reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-4 - Repealed.

History:
Laws 1997, ch. 243, § 4; 1998, ch. 41, § 8; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23E-4 NMSA 1978, as enacted by Laws 1997, ch. 243, § 4, relating to group health plan, group health insurance, prohibition of exclusions in certain cases, 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New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-5 - Repealed.

History:
Laws 1997, ch. 243, § 5; 1998, ch. 41, § 9; 2008, ch. 87, § 3; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23E-5 NMSA 1978, as enacted by Laws 1997, ch. 243, § 5, relating to group health plan, rules for crediting previous coverage, effective June 14, 2019.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New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-6 - Repealed.

History:
Laws 1997, ch. 243, § 6; 1998, ch. 41, § 10; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23E-6 NMSA 1978, as enacted by Laws 1997, ch. 243, § 6, relating to group health plan, group health insurance, method of crediting coverage, election, notice of election, 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New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-7 - Repealed.

History:
Laws 1997, ch. 243, § 7; 1998, ch. 41, § 11; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-23E-7 NMSA 1978, as enacted by Laws 1997, ch. 243, § 7, relating to group health plan, group health insurance, certification and disclosure of coverage, 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 23E - Health Insurance Portability › Section 59A-23E-9 - Group health plan; special enrollment periods for dependent beneficiaries.

A. A group health plan shall provide for a dependent special enrollment period described in Subsection B of this section during which a person may be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if the spouse is otherwise eligible for coverage, if:
(1) the plan makes coverage available to a dependent of an individual;
(2) the individual is a participant under the plan or has met any waiting period applicable to becoming a participant and is eligible to be enrolled under the plan but for a failure to enroll during a previous enrollment period; and
(3) the person has become the dependent of the individual through marriage, birth, adoption or placement for adoption.
B. A dependent special enrollment period pursuant to this subsection shall be for a period of not less than thirty days and shall begin on the later of:
(1) the date dependent coverage is made available; or
(2) the date of the marriage, birth, adoption or placement for adoption described in Subsection A of this section.
C. If an individual seeks to enroll a person as a dependent during the first thirty days of a dependent special enrollment period, the coverage of the dependent becomes effective:
(1) in the case of marriage, not later than the first day of the first month beginning after the date the completed request for enrollment is received;
(2) in the case of birth, as of the date of the birth; or
(3) in the case of adoption or placement for adoption, the date of the adoption or placement.
History:
Laws 1997, ch. 243, § 9; 1998, ch. 41, § 13.
ANNOTATIONS
The 1998 amendment,
effective March 6, 1998, substituted "Group health plan" for "Special enrollment periods for dependent beneficiaries" in the section heading; in Subsection A, deleted "or if not otherwise enrolled, the individual" following "which a person", and substituted "the" for "a" at the beginning of Paragraph A(3); in Subsection C, inserted "person as a" near the beginning, and deleted "a dependent's" following "in the case of" in Paragraphs C(2) and (3).
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-10 - Group health plan; group health insurance; use of affiliation period by health maintenance organizations as alternative to preexisting condition exclusion.

A. A health maintenance organization that offers health insurance coverage in connection with a group health plan and does not impose any preexisting condition exclusion allowed pursuant to Section 59A-23E-3 NMSA 1978 with respect to any particular coverage option may impose an affiliation period for the coverage option if that period:
(1) is applied uniformly without regard to any health status related factors; and
(2) does not exceed two months, or three months in the case of a late enrollee.
B. During an affiliation period, a health maintenance organization is not required to provide health care services or benefits to a participant or beneficiary, and it shall not charge a premium to a participant or beneficiary for any coverage.
C. An affiliation period begins to run on the enrollment date and shall run concurrently with any waiting period under the plan.
D. A health maintenance organization described in Subsection A of this section may use alternative methods different from those described in that subsection to address adverse selection as approved by the superintendent.
History:
Laws 1997, ch. 243, § 10; 1998, ch. 41, § 14.
ANNOTATIONS
The 1998 amendment,
effective March 6, 1998, substituted "Group health plan; group health insurance" for "Use of affiliation period by health maintenance organizations as alternative to preexisting condition exclusion" in the section heading and "59A-23E-3 NMSA 1978" for "3 of the Health Insurance Portability Act" near the middle of Subsection A.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-11 - Prohibiting discrimination based on health status against individual participants and beneficiaries.

