reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-4 - Risk retention groups authorized in New Mexico.

A. A risk retention group seeking a New Mexico certificate of authority shall, pursuant to the provisions of the New Mexico Insurance Code, be licensed to write only liability insurance pursuant to the Risk Retention and Purchasing Group Act and, except as provided elsewhere in that act, must comply with all of the laws, rules, regulations and requirements applicable to insurers obtaining a certificate of authority as a domestic insurer and with Sections 5 through 16 [59A-55-5 to 59A-55-16 NMSA 1978] of the Risk Retention and Purchasing Group Act to the extent such requirements are not a limitation on the laws, rules, regulations or requirements of New Mexico.
B. Before it may offer insurance in any state, each New Mexico domiciled risk retention group shall submit for approval to the New Mexico superintendent a plan of operation or feasibility study. The risk retention group shall submit an appropriate revision in the event of any subsequent material change in any item of the plan of operation or feasibility study, within ten days of any such change. The group shall not offer any additional kinds of liability insurance in this state or in any other state until a revision of such plan or study is approved by the superintendent.
C. At the time of filing its application for a certificate of authority, the risk retention group shall provide to the superintendent any information and fees the superintendent requires for the application process.
History:
Laws 1988, ch. 125, § 4.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-5 - Risk retention groups not having a New Mexico certificate of authority.

A. Risk retention groups chartered and licensed in states other than New Mexico and seeking to do business as a risk retention group in New Mexico shall provide to the superintendent before engaging in the business of insurance in New Mexico:
(1) a notice of operation in New Mexico which shall include the information required by the superintendent;
(2) a copy of its plan of operation or feasibility study submitted to the superintendent of the state in which the risk retention group is chartered or licensed unless exempted by regulation;
(3) as required by the superintendent, a copy of its financial statement prepared by one acceptable to the superintendent and any examinations or audit conducted of the risk retention group; and
(4) a designation of the superintendent as its agent for the purpose of receiving service of legal documents or process, with a filing fee determined by the superintendent.
B. The risk retention group shall also submit to the superintendent a copy of any revisions to its plan of operation or feasibility study required by the superintendent of the state in which it is chartered or licensed as well as any information required to verify its continuing qualification as a risk retention group under Subsection J of Section 3 [59A-55-3 NMSA 1978] of the Risk Retention and Purchasing Group Act.
History:
Laws 1988, ch. 125, § 5.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-7 - Compliance with unfair claims settlement practices.

All risk retention groups doing business in New Mexico and their agents and representatives shall comply with the provisions of Section 59A-16-20 NMSA 1978.
History:
Laws 1988, ch. 125, § 7.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-8 - Deceptive, false or fraudulent practices.

All risk retention groups doing business in New Mexico shall comply with the laws contained in the New Mexico Insurance Code regarding deceptive, false or fraudulent acts or practices.
History:
Laws 1988, ch. 125, § 8.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-9 - Examination regarding financial condition.

Each risk retention group shall submit to an examination by the superintendent to determine its financial condition if the superintendent of the jurisdiction in which the group is chartered and licensed has not initiated an examination or does not initiate an examination within sixty days after a request by the New Mexico superintendent. Any such examination shall be coordinated to avoid unjustified repetition and conducted in an expeditious manner and in accordance with the national association of insurance commissioner's handbook. All such examinations shall be paid for by the risk retention group pursuant to Section 59A-4-14 NMSA 1978.
History:
Laws 1988, ch. 125, § 9.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-10 - Notice to purchasers.

The superintendent may require risk retention groups to provide notice to purchasers concerning the limitation of regulatory oversight of risk retention groups and the lack of insolvency guaranty fund protection.
History:
Laws 1988, ch. 125, § 10.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-11 - Prohibited acts regarding solicitation or sale.

The following acts by a risk retention group are prohibited:
A. the solicitation or sale of insurance by a risk retention group to any person who is not eligible for membership in such group; and
B. the solicitation or sale of insurance by, or operation of, a risk retention group that is in hazardous financial condition or financially impaired.
History:
Laws 1988, ch. 125, § 11.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-12 - Prohibition on ownership by an insurance company.

No risk retention group shall be allowed to do business in this state if an insurance company is directly or indirectly a member or owner of such risk retention group, other than in the case of a risk retention group all of whose members are insurance companies.
History:
Laws 1988, ch. 125, § 12.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-13 - Prohibited coverage.

