laws 1994, ch. 75, § 32; 1997, ch. 243, § 25; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23C-7.1 NMSA 1978, as enacted by Laws 1994, ch. 75, § 32, relating to preexisting conditions, limitations, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-8 - Maintenance of records.

A. Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
B. Each small employer carrier shall file each March 1 with the superintendent an actuarial certification that the carrier is in compliance with this section and that the rating methods of the insurer are actuarially sound. The certification shall include the index rate for all classes of business as of January 1. A copy of the certification shall be retained by the insurer at its principal place of business.
C. A small employer carrier shall make the information and documentation described in Subsection A of this section available to the superintendent upon request. The information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the superintendent to persons outside of the department except as agreed to by the carrier or as ordered by a court of competent jurisdiction.
D. Each small employer carrier shall maintain at its principal place of business a complete copy of the disclosure of rating practices and renewability provided to the small employer for a period of three years during which time it shall be available to the superintendent upon request.
History:
Laws 1991, ch. 153, § 8.
ANNOTATIONS
Applicability.
— Laws 1991, ch. 153, § 11 made the provisions of the act applicable to each health benefit plan for a small employer under the Small Group Rate and Renewability Act that is delivered, issued for delivery, renewed or continued in this state after July 1, 1991 and provided that the date a plan is continued or renewed is the first rating period that commences after June 14, 1991.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-8.1 - Employer utilization and loss data availability.

Employer claims information, including utilization and loss experience under health insurance under a group health plan, a health benefit plan or a plan provided under Chapter 59A, Article 23C 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 to the carrier 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 permits identification of an individual insured or the insured's family or the specific conditions for which coverage was provided.
History:
Laws 2003, ch. 252, § 3.
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 23C - Small Group Rate and Renewability › Section 59A-23C-9 - Discretion of the superintendent.

The superintendent may suspend all or any part of Section 5 [59A-23C-5 NMSA 1978] of the Small Group Rate and Renewability Act as to the premium rates applicable to one or more small employers for one or more rating periods upon a filing by the small employer carrier and a finding by the superintendent that either the suspension is reasonable in light of the financial condition of the carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health benefits.
History:
Laws 1991, ch. 153, § 9.
ANNOTATIONS
Applicability.
— Laws 1991, ch. 153, § 11 made the provisions of the act applicable to each health benefit plan for a small employer under the Small Group Rate and Renewability Act that is delivered, issued for delivery, renewed or continued in this state after July 1, 1991 and provided that the date a plan is continued or renewed is the first rating period that commences after June 14, 1991.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23D - Medical Care Savings Accounts › Section 59A-23D-1 - Short title.

Chapter 59A, Article 23D NMSA 1978 may be cited as the "Medical Care Savings Account Act".
History:
Laws 1995, ch. 93, § 1; 1997, ch. 243, § 26; 1997, ch. 254, § 1.
ANNOTATIONS
The 1997 amendment,
effective April 11, 1997, substituted "Chapter 59A, Article 23D NMSA 1978" for "Sections 1 through 7 of this act".
Laws 1997, ch. 243, § 26, effective April 11, 1997, enacted identical amendments to this section. The section was set out as amended by Laws 1997, ch. 254, § 1.
See
12-1-8 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23D - Medical Care Savings Accounts › Section 59A-23D-3 - Account administrator; registration with department; department powers and duties.

A. An account administrator shall register annually with the department and pay an annual registration fee of twenty-five dollars ($25.00). The registration fee shall be deposited in the general fund. Registration as an account administrator does not affect the regulation of a bank, savings and loan association, credit union, trust company or insurance company as otherwise provided by law.
B. An account administrator shall provide to the department annually a list of the employers for whom it provides account administration and the number of employees and dependents for whom it administers accounts. The information shall be provided in the form requested by the department. The department may request other information it deems appropriate from the account administrator; provided, however, that the department shall not request any information about an individual employee or dependent unless a complaint has been filed with the department by that employee or dependent and the information is required to investigate the complaint.
C. The department may receive, investigate and settle complaints about medical care savings accounts and account administrators or it may refer complaints to other appropriate agencies.
D. The department, beginning January 1, 1998, shall adjust annually the deductible for qualified higher deductible health plans to reflect the adjustment allowed by the Internal Revenue Code of 1986 for medical savings accounts.
History:
Laws 1995, ch. 93, § 3; 1997, ch. 243, § 28; 1997, ch. 254, § 3.
ANNOTATIONS
Cross references.
— For the federal Internal Revenue Code,
see
26 U.S.C. § 1 et seq.
The 1997 amendment,
effective April 11, 1997, inserted "annually" and substituted "an annual" for "a" in the first sentence of Subsection A; rewrote Subsection D; and deleted former Subsection E relating to annual adjustment of the maximum employer contribution.
Laws 1997, ch. 243, § 28 and Laws 1997, ch. 254, § 3, both effective April 11, 1997, enacted identical amendments to this section. The section was set out as amended by Laws 1997, ch. 254, § 3.
See
12-1-8 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23D - Medical Care Savings Accounts › Section 59A-23D-4 - Medical care savings account program.

