reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-1 - Short title.

Sections 1 through 13 [59A-57A-1 to 59A-57A-13 NMSA 1978] of this act may be cited as the "Surprise Billing Protection Act".
History:
Laws 2019, ch. 227, § 1.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-3 - Emergency care; reimbursement; limitation on charges.

A. A health insurance carrier shall reimburse a nonparticipating provider for emergency care necessary to evaluate and stabilize a covered person if a prudent layperson would reasonably believe that emergency care is necessary, regardless of eventual diagnosis.
B. A health insurance carrier shall not require that prior authorization for emergency care be obtained by, or on behalf of, a covered person prior to the point of stabilization of that covered person if a prudent layperson would reasonably believe that the covered person requires emergency care.
C. A health insurance carrier may impose a cost-sharing or limitation of benefits requirement for emergency care performed by a nonparticipating provider only to the same extent that the copayment, co-insurance or limitation of benefits requirement applies for participating providers and is documented in the policy.
D. A health insurance carrier may require an emergency care provider to notify a health insurance carrier of a covered person's admission to the hospital within a reasonable time period after the covered person has been stabilized.
History:
Laws 2019, ch. 227, § 3.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-4 - Non-emergency care; limitation on charges.

A. Other than applicable cost sharing that would apply if a participating provider had rendered the same services, a health insurance carrier shall provide reimbursement for and a covered person shall not be liable for charges and fees for covered non-emergency care rendered by a nonparticipating provider that are delivered when:
(1) the covered person at an in-network facility does not have the ability or opportunity to choose a participating provider who is available to provide the covered services; or
(2) medically necessary care is unavailable within a health benefits plan's network; provided that "medical necessity" shall be determined by a covered person's provider in conjunction with the covered person's health benefits plan and health insurance carrier.
B. Except as set forth in Subsection A of this section, nothing in this section shall preclude a nonparticipating provider from balance billing for non- emergency care provided by a nonparticipating provider to an individual who has knowingly chosen to receive services from that nonparticipating provider.
History:
Laws 2019, ch. 227, § 4.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-5 - Credit against maximum out-of-pocket cost-sharing amount; communication by hospitals; advance notification of charges for health care services.

A. A nonparticipating provider shall not knowingly submit a surprise bill to a covered person.
B. In accordance with the hearing procedures established pursuant to the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978], a covered person may appeal a health insurance carrier's determination made regarding a surprise bill.
C. By July 1, 2020, the department of health shall require each health facility licensed pursuant to the Public Health Act [Chapter 24, Article 1 NMSA 1978] to post the following on the health facility's website in a publicly accessible manner:
(1) the names and hyperlinks for direct access to the websites of all health insurance carriers with which the hospital has a contract for services;
(2) a statement that sets forth the following:
(a) services may be performed in the hospital by participating providers as well as nonparticipating providers who may separately bill the patient;
(b) providers that perform health care services in the hospital may or may not participate in the same health benefits plans as the hospital; and
(c) prospective patients should contact their health insurance carriers in advance of receiving services at that hospital to determine whether the scheduled health care services provided in that hospital will be covered at in-network rates;
(3) the rights of covered persons under the Surprise Billing Protection Act; and
(4) instructions for contacting the superintendent.
D. Any written communication, other than a receipt of payment, from a provider or health insurance carrier pertaining to a surprise bill, shall clearly state that the covered person is responsible only for payment of applicable in-network cost-sharing amounts under the covered person's health benefits plan. A collection agency collecting medical debt from New Mexico residents shall post a notice of consumer rights pursuant to the Surprise Billing Protection Act on its website.
E. When a nonparticipating provider under nonemergency circumstances has advance knowledge that the nonparticipating provider is not contracted with the covered person's health insurance carrier, the nonparticipating provider shall inform the covered person of the nonparticipating provider's nonparticipating status and advise the covered person to contact the covered person's health insurance carrier to discuss the covered person's options.
History:
Laws 2019, ch. 227, § 5.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-6 - Covered persons; providers; overpayment.