The terms of any insurance policy issued by any risk retention group shall not provide or be construed to provide coverage prohibited generally by statute of this state or declared unlawful by the highest court of this state whose law applies to such policy.
History:
Laws 1988, ch. 125, § 13.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-14 - Delinquency proceedings.

A risk retention group not having a New Mexico certificate of authority that is doing business in New Mexico shall comply with a lawful order issued in a voluntary dissolution proceeding or in a delinquency proceeding commenced by a state superintendent if there has been a finding of financial impairment after an examination under Section 9 [59A-55-9 NMSA 1978] of the Risk Retention and Purchasing Group Act.
History:
Laws 1988, ch. 125, § 14.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-15 - Penalties.

A risk retention group that violates any provision of the Risk Retention and Purchasing Group Act shall be subject to fines and penalties, including revocation of its right to do business in New Mexico, applicable to licensed insurers generally.
History:
Laws 1988, ch. 125, § 15.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-16 - Operation prior to enactment of act.

In addition to complying with the requirements of the Risk Retention and Purchasing Group Act, any risk retention group operating in New Mexico prior to enactment of that act shall, within thirty days after the effective date of that act, comply with the provisions of Section 4 or 5 [59A-55-4 or 59A-55-5 NMSA 1978] of that act.
History:
Laws 1988, ch. 125, § 16.
ANNOTATIONS
Compiler's notes.
— The phrase "effective date of that act" means July 1, 1988, the effective date of Laws 1988, Chapter 125, which enacted the Risk Retention and Purchasing Group Act.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-17 - Compulsory associations.

A. No risk retention group shall be required or permitted to join or contribute financially to any insurance insolvency guaranty fund or similar mechanism in New Mexico nor shall any risk retention group or its insureds or claimants against its insureds receive any benefit from any such fund for claims arising under the insurance policies issued by such risk retention group.
B. When a purchasing group obtains insurance covering its members' risks from an insurer not authorized in this state or a risk retention group, no such risks wherever resident or located shall be covered by any insurance guaranty fund or similar mechanism in this state.
C. When a purchasing group obtains insurance covering its members' risks from an authorized insurer, only risks resident or located in this state shall be covered by the state guaranty fund.
History:
Laws 1988, ch. 125, § 17.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-18 - Purchasing groups' exemption from certain laws.

A purchasing group and its insurer or insurers shall be subject to all applicable laws of this state, except that a purchasing group and its insurer or insurers shall be exempt in regard to liability insurance for the purchasing group from any law that would:
A. prohibit the establishment of a purchasing group;
B. make it unlawful for an insurer to provide or offer to provide insurance on a basis providing to a purchasing group or its members advantages based on their loss and expense experience not afforded to other persons with respect to rates, policy forms, coverages or other matters;
C. prohibit a purchasing group or its members from purchasing insurance on a group basis described in Subsection B of this section;
D. prohibit a purchasing group from obtaining insurance on a group basis because the group has not been in existence for a minimum period of time or because any member has not belonged to the group for a minimum period of time;
E. require that a purchasing group must have a minimum number of members, common ownership or affiliation or certain legal form;
F. require that a certain percentage of a purchasing group must obtain insurance on a group basis;
G. otherwise discriminate against a purchasing group or any of its members; or
H. require that any insurance policy issued to a purchasing group or any of its members be countersigned by an insurance agent or broker residing in New Mexico.
History:
Laws 1988, ch. 125, § 18.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-19 - Notice and registration requirements of purchasing groups.