A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not establish rules for eligibility or continued eligibility of any individual to enroll or continue to participate in a health plan, or eligibility or continued eligibility for benefits, based on any of the following factors in relation to the individual or a dependent of the individual:
A. health status;
B. medical condition, including both physical and mental illnesses;
C. claims experience;
D. receipt of health care;
E. medical history;
F. genetic information;
G. evidence of insurability, including conditions arising out of acts of domestic violence;
H. disability;
I. gender;
J. national origin;
K. sexual orientation; or
L. any other health status-related factor that the superintendent specifies in rules of the office of superintendent of insurance.
History:
Laws 1997, ch. 243, § 11; 1998, ch. 41, § 15; 2019, ch. 259, § 10.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, provided that factors such as health status, gender, national origin and sexual orientation may not be taken into account by an insurer in establishing eligibility for coverage; in the section heading, deleted "Group health plan; group health insurance"; deleted subsection designation A and redesignated former Paragraphs A(1) through A(8) as Subsections A through H, respectively; in the introductory clause, deleted "Except as provided in Subsection B of this section", after "participate in a health plan", added "or eligibility or continued eligibility for benefits", and after "the following", deleted "health status related"; deleted former Subsection B; and added new Subsections I through L.
The 1998 amendment,
effective March 6, 1998, substituted "Group health plan; group health insurance" for "Prohibiting discrimination based on health status against individual participants and beneficiaries in eligibility to enroll" in the section heading and "59A-23E-3 NMSA 1978" for "3 of the Health Insurance Portability Act" near the beginning in Subsection B.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-12 - Prohibiting discrimination based on health status against individual participants and beneficiaries in premium contributions.

A. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not require an individual as a condition of enrollment or continued enrollment under the plan to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of the health status related factor in relation to the individual or a person enrolled under the plan as a dependent of the individual.
B. The provisions of Subsection A of this section shall not be construed to:
(1) restrict the amount that an employer or an individual may be charged for coverage under a group health plan or individual health coverage; or
(2) prevent a group health plan or a health insurance issuer offering group health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
C. A group health benefits plan or a health insurance issuer that offers group health insurance coverage in connection with a group health benefits plan shall not adjust premiums or contribution amounts for the group covered under the plan on the basis of genetic information.
History:
Laws 1997, ch. 243, § 12; 1998, ch. 41, § 16; 2019, ch. 259, § 11.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, provided that a group health benefits plan or a health insurance issuer may not adjust premiums or contribution amounts on the basis of genetic information; in the section heading, deleted "Group health plan; group health insurance"; in Subsection A, deleted "Except as provided in Subsection B of this section", after "health status related", deleted "factors specified in Subsection A of Section 59A-23E-11 NMSA 1978" and added "factor"; in Subsection B, added paragraph designations "(1)" and "(2)"; and added Subsection C.
The 1998 amendment,
effective March 6, 1998, substituted "Group health plan; group health insurance" for "Prohibiting discrimination based on health status against individual participants and beneficiaries in premium contributions" in the section heading, and in Subsection A, substituted "59A-23E-11 NMSA 1978" for "11 of the Health Insurance Portability Act" and "a person" for "an individual" near the end.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-15 - Disclosure of information by health insurance issuers.

A. A health insurance issuer when offering health insurance coverage to an employer or individual shall:
(1) make a reasonable disclosure to the small employer or individual as part of its solicitation and sales materials, of the availability of information described in Subsection B of this section; and
(2) upon request of the employer or individual provide the information described.
B. Except as provided in Subsection D of this section, a health insurance issuer offering a health plan to an employer or individual shall provide information pursuant to Subsection A of this section concerning:
(1) the provisions of coverage concerning the issuer's right to change premium rates and the factors that may affect changes in premium rates;
(2) the provisions of coverage relating to renewability of coverage; and
(3) the benefits and premiums available under all health insurance coverage for which the small employer is qualified.
C. Information furnished pursuant to this section shall be provided to employers or individuals in a manner determined to be understandable by the average employer or individual and shall be sufficient to reasonably inform employers or individuals of their rights and obligations under the health insurance coverage.
D. A health insurance issuer is not required by this section to disclose information that is proprietary and trade secret information.
History:
Laws 1997, ch. 243, § 15; 1998, ch. 41, § 19; 2019, ch. 259, § 14.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, removed language regarding pre-existing condition exclusion; in the section heading, deleted "offering health insurance coverage to small employers"; and in Subsection B, deleted former Paragraph B(3) and redesignated former Paragraph B(4) as Paragraph B(3).
The 1998 amendment,
effective March 6, 1998, inserted "; offering health insurance coverage to small employers" at the end of the section heading.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-17 - Treatment of partners and self-employed individuals in connection with group health plans.

