2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 18 - The Insurance Contract › Section 59A-18-13.1 - Adjusted community rating.

A. Every insurer, fraternal benefit society, multiple employer welfare arrangement, health maintenance organization or nonprofit health care plan that provides primary health insurance or health care coverage insuring or covering major medical expenses shall, in determining the initial year's premium charged for an individual, use only the rating factors of age, geographic area of the place of employment and smoking practices, except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment.
B. Separately for an insurer's individual and group policies, no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under nineteen years of age or children nineteen to twenty-five years of age who are full-time students may have rates that are lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from offering rates that differ depending upon family composition. For the purposes of this subsection, "family composition" refers only to whether coverage covers an individual or a family.
C. The provisions of this section do not preclude an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from using health status or occupational or industry classification in establishing the amount a large group health benefits plan may be charged for coverage.
D. As used in Subsection C of this section, "health status" does not include genetic information.
E. The superintendent shall adopt regulations to implement the provisions of this section.
History:
Laws 1994, ch. 75, § 26; 1997, ch. 22, § 1; 1997, ch. 243, § 18; 1998, ch. 41, § 1; 2010, ch. 95, § 1; 2019, ch. 259, § 1.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, removed provisions that provided for gender-based premium rates, and revised certain provisions to align with federal law; in Subsection A, after "society", added "multiple employer welfare arrangement", and after "factors of age", deleted "gender pursuant to Subsection B of this section"; deleted Subsection B and redesignated former Subsections C through F as Subsections B through E, respectively; in Subsection B, added "Separately for an insurer's individual and group policies", after "prohibit an insurer", added "multiple employer welfare arrangement", and added "For the purposes of this subsection, 'family composition' refers only to whether coverage covers an individual or a family"; in Subsection C, in the introductory clause, after "insurer", added "multiple employer welfare arrangement", deleted Paragraph C(1) and paragraph designation "(2)", after "the amount", deleted "an employer may be charged for coverage under the group health plan" and added "a large group health benefits plan may be charged for coverage"; and in Subsection D, changed "Subsection D", to "Subsection C".
The 2010 amendment,
effective May 19, 2010, in Subsection A, after "use only the rating factors of age, gender", added "pursuant to Subsection B of this section"; in Subsection B, after "rates in the age group by more than", deleted "twenty percent of the lower rate, and no persons rate shall" and added the remainder of the sentence, including Paragraphs (1) through (4); designated the former second paragraph in Subsection B as Subsection C; and in Subsection C, in the first sentence, added "No person's rate"; in the second sentence, after "restrictions shall not prohibit an insurer", added "fraternal benefit"; after "society,", added "health maintenance"; after "organization or", added "nonprofit health care"; and relettered the succeeding subsections accordingly.
The 1998 amendment,
effective March 6, 1998, redesignated the second and third sentences of Subsection A as Subsection B; added Subsection C; and redesignated Subsection B as Subsection D.
The 1997 amendment,
effective April 11, 1997, in Subsection A, deleted "Until July 1, 1998" from the beginning, inserted "except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment" at the end of the first sentence, and inserted "or children aged nineteen to twenty-five who are full-time students" following "under the age of nineteen" in the second sentence; deleted former Subsection B relating to charging the same premium for the same coverage regardless of medical risk, job risk, or gender; and redesignated former Subsection C as Subsection B.