A. A purchasing group which intends to do business in New Mexico shall, prior to doing business, furnish notice to the superintendent. The notice shall contain all information requested by the superintendent.
B. The purchasing group shall register with and designate the superintendent as its agent solely for the purpose of receiving service of legal documents or process, for which a filing fee shall be imposed by the superintendent, except that such requirements shall not apply in the case of a purchasing group which only purchases insurance that was authorized under the federal Product Liability Risk Retention Act of 1981 and:
(1) which in any state:
(a) was domiciled before April 1, 1986; and
(b) is domiciled on and after October 27, 1986; or
(2) which:
(a) before October 27, 1986 purchased insurance from an insurance carrier licensed in any state; and
(b) since October 27, 1986 purchased its insurance from an insurance carrier licensed in any state;
(3) which was a purchasing group under the requirements of the Product Liability Risk Retention Act of 1981 before October 27, 1986; and
(4) which does not purchase insurance that was not authorized for purposes of an exemption under the Product Liability Risk Retention Act of 1981, as in effect before October 27, 1986.
C. Each purchasing group that is required to give notice pursuant to Subsection A of this section shall also furnish such information as may be required by the superintendent.
D. Any purchasing group which was doing business in this state prior to the enactment of the Risk Retention and Purchasing Group Act shall, within thirty days after the effective date of that act, furnish notice to the commissioner pursuant to the provisions of Subsection A of this section and furnish such information as may be required pursuant to Subsections B and C of this section.
History:
Laws 1988, ch. 125, § 19.
ANNOTATIONS
Cross references.
— For the Federal Product Liability Risk Retention Act of 1981,
see
15 U.S.C. § 3901 et seq.
Compiler's notes.
— The phrase "effective date of that act" means July 1, 1988, the effective date of Laws 1988, Chapter 125, which enacted the Risk Retention and Purchasing Group Act.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-20 - Restrictions on insurance purchased by purchasing groups.

A. A purchasing group may not purchase insurance from a risk retention group that is not chartered in a state or from an insurer not admitted in the state in which the purchasing group is located, unless the purchase is effected through a licensed agent or broker acting pursuant to the surplus lines laws and regulations of the state.
B. A purchasing group may purchase insurance for its members in this state or covering its members' risks resident or located in this state only from insurers admitted in this state, from insurers that are eligible surplus lines insurers in this state or from risk retention groups that have registered in this state.
C. A purchasing group which obtains liability insurance from an insurer not admitted in this state or a risk retention group shall inform each of the members of such group that have a risk resident or located in this state that such risk is not protected by an insurance insolvency guaranty fund in this state and that such risk retention group or such insurer may not be subject to all insurance laws and regulations of this state.
D. No purchasing group may purchase insurance providing for a deductible or self-insured retention unless the deductible or self-insured retention is the sole responsibility of each individual member of the purchasing group.
History:
Laws 1988, ch. 125, § 20; 1999, ch. 289, § 40.
ANNOTATIONS
The 1999 amendment,
effective June 18, 1999, added Subsection B and redesignated former Subsections B and C as Subsections C and D.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-21 - Repealed.

History:
Laws 1988, ch. 125, § 21; repealed by Laws 2018, ch. 57, § 31.
ANNOTATIONS
Repeals.
— Laws 2018, ch. 57, § 31 repealed 59A-55-21 NMSA 1978, as enacted by Laws 1988, ch. 125, § 21, relating to purchasing group taxation, effective January 1, 2020. For provisions of former section,
see
the 2019 NMSA on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-22 - Administrative and procedural authority regarding risk retention groups and purchasing groups.

The superintendent is authorized to make use of any of the powers established under the New Mexico Insurance Code to enforce the laws of New Mexico not specifically preempted by the Risk Retention Act of 1986 including the superintendent's administrative authority to investigate, issue subpoenas, conduct depositions and hearings, issue orders, impose penalties and seek injunctive relief. With regard to any investigation, administrative proceedings or litigation, the procedural laws of New Mexico shall apply. The injunctive authority of the superintendent, in regard to risk retention groups, is restricted by the requirement that any injunction be issued by a court of competent jurisdiction.
History:
Laws 1988, ch. 125, § 22.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
Compiler's notes.
— The reference to the Risk Retention Act of 1986 should be either to the Risk Retention Amendments of 1986, which appear as 15 U.S.C. §§ 3901 to 3903, 3905, 3906 and 42 U.S.C. §§ 9671 to 9675, or to the Liability Risk Retention Act of 1986, which appears as 15 U.S.C. §§ 3901 to 3903.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-23 - Penalties.

A risk retention group that violates any provision of the Risk Retention and Purchasing Group Act shall be subject to fines and penalties applicable to licensed insurers generally, including revocation of its certificate of authority or the right to do business in New Mexico, or both.
History:
Laws 1988, ch. 125, § 23.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-24 - Duty of insurance producers to obtain license.