A. If a covered person pays a nonparticipating provider more than the in-network cost-sharing amount for services provided under circumstances giving rise to a surprise bill, the nonparticipating provider shall refund to the covered person within forty-five calendar days of receipt of payment from the health insurance carrier any amount paid in excess of the in-network cost-sharing amount.
B. If a nonparticipating provider has not made a full refund to the covered person of any amount paid in excess of the in-network cost-sharing amount to the covered person within forty-five calendar days of receipt, interest shall accrue at the rate set for payment of interest on a health plan's liability for clean claims submitted by eligible providers to a health plan pursuant to Chapter 59A, Article 16 NMSA 1978.
C. A covered person may seek recovery of the refund of the amount the covered person has paid in excess of the in-network cost-sharing amount that a nonparticipating provider owes, plus interest, pursuant to Subsection B of this section by filing an appeal with the office of superintendent of insurance. The superintendent of insurance shall develop an appeals process pursuant to this section.
History:
Laws 2019, ch. 227, § 6.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-7 - Nonparticipating providers; rebates and inducements; prohibition.

A nonparticipating provider shall not, either directly or indirectly, knowingly waive, rebate, give, pay or offer to waive, rebate, give or pay all or part of a cost-sharing amount owed by a covered person pursuant to the terms of the covered person's health benefits plan as an inducement for the covered person to seek a health care service from that nonparticipating provider. The superintendent may impose fines on providers for unlawful rebates and inducements; provided that a provider on which the superintendent intends to impose a fine shall be entitled to a hearing in accordance with the provisions of Section 59A-4-15 NMSA 1978.
History:
Laws 2019, ch. 227, § 7.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-8 - Health care provider reimbursement rates; surprise billing.

A. The superintendent shall convene appropriate stakeholders, including rural providers, insurers and consumer advocates, and review the reimbursement rate for surprise bills annually to ensure fairness to providers and to evaluate the impact on health insurance premiums and health benefits plan networks.
B. Calculation of the date of health insurance carrier receipt of a claim shall align with requirements for prompt payment established pursuant to Section 59A-16-21.1 NMSA 1978.
C. A health insurance carrier shall make available to providers access to claims status information.
History:
Laws 2019, ch. 227, § 8.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-9 - Reasonable health care cost management permitted.

Nothing in the Surprise Billing Protection Act shall be construed to prohibit a health insurance carrier from appropriately using reasonable health care cost management techniques.
History:
Laws 2019, ch. 227, § 9.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-10 - Private cause of action.

Except as provided in Subsection C of Section 6 [59A-57A-6 NMSA 1978] of the Surprise Billing Protection Act, nothing in that act shall be construed to create or imply a private cause of action for a violation of that act.
History:
Laws 2019, ch. 227, § 10.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-11 - Information from provider networks.

The superintendent:
A. may require that health insurance carriers report the annual percentage of claims and expenditures paid to nonparticipating providers for health care services; and
B. may require by rule a report on changes to the percent of claims paid as an emergency claim.
History:
Laws 2019, ch. 227, § 11.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-12 - Applicability.

The provisions of the Surprise Billing Protection Act apply to the following types of health coverage delivered or issued for delivery in this state:
A. group health coverage governed by the provisions of the Health Care Purchasing Act [Chapter 13, Article 7 NMSA 1978];
B. individual health insurance policies, health benefits plans and certificates of insurance governed by the provisions of Chapter 59A, Article 22 NMSA 1978;
C. multiple-employer welfare arrangements governed by the provisions of Section 59A-15-20 NMSA 1978;
D. group and blanket health insurance policies, health benefits plans and certificates of insurance governed by the provisions of Chapter 59A, Article 23 NMSA 1978;
E. individual and group health maintenance organization contracts governed by the provisions of the Health Maintenance Organization Law; and
F. individual and group nonprofit health benefits plans governed by the provisions of the Nonprofit Health Care Plan Law [Chapter 59A, Article 47 NMSA 1978].
History:
Laws 2019, ch. 227, § 12.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57A - Surprise Billing Protection › Section 59A-57A-13 - Providers; reimbursement for a surprise bill. (Repealed effective July 1, 2028.)

A. For services provided pursuant to Section 3 [59A-57A-3 NMSA 1978] or 4 [59A-57A-4 NMSA 1978] of the Surprise Billing Protection Act, a health insurance carrier shall directly reimburse a nonparticipating provider for care rendered the surprise bill reimbursement rate for services.
B. The surprise bill reimbursement rate shall be calculated using claims data reflecting the allowed amounts paid for claims paid in the 2017 plan year.
C. As used in this section, "surprise bill reimbursement rate" means the sixtieth percentile of the allowed commercial reimbursement rate for the particular health care service performed by a provider in the same or similar specialty in the same geographic area, as reported in a benchmarking database maintained by a nonprofit organization specified by the superintendent after consultation with health care sector stakeholders; provided that no surprise bill reimbursement rate shall be paid at less than one hundred fifty percent of the 2017 medicare reimbursement rate for the applicable health care service provided.
D. The nonprofit organization shall be conflict-free and unaffiliated with any stakeholder in the health care sector.
History:
Laws 2019, ch. 227, § 13.
ANNOTATIONS
Delayed repeals.
— Laws 2023, ch. 7, § 1, amended the delayed repeal date of Laws 2019, ch. 227, § 13, as enacted by Laws 2019, ch. 227, § 15, from July 1, 2023 to July 1, 2028.
Effective dates.
— Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-1 - Short title.

