2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 54 - Medical Insurance Pool › Section 59A-54-19 - Rates; standard risk rate.

A. The pool shall determine a standard risk rate by actuarially calculating the individual rate that an insurer would charge for an individual policy with the pool benefits issued to a person who was a standard risk. Separate schedules of standard risk rates based on age and other appropriate demographic characteristics may be used. In determining the standard risk rate, the pool shall consider the benefits provided, the standard risk experience and the anticipated expenses for a standard risk for the coverage provided. The rates charged for pool coverage shall be no more than one hundred fifty percent of the standard risk rate for each class of insureds.
B. The board shall adopt a low-income premium schedule that provides coverage at lower rates for those persons with an income less than four hundred percent of the current federal poverty level guidelines applicable to New Mexico, published by the United States department of health and human services. For individuals with household incomes of one hundred ninety-nine percent of the federal poverty level or lower, the premium reduction shall be seventy-five percent. For individuals with household incomes of two hundred percent to two hundred ninety-nine percent of the federal poverty level, the premium reduction shall be fifty percent. For individuals with household incomes of three hundred percent to three hundred ninety-nine percent of the federal poverty level, the premium reduction shall be twenty-five percent. The board shall determine income based on the preceding taxable year. No person shall be eligible for a low-income premium reduction if that person's premium is paid by a third party who is not a family member.
C. All rates and rate schedules shall be submitted to the superintendent for approval.
History:
1978 Comp., § 59A-54-19, enacted by Laws 1987, ch. 154, § 19; 1991, ch. 200, § 12; 1994, ch. 58, § 2; 2001, ch. 352, § 13; 2009, ch. 190, § 1; 2021, ch. 108, § 35.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, in Subsection B, after "twenty-five percent", deleted "with the exception of those individuals in this category who were enrolled and receiving a fifty percent reduction in premium prior to January 1, 2009, who shall be phased down to a twenty-five percent premium reduction over a two-year period, provided that they continue to re-qualify annually for a premium reduction in the three hundred percent to three hundred ninety-nine percent of the federal poverty level category".
The 2009 amendment,
effective June 19, 2009, in Subsection B, after "with an income less than", deleted "an amount to be determined by the board" and added the remainder of the sentence, and added the second through the fourth sentences; and in the fifth sentence, after "The board" deleted "shall adopt as many income categories as it finds practical and".
The 2001 amendment,
effective June 15, 2001, in Subsection B, deleted the former first three sentences, regarding the creation of a schedule of rates for the payment of the standard risk rate for those persons below, at, or up to 200% above the poverty level, and added the present first and last sentences.
The 1994 amendment,
effective May 18, 1994, added Subsection B and redesignated former Subsection B as Subsection C.
The 1991 amendment,
effective June 14, 1991, substituted "Rates" for "Premiums" in the section heading and rewrote the section to the extent that a detailed analysis is impracticable.