A. No person, firm, association or corporation shall act or aid in any manner in soliciting, negotiating or procuring liability insurance in New Mexico from a risk retention group unless such person, firm, association or corporation is licensed as an insurance producer pursuant to the provisions of the New Mexico Insurance Code.
B. No person, firm, association or corporation shall act or aid in any manner in soliciting, negotiating or procuring liability insurance:
(1) in New Mexico for a purchasing group from an authorized insurer or a risk retention group chartered in a state, unless such person, firm, association or corporation is licensed as an insurance producer pursuant to the provisions of the New Mexico Insurance Code;
(2) in New Mexico for any members of a purchasing group under a purchasing group's policy, unless such person, firm, association or corporation is licensed as an insurance producer pursuant to the provisions of the New Mexico Insurance Code; or
(3) from an insurer not authorized to do business in New Mexico on behalf of a purchasing group located in this state, unless such person, firm, association or corporation is licensed as a surplus lines agent or excess line broker pursuant to the provisions of the New Mexico Insurance Code.
C. Every person, firm, association or corporation licensed pursuant to the provisions of the New Mexico Insurance Code on business placed with risk retention groups or written through a purchasing group shall inform each prospective insured of the provisions of the notice required by Section 59A-55-10 NMSA 1978 in the case of a purchasing group.
History:
Laws 1988, ch. 125, § 24; 1999, ch. 272, § 27; 1999, ch. 289, § 41; 2016, ch. 89, § 69.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
The 2016 amendment,
effective July 1, 2017, replaced "agent" and "broker" with "insurance producer" throughout the section.
Severability.
— Laws 2016, ch. 89, § 71 provided that if any part or application of Laws 2016, ch. 89 is held invalid, the remainder or its application to other situations or persons shall not be affected.
The 1999 amendment,
effective June 18, 1999, deleted former Subsection C, which stated that any requirement of residence in the state shall not apply for the purposes of acting as an agent or broker for a risk retention group or purchasing group pursuant to Subsections A and B; redesignated former Subsection D as Subsection C; and updated the statutory reference in that subsection.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-25 - Binding effect of orders issued in United States district court.

An order issued by any district court of the United States enjoining a risk retention group from soliciting or selling insurance or operating in any state upon a finding that such a group is in hazardous financial or financially impaired condition shall be enforceable in the state courts of New Mexico.
History:
Laws 1988, ch. 125, § 25.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 55 - Risk Retention and Purchasing Groups › Section 59A-55-26 - Rules and regulations.

The superintendent may establish and from time to time amend such regulations relating to risk retention groups and purchasing groups as may be necessary or desirable to carry out the provisions of the Risk Retention and Purchasing Group Act.
History:
Laws 1988, ch. 125, § 26.
ANNOTATIONS
Severability.
— Laws 1988, ch. 125, § 27 provided for the severability of the act if any part or application thereof is held invalid.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-1 - Repealed.

History:
Laws 1994, ch. 75, § 1; 1997, ch. 243, § 34; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-1 NMSA 1978, as enacted by Laws 1994, ch. 75, § 1, relating to the short title of the Health Insurance Alliance Act, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-2 - Repealed.

History:
Laws 1994, ch. 75, § 2; 1997, ch. 243, § 35; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-2 NMSA 1978, as enacted by Laws 1994, ch. 75, § 2, relating to the purpose of the Health Insurance Alliance Act, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-3 - Repealed.

History:
Laws 1994, ch. 75, § 3; 1997, ch. 243, § 36; 1998, ch. 41, § 27; 2003, ch. 391, § 8; 2013, ch. 74, § 35; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-3 NMSA 1978, as enacted by Laws 1994, ch. 75, § 3, relating to definitions of the Health Insurance Alliance Act, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-4 - Repealed.

History:
Laws 1994, ch. 75, § 4; 1997, ch. 243, § 37; 2005, ch. 21, § 1; 2013, ch. 54, § 12; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-4 NMSA 1978, as enacted by Laws 1994, ch. 75, § 4, relating to creation of alliance and board, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-5 - Repealed.

History:
Laws 1994, ch. 75, § 5; 1997, ch. 243, § 38; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-5 NMSA 1978, as enacted by Laws 1994, ch. 75, § 5, relating to plan of operation, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-6 - Repealed.

History:
Laws 1994, ch. 75, § 6; 1997, ch. 243, § 39; 2010, ch. 95, § 5; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-6 NMSA 1978, as enacted by Laws 1994, ch. 75, § 6, relating to powers and duties of the board, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-7 - Repealed.