A. Any plan, fund or program that would not be an employee welfare benefit plan, except for the provisions of this section, that is established or maintained by a partnership, to the extent that the plan, fund or program provides medical care to current or former partners in the partnership or to their dependents directly or through insurance, reimbursement or otherwise, shall be treated as an employee welfare benefit plan that is a group health plan.
B. As used in this section:
(1) "employer" includes a partnership in relation to a partner; and
(2) "participant" includes:
(a) in connection with a group health plan maintained by a partnership, an individual who is a partner in relationship to the partnership; and
(b) in connection with a group health plan maintained by a self-employed individual under which one or more employees are participants, the self-employed individual, if he or his beneficiaries are or may become eligible to receive a benefit under the plan.
History:
Laws 1997, ch. 243, § 17; 1998, ch. 41, § 21.
ANNOTATIONS
The 1998 amendment,
effective March 6, 1998, in the section heading, substituted "partners" for "partnerships" following "of" and inserted "in connection with group health plans" at the end of the heading.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-18 - Requirement for mental health benefits in an individual or group health plan, or group health insurance offered in connection with the plan, for a plan year of an employer.

A. A group health plan or group or individual health insurance shall not impose treatment limitations or financial restrictions, limitations or requirements on the provision of mental health benefits that are more restrictive than the predominant restrictions, limitations or requirements that are imposed on coverage of benefits for other conditions.
B. As used in this section, "mental health benefits" means mental health benefits as described in the group health plan or group health insurance offered in connection with the plan.
History:
1978 Comp., § 59A-23E-18, enacted by Laws 2000, ch. 6, § 1; 2019, ch. 259, § 16; 2023, ch. 114, § 24.
ANNOTATIONS
Repeals and reenactments.
— Laws 2000, ch. 6, § 1 repealed 59A-23E-18 NMSA 1978, as enacted by Laws 1998, ch. 41, § 22, and enacted a new section, effective May 17, 2000.
The 2023 amendment,
effective June 16, 2023, removed language authorizing a group health plan or group or individual health insurance offered in connection with that plan to require pre-admission screening prior to the authorization of mental health benefits or to apply limitations that restrict mental health benefits provided under the plan to those that are medically necessary; deleted former Subsection B and redesignated former Subsection C as Subsection B; and in Subsection B, after "with the plan", deleted "but does not include benefits with respect to treatment of substance abuse, chemical dependency or gambling addiction".
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.
The 2019 amendment,
effective June 14, 2019, provided that a group health plan may not impose restrictions, limitations or requirements on the provisions of mental health benefits that are more restrictive than the predominant restrictions, limitations or requirements that are imposed on coverage of benefits for other conditions, and removed language that limits the annual premium increase based on providing mental health coverage parity; in Subsection A, after "group or individual health insurance", deleted "offered in connection with that plan, shall provide both medical and surgical benefits and mental health benefits. The plan", after "financial", added "restrictions, limitations", after "mental health benefits", deleted "if identical" and added "that are more restrictive than the predominant restrictions"; and deleted former Subsections C through E and redesignated former Subsection F as Subsection C.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-20 - Certification of coverage by issuers in the individual market.

The provisions of Section 59A-23E-7 NMSA 1978 [repealed] apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.
History:
1978 Comp., § 59A-23E-20, enacted by Laws 1998, ch. 41, § 24.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Laws 2019, ch. 259, § 22 repealed 59A-23E-7 NMSA 1978, effective June 14, 2019.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23F - New Mexico Health Insurance Exchange › Section 59A-23F-1 - Short title.