Chapter 59A, Article 58 NMSA 1978 may be cited as the "Service Contract Regulation Act".
History:
Laws 2001, ch. 206, § 1; 2017, ch. 125, § 1.
ANNOTATIONS
The 2017 amendment,
effective June 16, 2017, changed "Sections 1 through 19 of this act" to "Chapter 59A, Article 58 NMSA 1978".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-3 - Exclusions from act.

The provisions of the Service Contract Regulation Act do not apply to:
A. a warranty;
B. a maintenance agreement;
C. a service contract provided by a public utility on its transmission device if the service contract is regulated by the public regulation commission;
D. a service contract sold or offered for sale to a person who is not a consumer; or
E. a service contract for property if the purchase price of the property is less than two hundred fifty dollars ($250) and the consideration for the service contract is less than twenty-five dollars ($25.00).
History:
Laws 2001, ch. 206, § 3.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 3 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-4 - Prohibition of sale of service contract unless registered.

A provider shall not issue, sell or offer for sale service contracts in this state unless the provider has been registered with the superintendent pursuant to the provisions of the Service Contract Regulation Act. However, an administrator or seller of a service contract is not required to be registered. The provisions of this section shall not apply to major manufacturing companies' service contracts.
History:
Laws 2001, ch. 206, § 4; 2017, ch. 125, § 3.
ANNOTATIONS
The 2017 amendment,
effective June 16, 2017, excluded administrators and sellers of service contracts from the registration requirement; and added "However, an administrator or seller of a service contract is not required to be registered."
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-5 - Registration requirements.

A. A provider who wishes to issue, sell or offer for sale service contracts in this state must submit to the superintendent:
(1) a registration application on a form prescribed by the superintendent;
(2) proof that the provider has complied with the requirements for security pursuant to Section 59A-58-6 NMSA 1978;
(3) the name, address and telephone number of each administrator with whom the provider intends to contract, if any; and
(4) provided that House Bill 248 of the first session of the fifty-fifth legislature:
(a) becomes law, the registration renewal fee provided in Section 59A-6-1 NMSA 1978; or
(b) does not become law, a fee of five hundred dollars ($500).
B. A provider's registration is valid for one year after the date the registration is filed. A provider may renew the provider's registration if, before the registration expires, the provider submits to the superintendent an application on a form prescribed by the superintendent and, provided that House Bill 248 of the first session of the fifty-fifth legislature:
(1) becomes law, the registration renewal fee provided in Section 59A-6-1 NMSA 1978; or
(2) does not become law, a fee of five hundred dollars ($500).
C. The provisions of this section shall not apply to major manufacturing companies' service contracts.
D. Service contract forms are not required to be filed with the superintendent.
History:
Laws 2001, ch. 206, § 5; 2017, ch. 125, § 4; 2021, ch. 108, § 36.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, revised registration requirements to issue, sell or offer for sale service contracts, conditioned on the passage of House Bill 248 of the first session of the fifty-fifth legislature; in Subsection A, added Paragraph A(4); and in Subsection B, after "superintendent and", added "provided that House Bill 248 of the first session of the fifty-fifth legislature", and added Paragraphs B(1) and B(2).
The 2017 amendment,
effective June 16, 2017, specified that service contract forms are not required to be filed with the superintendent of insurance, and made certain technical changes; in Subsection A, in Paragraph A(2), changed "7 of the Service Contract Regulation Act" to "59A-58-6 NMSA 1978", in Paragraph A(3), after "contract", added "if any"; and added Subsection D.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-7 - Transactions exempt from premium tax.

The premium tax imposed pursuant to Chapter 59A, Article 6 NMSA 1978 does not apply to any business transacted pursuant to the provisions of the Service Contract Regulation Act.
History:
Laws 2001, ch. 206, § 7.
ANNOTATIONS
Cross references.
— For exemption of the Service Contract Regulation Act,
see
59A-58-7 NMSA 1978.
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 7 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-8 - Transactions not subject to New Mexico Insurance Code; exceptions.