History:
Laws 1994, ch. 75, § 7; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-7 NMSA 1978, as enacted by Laws 1994, ch. 75, § 7, relating to policy forms, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-8 - Repealed.

History:
Laws 1994, ch. 75, § 8; 1997, ch. 243, § 40; 2005, ch. 21, § 2; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-8 NMSA 1978, as enacted by Laws 1994, ch. 75, § 8, relating to approved health plan, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-9 - Repealed.

History:
Laws 1994, ch. 75, § 9; 1997, ch. 243, § 41; 2001, ch. 310, § 1; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-9 NMSA 1978, as enacted by Laws 1994, ch. 75, § 9, relating to reinsurance, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-10 - Repealed.

History:
Laws 1994, ch. 75, § 10; 1997, ch. 243, § 42; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-10 NMSA 1978, as enacted by Laws 1994, ch. 75, § 10, relating to administration, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-11 - Repealed.

History:
Laws 1994, ch. 75, § 11; 1997, ch. 243, § 43; 1999, ch. 289, § 42; 2001, ch. 310, § 2; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-11 NMSA 1978, as enacted by Laws 1994, ch. 75, § 11, relating to assessments, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-12 - Repealed.

History:
Laws 1994, ch. 75, § 12; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-12 NMSA 1978, as enacted by Laws 1994, ch. 75, § 12, relating to initial administrative assessment, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-13 - Repealed.

History:
Laws 1994, ch. 75, § 13; 1997, ch. 243, § 44; 2001, ch. 310, § 3; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-13 NMSA 1978, as enacted by Laws 1994, ch. 75, § 13, relating to alliance administrator, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-14 - Repealed.

History:
Laws 1994, ch. 75, § 14; 1997, ch. 243, § 45; 2006, ch. 3, § 1; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-14 NMSA 1978, as enacted by Laws 1994, ch. 75, § 14, relating to eligibility, guaranteed issue and plan provisions, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-15 - Repealed.

History:
Laws 1994, ch. 75, § 15; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-15 NMSA 1978, as enacted by Laws 1994, ch. 75, § 15, relating to notice of alliance by members, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-16 - Repealed.

History:
Laws 1994, ch. 75, § 16; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-16 NMSA 1978, as enacted by Laws 1994, ch. 75, § 16, relating to enrollment, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-17 - Repealed.

History:
Laws 1994, ch. 75, § 17; 1997, ch. 243, § 46; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-17 NMSA 1978, as enacted by Laws 1994, ch. 75, § 17, relating to benefits, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-18 - Repealed.

History:
Laws 1994, ch. 75, § 18; 1997, ch. 243, § 47; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-18 NMSA 1978, as enacted by Laws 1994, ch. 75, § 18, relating to deductibles, co-insurance and maximum out-of-pocket payments, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-19 - Repealed.

History:
Laws 1994, ch. 75, § 19; 1997, ch. 243, § 48; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-19 NMSA 1978, as enacted by Laws 1994, ch. 75, § 19, relating to dependent family member required coverage and small employer responsibility, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-20 - Repealed.

History:
Laws 1994, ch. 75, § 20; 1997, ch. 243, § 49; 1998, ch. 41, § 28; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-20 NMSA 1978, as enacted by Laws 1994, ch. 75, § 20, relating to renewability, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-21 - Repealed.

History:
Laws 1994, ch. 75, § 21; 1997, ch. 243, § 50; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-21 NMSA 1978, as enacted by Laws 1994, ch. 75, § 21, relating to regulations, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-22 - Repealed.

History:
Laws 1994, ch. 75, § 22; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-22 NMSA 1978, as enacted by Laws 1994, ch. 75, § 22, relating to collective action, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-23 - Repealed.

History:
Laws 1994, ch. 75, § 23; 1997, ch. 243, § 51; 2005, ch. 21, § 3; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-23 NMSA 1978, as enacted by Laws 1994, ch. 75, § 23, relating to rates and standard risk rate, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-24 - Repealed.

History:
Laws 1994, ch. 75, § 24; 1997, ch. 243, § 52; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-24 NMSA 1978, as enacted by Laws 1994, ch. 75, § 24, relating to benefit payments reduction, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 56 - Health Insurance Alliances (Repealed.) › Section 59A-56-25 - Repealed.