Chapter 59A, Article 23F NMSA 1978 may be cited as the "New Mexico Health Insurance Exchange Act".
History:
Laws 2013, ch. 54, § 1; 2020, ch. 35, § 1.
ANNOTATIONS
The 2020 amendment,
effective May 20, 2020, changed "Sections 1 through 8 of this act" to "Chapter 59A, Article 23F NMSA 1978".
Severability.
— Laws 2013, ch. 54, § 16 provided that if any part or application of Laws 2013, ch. 54, §§ 1 through 15 are 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 23F - New Mexico Health Insurance Exchange › Section 59A-23F-4 - Board of directors; powers.

The board may:
A. seek and receive grant funding from federal, state or local governments or private philanthropic organizations to defray the costs of operating the exchange;
B. generate funding, including charging assessments or fees, to support its operations in accordance with provisions of the New Mexico Health Insurance Exchange Act solely for the reasonable administrative costs of the exchange; provided that no assessment or user fee shall be imposed upon a carrier that exclusively offers policies, plans or contracts outside the exchange intended to supplement major medical coverage, including medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy;
C. establish a Native American service center to ensure that the exchange:
(1) is accessible to Native Americans;
(2) complies with the provisions of the federal Indian Health Care Improvement Act and Indian-specific provisions of the federal Patient Protection and Affordable Care Act; and
(3) facilitates meaningful, ongoing consultation with Native Americans;
D. create ad hoc advisory councils;
E. request assistance from other boards, commissions, departments, agencies and organizations as necessary to provide appropriate expertise to accomplish the exchange's duties;
F. enter into contracts with persons or other organizations as necessary or proper to carry out the provisions and purposes of the New Mexico Health Insurance Exchange Act, including the authority to contract or employ staff for the performance of administrative, legal, actuarial, accounting and other functions; provided that no contractor shall be a health insurance issuer or a producer;
G. enter into contracts with similar exchanges of other states for the joint performance of common administrative functions;
H. enter into information-sharing agreements with federal and state agencies and other state exchanges to carry out its responsibilities; provided that these agreements include adequate protections of the confidentiality of the information to be shared and comply with all state and federal laws and regulations;
I. sue or be sued or otherwise take any necessary or proper legal action in the execution of its duties and powers;
J. appoint board committees, which may include non-board members, to provide technical assistance in the operation of the exchange and any other function within the authority of the exchange; and
K. conduct periodic audits to assure the general accuracy of the financial data submitted to the exchange.
History:
Laws 2013, ch. 54, § 4.
ANNOTATIONS
Emergency clauses.
— Laws 2013, ch. 54, § 17 contained an emergency clause and was approved March 28, 2013.
Severability.
— Laws 2013, ch. 54, § 16 provided that if any part or application of Laws 2013, ch. 54, §§ 1 through 15 are 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 23F - New Mexico Health Insurance Exchange › Section 59A-23F-6 - Board duties; reporting.

The board shall:
A. between July 1, 2013 and January 1, 2015, provide quarterly reports to the legislature, the governor and the superintendent on the implementation of the exchange and report annually and upon request thereafter;
B. keep an accurate accounting of all of the activities, receipts and expenditures of the exchange and submit this information annually to the superintendent and as required by federal law to the federal secretary of health and human services;
C. beginning with the first year of operation in which access to health insurance coverage is provided, obtain an annual audit of the exchange's operations from an independent certified public accountant;
D. publish the administrative costs of the exchange as required by state or federal law; and
E. discharge those duties required to implement and operate the exchange in accordance with the provisions of the New Mexico Health Insurance Exchange Act consistent with state and federal law.
History:
Laws 2013, ch. 54, § 6.
ANNOTATIONS
Emergency clauses.
— Laws 2013, ch. 54, § 17 contained an emergency clause and was approved March 28, 2013.
Severability.
— Laws 2013, ch. 54, § 16 provided that if any part or application of Laws 2013, ch. 54, §§ 1 through 15 are 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 23F - New Mexico Health Insurance Exchange › Section 59A-23F-7 - Superintendent of insurance; rulemaking.