A. Except as otherwise provided in the Service Contract Regulation Act, the marketing, issuance, sale, offering for sale, making, proposing to make and administration of service contracts are not subject to the provisions of the New Mexico Insurance Code [Chapter 59A NMSA 1978], except, when applicable, the provisions of Chapter 59A, Article 16 NMSA 1978.
B. A provider, person who sells service contracts, administrator or any other person is not required to obtain a certificate of authority or license from the superintendent to issue, sell, offer for sale or administer service contracts.
History:
Laws 2001, ch. 206, § 8.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 8 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-9 - Right of holder to return service contract for refund.

A. A service contract is void and a provider shall refund to the holder the purchase price of the service contract if the holder has not made a claim under the service contract and the holder returns the service contract to the provider:
(1) within twenty days after the date the provider mails a copy of the service contract to the holder;
(2) within ten days after the purchaser receives a copy of the service contract if the provider furnishes the holder with the copy at the time the contract is purchased; or
(3) within a longer period specified in the service contract.
B. The right of a holder to return a service contract pursuant to Subsection A of this section applies only to the original purchaser of the service contract.
C. Subsequent to the time period specified in Subsection A of this section, or if a claim was made during that time period, a holder may cancel a service contract and the provider shall refund to the contract holder one hundred percent of the unearned pro rata provider fee, less any claims paid. If the service contract is canceled by the holder, a reasonable administrative fee may be charged by the provider, not to exceed ten percent of the purchase price of the service contract. A provider who cancels a service contract may not impose an administrative fee.
D. A service contract must include a provision that clearly states the right of a holder to return a service contract pursuant to this section. Notwithstanding Subsection C of this section, a provider is not required to deduct the amount of any claims paid under a service contract from the amount of a refund a holder is entitled to.
E. The provider shall refund to the holder or credit to the account of the holder the purchase price of the service contract within sixty days after a service contract is returned pursuant to Subsection A of this section. If the provider fails to refund the purchase price or credit the account of the holder within that time, the provider shall pay the holder a penalty of ten percent of the purchase price for each thirty-day period or portion thereof that the refund and any accrued penalties remain unpaid.
History:
Laws 2001, ch. 206, § 9; 2019, ch. 254, § 2.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, revised the procedure for canceling a service contract; in Subsection B, after "contract pursuant to", added "Subsection A"; added a new Subsection C and redesignated former Subsections C and D as Subsections D and E, respectively; and in Subsection D, added the last sentence.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-10.1 - Automatic renewal; notice.

A. A provider shall not include an automatic renewal provision within a service contract offered in this state unless the provider discloses the terms of the automatic renewal provision in a clear and conspicuous manner, or in the case of an offer conveyed by voice, in temporal proximity, to the request for consent to the offer and the consumer consents to the terms of the automatic renewal provision.
B. A provider shall provide notice to a holder specifying, in a clear and conspicuous manner, the procedure by which the holder may cancel the service contract, and such notice shall be provided at least thirty days before the last day on which the holder may give notice of the holder's intention not to renew the service contract but not sooner than sixty days before the last day on which the holder may give notice of the holder's intention not to renew.
C. The notice required by Subsection B of this section may be provided by United States mail, postage prepaid, or electronic mail if the consumer consents to receive notice via electronic mail at the inception of the service contract.
History:
Laws 2019, ch. 254, § 3.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 254 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 58 - Service Contract Regulation › Section 59A-58-11 - Receipt for and copy of service contract required.

A. A provider shall provide a receipt for, or other written evidence of, the purchase of a service contract.
B. The provider shall furnish a copy of the service contract to the holder within a reasonable time after the contract is purchased.
History:
Laws 2001, ch. 206, § 11.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 11 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-12 - Cancellation of service contract.

A. No service contract that has been in effect for at least seventy days may be canceled by the provider before the expiration of the agreed term or one year after the effective date of the service contract, whichever occurs first, except on any of the following grounds:
(1) failure by the holder to pay an amount when due;
(2) conviction of the holder of a crime that results in an increase in the service required under the service contract;
(3) discovery of fraud or material misrepresentation by the holder in obtaining the service contract or in presenting a claim for service thereunder; or
(4) discovery of either of the following if it occurred after the effective date of the service contract and substantially and materially increased the service required under the service contract:
(a) an act or omission by the holder; or
(b) a violation by the holder of any condition of the service contract.
B. No cancellation of a service contract may become effective until at least fifteen days after the notice of cancellation is mailed to the holder.
History:
Laws 2001, ch. 206, § 12.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 12 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-13 - Business name restrictions.

