2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23C - Small Group Rate and Renewability › Section 59A-23C-5.1 - Adjusted community rating.

A. A health benefit plan that is offered by a carrier to a small employer shall be offered without regard to the health status of any individual in the group, except as provided in the Small Group Rate and Renewability Act. The only rating factors that may be used to determine the initial year's premium charged a group, subject to the maximum rate variation provided in this section for all rating factors, are the group members':
(1) ages;
(2) geographic areas of the place of employment; or
(3) smoking practices.
B. Separately for an insurer's individual and group policies, no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under nineteen years of age or children nineteen to twenty-five years of age who are full-time students may have rates that are lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from offering rates that differ depending upon family composition. For the purposes of this subsection, "family composition" refers only to whether coverage covers an individual or a family.
C. The superintendent shall adopt and promulgate rules to implement the provisions of this section.
History:
Laws 1994, ch. 75, § 33; 1997, ch. 22, § 3; 1997, ch. 243, § 24; 1998, ch. 41, § 4; 2010, ch. 95, § 4; 2019, ch. 259, § 5.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, removed language that permitted insurance premium rates to be based on gender, and revised certain provisions to align with federal law; in Subsection A, deleted Paragraph A(2) and redesignated former Paragraphs A(3) and A(4) as Paragraphs A(2) and A(3); deleted Subsection B and redesignated former C as Subsection B; in Subsection B, added "Separately for an insurer's individual and group policies", after "shall not prohibit", deleted "a carrier" and added "an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan", and added "For the purposes of this subsection, 'family composition' refers only to whether coverage covers an individual or family."; and deleted Subsections D and E and redesignated former Subsection F as Subsection C.
The 2010 amendment,
effective May 19, 2010, in Paragraph (2) of Subsection A, after "genders", added "pursuant to Subsection B of this section"; in Subsection B, after "another person's rate in the age group by more than", deleted "twenty percent of the lower rate, and no person's rate shall" and added the remainder of the sentence, including Paragraphs (1) through (4); redesignated the former second paragraph in Subsection B as Subsection C; in the first sentence of Subsection C, added "No person's rate shall"; and relettered the succeeding subsections accordingly.
The 1998 amendment
deleted "Until July 1, 1998," preceding "a health benefit" in Subsection A; added Subsection C; and redesignated former Subsection C as Subsection D.
The 1997 amendment,
effective April 11, 1997, deleted "until July 1, 1998" from the beginning and inserted "or children aged nineteen to twenty-five who are full-time students" near the end of the first sentence in Subsection B; deleted former Subsection C relating to charging the same premium for the same coverage; and redesignated former Subsection D as Subsection C.