The superintendent shall coordinate with the board to promulgate rules necessary to implement and carry out the provisions of the New Mexico Health Insurance Exchange Act, including rules to establish the criteria for certification of qualified health plans.
History:
Laws 2013, ch. 54, § 7; 2020, ch. 35, § 5.
ANNOTATIONS
The 2020 amendment,
effective May 20, 2020, required the superintendent of insurance to coordinate with the board of directors of the exchange to promulgate rules necessary to implement and carry out the provisions of the New Mexico Health Insurance Exchange Act; and after "shall", added "coordinate with the board to".
Severability.
— Laws 2013, ch. 54, § 16 provided that if any part or application of Laws 2013, ch. 54, §§ 1 through 15 are 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 23F - New Mexico Health Insurance Exchange › Section 59A-23F-8 - Funding.

A. To fund the planning, implementation and operation of the exchange, the board shall contract with the human services department [health care authority department] or any other state agency that receives federal funds allocated, appropriated or granted to the state for purposes of funding the planning, implementation or operation of a health insurance exchange.
B. The human services department [health care authority department] or any other state agency that receives federal funds allocated, appropriated or granted to the state for purposes of funding the planning, implementation or operation of a health insurance exchange shall contract with the board to provide those funds to the exchange in consideration for its planning, implementation or operation.
History:
Laws 2013, ch. 54, § 8.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Laws 2023, ch. 205, § 16 provided that references to the human services department shall be deemed to be references to the health care authority department.
Emergency clauses.
— Laws 2013, ch. 54, § 17 contained an emergency clause and was approved March 28, 2013.
Severability.
— Laws 2013, ch. 54, § 16 provided that if any part or application of Laws 2013, ch. 54, §§ 1 through 15 are 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 23F - New Mexico Health Insurance Exchange › Section 59A-23F-9 - Standardized health plans.

A. The board may establish no more than three standardized health plans for each of three levels of coverage with increasing benefits, designated bronze, silver and gold plans.
B. In establishing standardized health plans, the board may design those plans to:
(1) limit increases in health plan premium rates;
(2) reduce the deductible portion of a benefit an insured individual is required to pay;
(3) make more services available before a deductible amount is applied to a benefit;
(4) provide predictable cost sharing;
(5) maximize available subsidies;
(6) limit adverse premium impacts;
(7) reduce barriers to maintaining and improving health; and
(8) encourage choice based on value.
C. The board may update the standardized health plans annually.
D. The board shall provide for notice and public comment before finalizing each year's standardized health plans.
E. The board shall establish a procedure and time line for providing written notice of the standardized health plans to health insurance issuers before the year in which the health plans are to be offered on the exchange.
F. Beginning on January 1, 2022, the board may require a health insurance issuer offering a qualified health plan through the exchange to offer one silver standardized health plan and one gold standardized health plan on the exchange. If a health insurance issuer offers a bronze health plan through the exchange, the exchange may also require the issuer to offer one bronze standardized health plan through the exchange.
G. A health insurance issuer offering standardized health plans through the exchange may also offer nonstandardized health plans through the exchange.
H. The actuarial value of nonstandardized silver health plans offered through the exchange shall not be less than the actuarial value of the standardized silver health plan with the lowest actuarial value.
History:
Laws 2020, ch. 35, § 7.
ANNOTATIONS
Effective dates.
— Laws 2020, ch. 35 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 20, 2020, 90 days after adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23F - New Mexico Health Insurance Exchange › Section 59A-23F-10 - Reporting.

The board shall make reports publicly available as follows:
A. during all exchange open enrollment periods beginning on or after October 1, 2021, the board shall produce weekly reports that include information on:
(1) applications;
(2) plan selections;
(3) new enrollees;
(4) enrollees renewing coverage;
(5) call center volume; and
(6) website traffic;
B. within sixty days following the last day of each open enrollment period beginning on or after October 1, 2021, the board shall produce a report with the number of effectuated enrollments from the most recent open enrollment period; and
C. beginning on September 1, 2022, and on each succeeding September 1, the board, in consultation with the superintendent, shall issue a report that includes analysis of:
(1) the individual health insurance market;
(2) on- and off-exchange enrollment and demographics;
(3) small business enrollment;
(4) qualified health plan pricing;
(5) outreach and enrollment assistance activities;
(6) the impact of offering standardized health plans; and
(7) the remaining uninsured in New Mexico and strategies to reach them.
History:
Laws 2020, ch. 35, § 8.
ANNOTATIONS
Effective dates.
— Laws 2020, ch. 35 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 20, 2020, 90 days after adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-1 - Short title.