A. Except as otherwise provided in this section, a provider shall not include in the name of his business:
(1) the words "insurance", "casualty", "surety", "mutual" or any other word or term that implies that he is engaged in the business of transacting insurance or is a surety company; or
(2) a name that is deceptively similar to the name or description of an insurer or surety company or the name of another provider.
B. A provider may include the word "guaranty" or a similar word in the name of his business.
C. This section does not apply to a provider who, before January 1, 2002, includes in the name of his business a name that does not comply with the provisions of Subsection A of this section. Such a provider shall include in each service contract he issues, sells or offers for sale a statement that the service contract is not a contract of insurance.
History:
Laws 2001, ch. 206, § 13.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 13 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-14 - Prohibition of requiring purchase of service contract as a condition of loan approval or purchase of property.

No person may require the purchase of a service contract as a condition for the approval of a loan or the purchasing of property.
History:
Laws 2001, ch. 206, § 14.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 14 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-15 - Records requirements.

A. A provider shall maintain records of the transactions governed by the Service Contract Regulation Act. The records of a provider shall include:
(1) a copy of each type of service contract that the provider issues, sells or offers for sale;
(2) the name and address of each holder who possesses a service contract under which the provider has a duty to perform, to the extent that the provider knows the name and address of each holder;
(3) a list that includes each location where the provider issues, sells or offers for sale service contracts; and
(4) the date and a description of each claim made by a holder under a service contract.
B. Except as otherwise provided in this subsection, a provider shall retain all records relating to a service contract for at least one year after the contract has expired. A provider who intends to discontinue doing business in this state shall provide the superintendent with satisfactory proof that he has discharged his duties to the holders in this state and shall not destroy his records without the prior approval of the superintendent.
C. The records required to be maintained pursuant to this section may be stored on a computer disk or other storage device for a computer from which the records can be readily printed.
D. The provisions of this section shall not apply to major manufacturing companies' service contracts.
History:
Laws 2001, ch. 206, § 15.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 15 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-16 - Examinations and inspection of books by superintendent.

A. The superintendent may conduct examinations to enforce the provisions of the Service Contract Regulation Act pursuant to Chapter 59A, Article 4 NMSA 1978 at such times as he deems necessary.
B. A provider shall, upon the request of the superintendent, make available to the superintendent for inspection any accounts, books and records concerning any service contract issued, sold or offered for sale by the provider that are reasonably necessary to enable the superintendent to determine whether the provider is in compliance with the provisions of the Service Contract Regulation Act.
C. The provisions of this section shall not apply to major manufacturing companies' service contracts.
History:
Laws 2001, ch. 206, § 16.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 16 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-17 - Civil penalty for violation.

A person who violates any provision of the Service Contract Regulation Act or an order or rule of the superintendent issued or adopted pursuant thereto may be assessed a civil penalty by the superintendent of not more than five thousand dollars ($5,000) for each act or violation, not to exceed an aggregate amount of one hundred thousand dollars ($100,000) for violations of a similar nature. For the purposes of this section, violations shall be deemed to be of a similar nature if the violations consist of the same or similar conduct, regardless of the number of times the conduct occurred.
History:
Laws 2001, ch. 206, § 17.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 17 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 58 - Service Contract Regulation › Section 59A-58-18 - Rulemaking.

The superintendent may adopt rules necessary to carry out the provisions of the Service Contract Regulation Act.
History:
Laws 2001, ch. 206, § 18.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 206, § 20 made Laws 2001, ch. 206, § 18 effective July 1, 2002.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 59 - Prescription Drug Uniform Information Card › Section 59A-59-1 - Short title.

This act [59A-59-1 to 59A-59-4 NMSA 1978] may be cited as the "Prescription Drug Uniform Information Card Act".
History:
Laws 2003, ch. 373, § 1.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 373, § 5 made the Prescription Drug Uniform Information Card Act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 59 - Prescription Drug Uniform Information Card › Section 59A-59-2 - Intent of legislature.

It is the intent of the legislature to improve care for patients by enacting the Prescription Drug Uniform Information Card Act to minimize confusion, eliminate unnecessary paperwork, decrease administrative burdens and streamline dispensing of prescription products paid for by third party payors.
History:
Laws 2003, ch. 373, § 2.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 373, § 5 made the Prescription Drug Uniform Information Card Act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 59 - Prescription Drug Uniform Information Card › Section 59A-59-4 - Applicability.