History:
Laws 1994, ch. 75, § 25; 2005, ch. 21, § 4; 2013, ch. 74, § 36; repealed by Laws 2013, ch. 54, § 15.
ANNOTATIONS
Repeals.
— Laws 2013, ch. 54, § 15 repealed 59A-56-25 NMSA 1978, as enacted by Laws 1994, ch. 75, § 25, relating to expanded service development, effective January 1, 2015. For provisions of former section,
see
the 2014 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-1 - Short title.

Chapter 59A, Article 57 NMSA 1978 may be cited as the "Patient Protection Act".
History:
Laws 1998, ch. 107, § 1; 2003, ch. 327, § 1.
ANNOTATIONS
The 2003 amendment,
effective June 20, 2003, substituted "Chapter 59A, Article 57 NMSA 1978" for "Sections 1 through 11 of this act".
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Construction and application of state patient bill of rights statutes, 87 A.L.R.5th 277.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-2 - Purpose of act.

The purpose of the Patient Protection Act is to regulate aspects of health insurance by specifying patient and provider rights and confirming and clarifying the authority of the department to adopt regulations to provide protections to persons enrolled in managed health care plans. The insurance protections should ensure that managed health care plans treat patients fairly and arrange for the delivery of good quality services.
History:
Laws 1998, ch. 107, § 2.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-4.1 - External grievance appeals; appointment; compensation.

A. The superintendent may appoint one or more qualified individuals to review external grievance appeals.
B. The superintendent shall fix the reasonable compensation of each appointee based upon, but not limited to, compensation amounts suggested by national or state legal or medical professional societies, organizations or associations.
C. Upon completion of the external grievance appeal review, the superintendent shall prepare a detailed statement of compensation due each appointee and shall present the statement to the enrollee's health insurer.
D. The enrollee's health insurer shall pay the compensation directly to each appointee who participated in the external grievance appeal review.
E. The superintendent shall promulgate rules to implement this section.
History:
Laws 2003, ch. 327, § 2.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 327 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 20, 2003, 90 days after adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-5 - Consumer assistance; consumer advisory boards; ombudsman office; reports to consumers; superintendent's orders to protect consumers.

A. Each managed health care plan shall establish and adequately staff a consumer assistance office. The purpose of the consumer assistance office is to respond to consumer questions and concerns and assist patients in exercising their rights and protecting their interests as consumers of health care.
B. Each managed health care plan shall establish a consumer advisory board. The board shall meet at least quarterly and shall advise the plan about the plan's general operations from the perspective of the enrollee as a consumer of health care. The board shall also review the operations of and be advisory to the plan's consumer assistance office.
D.[C.] The department shall prepare an annual report assessing the operations of managed health care plans subject to the department's oversight, including information about consumer complaints.
E.[D.] A person adversely affected may file a complaint with the superintendent regarding a violation of the Patient Protection Act. Prior to issuing any remedial order regarding violations of the Patient Protection Act or its regulations, the superintendent shall hold a hearing in accordance with the provisions of Chapter 59A, Article 4 NMSA 1978. The superintendent may issue any order he deems necessary or appropriate, including ordering the delivery of appropriate care, to protect consumers and enforce the provisions of the Patient Protection Act. The superintendent shall adopt special procedures to govern the submission of emergency appeals to him in health emergencies.
History:
Laws 1998, ch. 107, § 5.
ANNOTATIONS
Compiler's notes.
— Laws 1998, ch. 107, § 5, as enacted by the legislature, included the provisions of Subsection C, which read: "The department shall establish and adequately staff a managed care ombudsman office, either within the department or by contract. The purpose of the managed care ombudsman office shall be to assist patients in exercising their rights and help advocate for and protect patient interests. The department's managed care ombudsman office shall work in conjunction with each plan's consumer assistance office and shall independently evaluate the effectiveness of the plan's consumer assistance office. The department's managed care ombudsman office may require a plan's consumer assistance office to adopt measures to ensure that the plan operates effectively to protect patient rights and inform consumers of the information to which they are entitled." Subsection C was vetoed by the governor on March 10, 1998.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-6 - Fairness to health care providers; gag rules prohibited; grievance procedure for providers.