Chapter 59A, Article 23G NMSA 1978 may be cited as the "Short-Term Health Plan and Excepted Benefit Act".
History:
Laws 2019, ch. 235, § 1; 2023, ch. 169, § 6.
ANNOTATIONS
The 2023 amendment,
effective June 16, 2023, changed "Sections 1 through 7 of this act" to "Chapter 59A, Article 23G NMSA 1978".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-3 - Short-term plans; excepted benefits; standards for policy provisions.

A. The superintendent shall adopt and promulgate rules to establish specific standards:
(1) that set the manner, content and required disclosure for the sale of short-term plans and excepted benefits plans, including standards for full and fair disclosure; and
(2) for the sale of short-term plans and excepted benefits plans, which standards shall include standards relating to:
(a) terms of renewability or extension of coverage;
(b) initial and subsequent conditions of eligibility;
(c) nonduplication of coverage provisions;
(d) coverage of dependents;
(e) preexisting conditions;
(f) termination of insurance;
(g) probationary periods;
(h) limitations;
(i) exceptions;
(j) reductions and exclusions;
(k) elimination periods;
(l) requirements for replacement by the health insurance carrier;
(m) recurrent conditions;
(n) the definition of terms to describe the specific types of coverage sold pursuant to the Short-Term Health Plan and Excepted Benefit Act and specific standards and policy provisions required of these plans;
(o) benefit duration;
(p) scope of coverage;
(q) advertising and marketing;
(r) sales practices;
(s) mandatory disclosures;
(t) coverage suitability; and
(u) policy and certificate approval.
B. All advertisements, marketing materials and application and policy forms relating to short-term plans shall prominently display a notice that the coverage is unavailable to any potential insured who has been covered under a short-term plan in the previous twelve-month period.
History:
Laws 2019, ch. 235, § 3.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 235 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-4 - Benefits; minimum standards.

A. The superintendent shall adopt and promulgate rules to establish minimum standards for benefits provided by short-term plans and excepted benefits plans that are subject to the Short-Term Health Plan and Excepted Benefit Act.
B. Rules of the superintendent shall require short-term plans to cover state-mandated benefits in addition to each of the following categories of benefits:
(1) diagnostic;
(2) rehabilitative;
(3) maternity;
(4) neonatal;
(5) behavioral health services;
(6) emergency services;
(7) hospitalization;
(8) ambulatory services; and
(9) prescription drugs.
History:
Laws 2019, ch. 235, § 4.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 235 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-5 - Rates; medical loss ratios.

The superintendent shall adopt and promulgate rules to establish standards for rates, including medical loss ratios, of short-term plans and excepted benefits plans. Rules relating to rates shall be based on generally recognized and current actuarial standards.
History:
Laws 2019, ch. 235, § 5.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 235 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-6 - Prohibition; association, trust or multiple employer welfare arrangement plans.

No insurer shall issue, and no association, trust or multiple employer welfare arrangement shall offer, a short-term or excepted benefits plan to a resident of the state unless through a bona fide association.
History:
Laws 2019, ch. 235, § 6.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 235 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-7 - Exclusion prohibition not applicable to excepted benefit plans or policies.