A. All health benefit plans issued or renewed on or after July 1, 2003 shall comply with the Prescription Drug Uniform Information Card Act no later than two years after July 1, 2003. For purposes of that act, renewal of a health benefit policy, contract or plan is presumed to occur on each anniversary of the date on which coverage was first effective for the persons covered by the health benefit plan.
B. The Prescription Drug Uniform Information Card Act shall not apply to the medicaid fee-for-service prescription drug program.
History:
Laws 2003, ch. 373, § 4.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 373, § 5 made the Prescription Drug Uniform Information Card Act effective July 1, 2003.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 60 - Portable Electronics Insurance › Section 59A-60-1 - Short title.

Sections 4 through 10 [59A-60-1 to 59A-60-7 NMSA 1978] of this act may be cited as the "Portable Electronics Insurance Act".
History:
Laws 2013, ch. 140, § 4.
ANNOTATIONS
Effective dates.
— Laws 2013, ch. 140, § 14 made Laws 2013, ch. 140, § 4 effective July 1, 2013.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 60 - Portable Electronics Insurance › Section 59A-60-2 - Definitions.

As used in the Portable Electronics Insurance Act:
A. "customer" means a person who purchases portable electronics or services;
B. "enrolled customer" means a customer who elects coverage under a portable electronics insurance policy issued to a vendor of portable electronics;
C. "location" means any physical location in the state of New Mexico or any web site, call center site or similar location directed to residents of the state of New Mexico;
D. "portable electronics" means electronic devices that are portable in nature and their accessories;
E. "portable electronics insurance" means insurance providing coverage for the repair or replacement of portable electronics that may provide coverage for portable electronics against any one or more of the following causes of loss: loss, theft, inoperability due to mechanical failure, malfunction, damage or other similar causes of loss. "Portable electronics insurance" also includes any agreement whereby a person or any legal entity, in exchange for consideration paid, agrees to provide for the future repair, replacement or provision of portable electronics. "Portable electronics insurance" does not include:
(1) a service contract governed by the Service Contract Regulation Act [Chapter 59A, Article 58 NMSA 1978];
(2) a policy of insurance covering a seller's or a manufacturer's obligations under a warranty; or
(3) a homeowner's, renter's, private passenger automobile, commercial multiperil or similar policy;
F. "portable electronics transaction" means:
(1) the sale or lease of portable electronics by a vendor to a customer; or
(2) the sale of a service related to the use of portable electronics by a vendor to a customer;
G. "superintendent" means the superintendent of insurance;
H. "supervising entity" means a business entity that is a licensed insurer or insurance producer that is appointed by an insurer to supervise the administration of a portable electronics insurance program; and
I. "vendor" means a person in the business of engaging in portable electronics transactions directly or indirectly.
History:
Laws 2013, ch. 140, § 5.
ANNOTATIONS
Effective dates.
— Laws 2013, ch. 140, § 14 made Laws 2013, ch. 140, § 5 effective July 1, 2013.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 60 - Portable Electronics Insurance › Section 59A-60-3 - Licensure of vendors.

A. A vendor is required to hold a limited agent's license pursuant to Section 59A-12-18 NMSA 1978 to sell or offer coverage under a policy of portable electronics insurance.
B. A limited agent's license issued to a vendor shall authorize any employee or authorized representative of the vendor to sell or offer coverage under a policy of portable electronics insurance to a customer at each location at which the vendor engages in portable electronics transactions.
C. The supervising entity shall maintain a registry of vendor locations that are authorized to sell or solicit portable electronics insurance coverage in this state. Upon request by the superintendent and with reasonable notice to the supervising entity, the registry shall be open to inspection and examination by the superintendent during regular business hours of the supervising entity.
D. Notwithstanding any other provision of law, a limited agent's license issued to a vendor shall authorize the licensee and its employees or authorized representatives to engage in those activities that are permitted by the Portable Electronics Insurance Act.
History:
Laws 2013, ch. 140, § 6.
ANNOTATIONS
Effective dates.
— Laws 2013, ch. 140, § 14 made Laws 2013, ch. 140, § 6 effective July 1, 2013.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 60 - Portable Electronics Insurance › Section 59A-60-4 - Requirements for sale of portable electronics insurance.