A. Except as otherwise provided by statute, contract or collective bargaining agreement, an employer may establish a medical care savings account program for his employees.
B. In establishing the program, the employer shall:
(1) provide a qualified higher deductible health plan for the benefit of his employees;
(2) contribute to medical care savings accounts for the employees; and
(3) appoint an account administrator to administer the savings accounts.
C. Principal contributed to and interest earned on a medical care savings account and money paid for eligible medical expenses are exempt from taxation under the Income Tax Act [Chapter 7, Article 2 NMSA 1978].
D. Before establishing a program, the employer shall notify all employees in writing of the federal tax status of the program and how federal income taxation affects New Mexico income taxes.
E. Any compensation required by the account administrator to administer the program shall be paid by the employer, and the employer shall not require the employee to contribute to such compensation while the employee participates in the program. If the employee ceases to participate in the program, he shall be responsible for costs associated with his account.
F. Nothing in the Medical Care Savings Account Act prohibits the employer from requiring the employee to contribute to the qualified higher deductible health plan or the medical care savings account.
G. Nothing in the Medical Care Savings Account Act requires an employee to participate in a program. The employer shall offer the program to all employees on a nondiscriminatory basis.
History:
Laws 1995, ch. 93, § 4; 2001, ch. 194, § 1.
ANNOTATIONS
The 2001 amendment,
effective June 15, 2001, in Subsection C, substituted "paid" for "reimbursed from the savings account to an employee" and deleted the second sentence, containing a definition of "reimbursement".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23D - Medical Care Savings Accounts › Section 59A-23D-5 - Account administrator; employer and employee responsibilities.

A. An employer, in conjunction with an account administrator, shall provide a current written statement to employees that details how money in their medical care savings accounts is or will be invested and the rate of return employees may reasonably anticipate on the investment of the savings accounts. The account administrator shall file the statement with the department.
B. Except as provided in Section 59A-23D-6 NMSA 1978, money in a savings account shall be used solely for the purpose of paying the eligible medical expenses of an employee and his dependents.
C. Payments may be made by the employee directly to a health care provider through the use of a debit card or check that accesses the employee's medical savings account. If the account administrator determines that the employee paid for goods or services that do not qualify as eligible medical expenses, the employee shall be required to reimburse his medical savings account, and he shall be liable for any federal and state taxes and penalties. If the employee chooses to be reimbursed for eligible medical expenses, the account administrator shall reimburse the employee from the employee's medical care savings account. When seeking reimbursement, the employee shall submit documentation of eligible medical expenses paid by the employee.
D. If an employer makes contributions to a program on a periodic installment basis, the employer may advance to an employee, interest free, an amount necessary to cover eligible medical expenses incurred that exceed the amount in the employee's savings account if the employee agrees to repay the advance from future installments or when he ceases to be an employee of the employer or a participant in the program. Such advances shall be exempt from taxation under the Income Tax Act [Chapter 7, Article 2 NMSA 1978].
History:
Laws 1995, ch. 93, § 5; 1997, ch. 243, § 29; 1997, ch. 254, § 4; 2001, ch. 194, § 2.
ANNOTATIONS
The 2001 amendment,
effective June 15, 2001, in Subsection C, added the first two sentences and in the third sentence, inserted "If the employee chooses to be reimbursed for eligible medical expenses", and deleted "for eligible medical expenses" following "savings account".
The 1997 amendment,
effective April 11, 1997, substituted "Section 59A-23D-6 NMSA 1978" for "Section 6 of this act" in Subsection B and made stylistic changes in Subsections A and B.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23D - Medical Care Savings Accounts › Section 59A-23D-7 - Report.

A. The superintendent shall report to the legislature on or before December 1, 1999 on the availability of health care coverage pursuant to the Medical Care Savings Account Act and the market share of programs in comparison with traditional employer-provided health insurance programs; the results of a survey of employer and employee satisfaction with programs; and the results of a loss ratio study relative to programs.
B. The superintendent shall adopt and promulgate regulations for enforcing and administering the provisions of the Medical Care Savings Account Act.
History:
Laws 1995, ch. 93, § 7; 1997, ch. 243, § 31; 1997, ch. 254, § 6.
ANNOTATIONS
The 1997 amendment,
effective April 11, 1997, designated the existing language as Subsection A, deleted "of insurance" following "superintendent" therein, and added Subsection B.
Laws 1997, ch. 243, § 31 and Laws 1997, ch. 254, § 6, both effective April 11, 1997, enacted identical amendments to this section. The section was set out as amended by Laws 1997, ch. 254, § 6.
See
12-1-8 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-1 - Short title.

Chapter 59A, Article 23E NMSA 1978 may be cited as the "Health Insurance Portability Act".
History:
Laws 1997, ch. 243, § 1; 1998, ch. 41, § 5.
ANNOTATIONS
The 1998 amendment,
effective March 6, 1998, substituted "Chapter 59A, Article 23E NMSA 1978" for "Sections 1 through 17 of this act" at the beginning of the section.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-3 - Limitation on preexisting condition exclusion period.

A health insurance issuer or health benefits plan offering group health insurance, blanket health insurance or individual health insurance shall not impose any preexisting condition exclusion with respect to that health insurance plan or coverage. A health insurance issuer or health insurance plan offering group health insurance, blanket health insurance or individual health insurance shall not impose a waiting period in excess of ninety days with respect to a health insurance plan or coverage.
History:
Laws 1997, ch. 243, § 3; 1998, ch. 41, § 7; 2019, ch. 259, § 8.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, prohibited a health insurance issuer or health benefits plan offering group health insurance, blanket health insurance or individual health insurance from imposing any preexisting condition exclusion in the health insurance plan or coverage, and prohibited a health insurance issuer or health insurance plan offering group health insurance, blanket health insurance or individual health insurance from imposing a waiting period greater than ninety days; in the section heading, deleted "Group health plan; group health insurance"; deleted "Except as provided in Section 59A-23E-4 NMSA 1978, a group health plan and a health insurance issuer offering group health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting condition exclusion only if"; and deleted former Subsections A through C and added new language to the section.
The 1998 amendment,
effective March 6, 1998, substituted "Group health plan; group health insurance" for "Limitation on preexisting condition exclusion period; crediting for periods of previous coverage" in the section heading and "59A-23E-4 NMSA 1978" for "4 of the Health Insurance Portability Act" near the beginning of the introductory paragraph.