A. Notwithstanding any other provisions of law, an excepted benefits policy or plan shall not exclude coverage for losses incurred for a preexisting condition more than twelve months from the effective date of coverage. The policy or plan shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment recommended by or received from a physician within twelve months before the effective date of coverage.
B. As used in this section, "excepted benefits" means benefits furnished pursuant to the following:
(1) coverage-only accident or disability income insurance;
(2) coverage issued as a supplement to liability insurance;
(3) liability insurance;
(4) workers' compensation or similar insurance;
(5) automobile medical payment insurance;
(6) credit-only insurance;
(7) coverage for on-site medical clinics;
(8) other similar insurance coverage specified in office of superintendent of insurance rules, under which benefits for medical care are secondary or incidental to other benefits;
(9) the following benefits if offered separately:
(a) limited-scope dental or vision benefits;
(b) benefits for long-term care, nursing home care, home health care, community-based care or any combination of those benefits; and
(c) other similar limited benefits specified in office of superintendent of insurance rules;
(10) the following benefits, offered as independent, non-coordinated benefits:
(a) coverage-only for a specified disease or illness; or
(b) hospital indemnity or other fixed indemnity insurance; and
(11) the following benefits if offered as a separate insurance policy:
(a) medicare supplemental health insurance as defined pursuant to Section 1882(g)(1) of the federal Social Security Act; and
(b) coverage supplemental to the coverage provided pursuant to Chapter 55 of Title 10 USCA and similar supplemental coverage provided to coverage pursuant to a group health plan.
History:
Laws 2019, ch. 259, § 21.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 259 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-8 - Dental plan; prior authorization.

A. For purposes of this section, "prior authorization" means a written communication indicating whether a specific service is covered or multiple services are covered and reimbursable at a specific amount, subject to applicable coinsurance and deductibles, and issued in response to a request submitted by a provider using a format prescribed by a dental plan.
B. A dental plan shall provide a prior authorization upon the submission of a properly formatted request from a covered person.
C. A dental plan shall not deny any claim subsequently submitted for services included in a prior authorization unless one of the following circumstances applies for each service denied:
(1) benefit limitations, including annual maximums or frequency limitations, not applicable at the time of the prior authorization, are reached due to the covered person's utilization subsequent to issuance of the prior authorization;
(2) the documentation submitted for the claim clearly fails to support the claim as originally authorized;
(3) subsequent to the issuance of a prior authorization, new services are provided to the covered person or a change in the covered person's condition occurs that would cause prior-authorized services to no longer be medically necessary, based on prevailing standards of care;
(4) subsequent to the issuance of a prior authorization, new services are provided to the covered person or a change in the covered person's condition occurs such that the prior-authorized procedure would at that time require disapproval pursuant to the terms and conditions for coverage under the covered person's plan in effect at the time the request for prior authorization was made; or
(5) denial of the claim was due to one of the following reasons:
(a) another entity is responsible for payment;
(b) the provider has already been paid for the services identified on the claim;
(c) the claim submitted was fraudulent;
(d) the prior authorization was based on erroneous information provided to the dental plan by the provider, the covered person or other person; or
(e) the covered person was not eligible for the service on the date it was provided and the provider did not know, or with the exercise of reasonable care, could not have known the covered person's eligibility status.
History:
Laws 2023, ch. 169, § 7.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 169 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. 169, § 12 provided that the provisions of Laws 2023, ch. 169 apply to dental plans issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-9 - Dental plan; designation of payment.

A. A dental plan shall provide for the direct payment of covered benefits to a provider, specified by a covered person, regardless of the provider's network or contractual status with the dental plan.
B. A dental plan shall provide for the direct payment of covered benefits to a provider, specified by a covered person, by including on its claim forms an:
(1) option for the designation of payment from the covered person to the provider; and
(2) an attestation to be completed by the covered person.
History:
Laws 2023, ch. 169, § 8.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 169 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. 169, § 12 provided that the provisions of Laws 2023, ch. 169 apply to dental plans issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-10 - Dental plan; erroneously paid claims; restrictions on recovery.

A. A dental plan shall establish policies and procedures for payment recovery, including providing:
(1) notice to the provider that identifies the error made in the processing or payment of the claim;
(2) an explanation of the recovery being sought; and
(3) an opportunity for the provider to appeal the recovery being sought as set forth in Subsection C of this section.
B. A dental plan shall not initiate payment recovery procedures more than twenty-four months after the original payment for a claim was made unless the claim was fraudulent or intentionally misrepresented.
C. A dental plan shall not attempt to recover an erroneously paid claim by withholding or reducing payment for a different claim unless the plan:
(1) notifies the provider, in writing, within twelve months of the erroneously paid claim; and
(2) advises the provider that an automatic deduction shall occur within forty-five days of receiving notification unless the provider submits a written appeal to the plan pursuant to the grievance rules prescribed by the superintendent of insurance.
D. The provisions of this section shall not apply to duplicate payments.
History:
Laws 2023, ch. 169, § 9.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 169 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. 169, § 12 provided that the provisions of Laws 2023, ch. 169 apply to dental plans issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23G - Short-Term Health Plan and Excepted Benefit › Section 59A-23G-11 - Dental plan; methods of payment.