A. At every location where portable electronics insurance is offered to customers, brochures or other written materials shall be made available to a prospective customer that:
(1) disclose that portable electronics insurance may provide a duplication of coverage already provided by a customer's homeowner's insurance policy, renter's insurance policy or other source of coverage;
(2) state that the enrollment by the customer in a portable electronics insurance program is not required in order to purchase or lease portable electronics or services;
(3) summarize the material terms of the insurance coverage, including:
(a) the identity of the insurer;
(b) the identity of the supervising entity;
(c) the amount of any applicable deductible and how it is to be paid;
(d) benefits of the coverage; and
(e) key terms and conditions of coverage, including whether portable electronics may be repaired or replaced with similar make and model reconditioned or nonoriginal manufacturer parts or equipment;
(4) summarize the process for filing a claim, including a description of how to return portable electronics, and the maximum fee applicable in the event the customer fails to comply with any equipment return requirements; and
(5) state that an enrolled customer may cancel enrollment for coverage under a portable electronics insurance policy at any time and the person paying the premium shall receive a refund of any applicable unearned premium.
B. The written materials required by this section shall not be subject to filing or approval requirements with the superintendent.
C. Portable electronics insurance may be offered on a month-to-month or other periodic basis as a group or master commercial inland marine policy issued to a vendor for its enrolled customers.
D. Eligibility and underwriting standards for customers electing to enroll in coverage shall be established for each portable electronics insurance program.
History:
Laws 2013, ch. 140, § 7.
ANNOTATIONS
Effective dates.
— Laws 2013, ch. 140, § 14 made Laws 2013, ch. 140, § 7 effective July 1, 2013.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 60 - Portable Electronics Insurance › Section 59A-60-6 - Penalties; suspension or revocation of license.

A person who violates any provision of the Portable Electronics Insurance Act may, after notice and hearing, be subject to:
A. fines not to exceed one thousand dollars ($1,000) per violation and not to exceed a total of ten thousand dollars ($10,000); or
B. as the superintendent deems necessary:
(1) suspension of the privilege of transacting portable electronics insurance at specific locations where violations have occurred; or
(2) suspension or revocation of the ability of individual employees or authorized representatives of a vendor to act under the license.
History:
Laws 2013, ch. 140, § 9.
ANNOTATIONS
Effective dates.
— Laws 2013, ch. 140, § 14 made Laws 2013, ch. 140, § 9 effective July 1, 2013.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 61 - Pharmacy Benefits Manager Regulation › Section 59A-61-1 - Short title.

Chapter 59A, Article 61 NMSA 1978 may be cited as the "Pharmacy Benefits Manager Regulation Act".
History:
Laws 2014, ch. 14, § 1; 2017, ch. 16, § 1.
ANNOTATIONS
The 2017 amendment,
effective June 16, 2017, deleted "Sections 1 through 6 of this act" and added "Chapter 59A, Article 61 NMSA 1978".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 61 - Pharmacy Benefits Manager Regulation › Section 59A-61-6 - Audit; pharmacy benefits manager.

A pharmacy benefits manager licensed pursuant to the Pharmacy Benefits Manager Regulation Act shall be subject to Section 61-11-18.2 NMSA 1978. A pharmacy benefits manager shall not reduce or eliminate payment on an adjudicated claim except as permitted by Section 61-11-18.2 NMSA 1978.
History:
Laws 2014, ch. 14, § 6; 2019, ch. 269, § 5.
ANNOTATIONS
The 2019 amendment,
effective July 1, 2019, provided that a pharmacy benefits manager shall not reduce or eliminate payment on an adjudicated claim except as permitted by Section 61-11-18.2 NMSA 1978; and added the last sentence of the section.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 61 - Pharmacy Benefits Manager Regulation › Section 59A-61-7 - Pharmacy benefits managers; prohibited pharmacy fees.

A. A pharmacy benefits manager shall not charge a pharmacy a fee related to the adjudication of a claim, including:
(1) the receipt and processing of a pharmacy claim;
(2) the development or management of a claim processing or adjudication network; or
(3) participation in a claim processing or claim adjudication network.
B. A pharmacy benefits manager shall not charge a pharmacy a fee for a service unless the fee for service is itemized in the pharmacy benefits management contract.
History:
Laws 2017, ch. 16, § 2; 2019, ch. 269, § 6.
ANNOTATIONS
The 2019 amendment,
effective July 1, 2019, provided that a pharmacy benefits manager shall not charge a pharmacy fee for a service unless the fee for service is itemized in the pharmacy benefits management contract; added new subsection designation "A." and redesignated former Subsections A through C as Paragraphs A(1) through A(3); and added new Subsection B.
Applicability.
— Laws 2017, ch. 16, § 3 provided that the provisions of Laws 2017, ch. 16, § 2 apply to any contract executed or renewed on or after June 16, 2017 and shall not be construed to affect the terms of a contract entered into or renewed before June 16, 2017.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 61 - Pharmacy Benefits Manager Regulation › Section 59A-61-8 - Registration of pharmacy services administrative organizations required.