A. For purposes of this section, "credit card payment" means a type of electronic funds transfer whereby:
(1) a health insurance carrier issues a single-use series of numbers associated with the payment of services rendered by the provider and chargeable to a predetermined amount; and
(2) the provider is responsible for processing the payment by using a credit card terminal or internet portal.
B. A health insurance carrier shall not place restrictions on a provider regarding acceptable methods of payment, including designating credit card payments as the only acceptable form of payment.
C. When transmitting a payment to a provider using an electronic funds transfer, other than one made through the automated clearinghouse network, a health insurance carrier:
(1) shall not charge a fee to the provider solely to transmit a payment without the provider's consent;
(2) shall notify the provider of any other fees associated with transmitting a payment; and
(3) shall provide a provider with a fee-free method of transmitting a payment and provide instructions for utilizing the method.
History:
Laws 2023, ch. 169, § 10.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 169 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. 169, § 12 provided that the provisions of Laws 2023, ch. 169 apply to dental plans issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23H - Easy Enrollment › Section 59A-23H-1 - Short title.

Sections 1 through 6 [59A-23H-1 to 59A-23H-6 NMSA 1978] of this act may be cited as the "Easy Enrollment Act".
History:
Laws 2022, ch. 33, § 1.
ANNOTATIONS
Effective dates.
— Laws 2022, ch. 33 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 18, 2022, 90 days after adjournment of the legislature.
Applicability.
— Laws 2022, ch. 33, § 9 provided that the provisions of Laws 2022, ch. 33 apply to taxable years beginning on or after January 1, 2022.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23H - Easy Enrollment › Section 59A-23H-2 - Definitions.

As used in the Easy Enrollment Act:
A. "department" means the human services department [health care authority department];
B. "exchange" means the New Mexico health insurance exchange;
C. "health coverage program" means medicaid, health care coverage available through the federal children's health insurance program, a qualified health plan available through the exchange pursuant to the New Mexico Health Insurance Exchange Act [Chapter 59A, Article 23F NMSA 1978] or a health plan available through the New Mexico medical insurance pool pursuant to the Medical Insurance Pool Act [Chapter 59A, Article 54 NMSA 1978];
D. "insurance-relevant information" means information pertaining to the insurance enrollment status of a taxpayer or members of a taxpayer's household and that is derived or obtained from the taxpayer's state income tax return; provided that information is limited to that information necessary to assess the eligibility of the taxpayer or members of the taxpayer's household for health coverage programs and includes:
(1) adjusted gross income and other types of reported income used to assess eligibility for health coverage programs;
(2) household size;
(3) claimed dependents; and
(4) contact information and identifying information necessary to assess health coverage program eligibility and used to match against relevant third-party data sources;
E. "medicaid" means the joint federal-state health coverage program pursuant to Title 19 or Title 21 of the federal Social Security Act, as amended, and the rules promulgated pursuant to that act;
F. "qualified health plan" means a health plan that has in effect a certification from the superintendent of insurance that meets the standards set forth in applicable federal and state law and rules as well as any additional requirements established by the board of directors of the exchange pursuant to the New Mexico Health Insurance Exchange Act; and
G. "taxpayer" means an individual subject to the tax imposed pursuant to the Income Tax Act [Chapter 7, Article 2 NMSA 1978].
History:
Laws 2022, ch. 33, § 2.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Laws 2023, ch. 205, § 16 provided that references to the human services department shall be deemed to be references to the health care authority department.
Cross references.
— For Titles XIX and XXI of the Social Security Act,
see
42 U.S.C.S. §§ 1396 et seq. and 1397 et seq., respectively.
Effective dates.
— Laws 2022, ch. 33 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective May 18, 2022, 90 days after adjournment of the legislature.
Applicability.
— Laws 2022, ch. 33, § 9 provided that the provisions of Laws 2022, ch. 33 apply to taxable years beginning on or after January 1, 2022.