A pharmacy services administrative organization shall register with the superintendent on a form and in a time frame and method of submission specified by the superintendent.
History:
Laws 2019, ch. 269, § 7.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 269, § 8 made Laws 2019, ch. 269 effective July 1, 2019.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 61 - Pharmacy Benefits Manager Regulation › Section 59A-61-9 - Prohibition on discrimination against a covered entity.

A. As used in this section:
(1) "340B drug" means a drug that is purchased at a discount in accordance with the 340B program requirements;
(2) "340B program" means the federal drug pricing program created pursuant to 42 U.S.C. Section 256b;
(3) "covered entity" means an entity participating in the 340B program; and
(4) "pharmacy benefits manager" means an entity that provides pharmacy benefits management services.
B. A pharmacy benefits manager or a third party shall not discriminate against a covered entity on the basis of its participation in the 340B program by:
(1) reimbursing a covered entity for a 340B drug at a rate lower than that paid for the same drug to pharmacies, similar in prescription volume, that are non-covered entities;
(2) assessing a fee, chargeback or other adjustment to the covered entity that is not assessed to non-covered entities;
(3) imposing a provision that prevents or interferes with a person's choice to receive 340B drugs from a covered entity; or
(4) imposing terms or conditions that differ from terms or conditions imposed on a non-covered entity, including:
(a) restricting or requiring participation in a pharmacy network;
(b) requiring more frequent auditing or a broader scope of audit for inventory management systems using generally accepted accounting principles;
(c) requiring a covered entity to reverse, resubmit or clarify a claim after the initial adjudication, unless these actions are in the normal course of pharmacy business and not related to the 340B program; or
(d) charging an additional fee or provision that prevents or interferes with an individual's choice to receive a 340B drug from a covered entity.
History:
Laws 2023, ch. 206, § 7.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 206 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.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 62 - Self-Service Storage Insurance License › Section 59A-62-1 - Short title.

Sections 1 through 11 [59A-62-1 to 59A-62-11 NMSA 1978] of this act may be cited as the "Self-Service Storage Insurance License Act".
History:
Laws 2019, ch. 219, § 1.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 219, § 14 made Laws 2019, ch. 219 effective July 1, 2019.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 62 - Self-Service Storage Insurance License › Section 59A-62-2 - Definitions.

As used in the Self-Service Storage Insurance License Act:
A. "occupant" means a person who is entitled to the use of storage space at a self-service storage facility, to the exclusion of others, under terms of a rental agreement, including a sublessee, successor or assignee;
B. "owner" means the owner, operator, franchisee, lessor or sublessor of a self-service storage facility, agent or any person authorized to manage the facility or to receive rent from an occupant under a rental agreement;
C. "personal property" means movable property not affixed to land, and includes goods, merchandise and household items;
D. "rental agreement" means any written agreement or lease between the owner and the occupant that establishes or modifies the terms, conditions or rules or any other provisions concerning the use and occupancy of storage space at a self-service storage facility;
E. "self-service storage facility" means any real property designed and used in the business of providing leased or rented storage space to occupants who have access to such facility for the purpose of storing and removing personal property;
F. "self-service storage insurance" means personal or commercial property insurance offered to an occupant in connection with and incidental to the rental of storage space at a self-service storage facility and that provides coverage for the loss of or damage to the occupant's personal property that occurs at the self-service storage facility or when such property is in transit to or from the facility during the period of the rental agreement;
G. "self-service storage insurance producer" means a business entity licensed only to offer insurance in connection with, and incidental to, rental agreements on behalf of an insurer authorized to write self-service storage insurance; and
H. "supervising entity" means an insurer issuing self-service storage insurance or a licensed insurance producer licensed pursuant to Article 11 of the Insurance Code that is authorized by an insurer to supervise the administration of a self-service storage insurance program.
History:
Laws 2019, ch. 219, § 2.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 219, § 14 made Laws 2019, ch. 219 effective July 1, 2019.