A. No managed health care plan may:
(1) adopt a gag rule or practice that prohibits a health care provider from discussing a treatment option with an enrollee even if the plan does not approve of the option;
(2) include in any of its contracts with health care providers any provisions that offer an inducement, financial or otherwise, to provide less than medically necessary services to an enrollee; or
(3) require a health care provider to violate any recognized fiduciary duty of his profession or place his license in jeopardy.
B. A plan that proposes to terminate a health care provider from the managed health care plan shall explain in writing the rationale for its proposed termination and deliver reasonable advance written notice to the provider prior to the proposed effective date of the termination.
C. A managed health care plan shall adopt and implement a process pursuant to which providers may raise with the plan concerns that they may have regarding operation of the plan, including concerns regarding quality of and access to health care services, the choice of health care providers and the adequacy of the plan's provider network. The process shall include, at a minimum, the right of the provider to present the provider's concerns to a plan committee responsible for the substantive area addressed by the concern, and the assurance that the concern will be conveyed to the plan's governing body. In addition, a managed health care plan shall adopt and implement a fair hearing plan that permits a health care provider to dispute the existence of adequate cause to terminate the provider's participation with the plan to the extent that the relationship is terminated for cause and shall include in each provider contract a dispute resolution mechanism.
History:
Laws 1998, ch. 107, § 6.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-7 - Point-of-service option plan.

A. Except as otherwise provided in this section, the department may require a plan that offers a point-of-service plan or open plan to include in any managed health care plan it offers an option for a point-of-service plan or open plan to the extent that the department determines that the open plan option is financially sound.
B. No health care insurer may be required to offer a point-of-service plan or open plan as an option under a medicaid-funded managed health care plan unless the human services department [health care authority department] has established such a requirement as part of a procurement for managed health care under the medicaid program.
History:
Laws 1998, ch. 107, § 7.
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.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-8 - Administrative costs and benefit costs disclosures.

The department shall adopt regulations to ensure that both the administrative costs and the direct costs of providing health care services of each managed health care plan are fully and fairly disclosed to consumers in a uniform manner that allows meaningful cost comparisons among plans.
History:
Laws 1998, ch. 107, § 8.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-9 - Private remedies to enforce patient and provider insurance rights; enrollee as third-party beneficiary to enforce rights.

A. A person who suffers a loss as a result of a violation of a right protected pursuant to the provisions of the Patient Protection Act, its regulations or a managed health care plan may bring an action to recover actual damages or the sum of one hundred dollars ($100), whichever is greater.
B. A person likely to be damaged by a denial of a right protected pursuant to the provisions of the Patient Protection Act or its regulations may be granted an injunction under the principles of equity and on terms that the court considers reasonable. Proof of monetary damage or intent to violate a right is not required.
C. To protect and enforce an enrollee's rights in a managed health care plan, an individual enrollee participating in or eligible to participate in a managed health care plan shall be treated as a third-party beneficiary of the managed health care plan contract between the plan and the party with which the plan directly contracts. An individual enrollee may sue to enforce the rights provided in the contract that governs the managed health care plan; provided, however, that the plan and the party to the contract may amend the terms of, or terminate the provisions of, the contract without the enrollee's consent.
D. The relief provided pursuant to this section is in addition to other remedies available against the same conduct under the common law or other statutes of this state.
E. In any class action filed pursuant to this section, the court may award damages to the named plaintiffs as provided in this section and may award members of the class the actual damages suffered by each member of the class as a result of the unlawful practice.
F. Nothing in the Patient Protection Act is intended to make a plan vicariously liable for the actions of independent contractor health care providers.
History:
Laws 1998, ch. 107, § 9.
ANNOTATIONS
Law reviews.
— For comment, "ERISA Right to Use: An RX for Health Care that Places Forum over Substantive Consumer Rights," see 31 N.M. L. Rev. 453 (2001).
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-10 - Application of act to medicaid program.

A. Except as otherwise provided in this section, the provisions of the Patient Protection Act apply to the medicaid program operation in the state. A managed health care plan offered through the medicaid program shall grant enrollees and providers the same rights and protections as are granted to enrollees and providers in any other managed health care plan subject to the provisions of the Patient Protection Act.
B. Nothing in the Patient Protection Act shall be construed to limit the authority of the human services department [health care authority department] to administer the medicaid program, as required by law. Consistent with applicable state and federal law, the human services department [health care authority department] shall have sole authority to determine, establish and enforce medicaid eligibility criteria, the scope, definitions and limitations of medicaid benefits and the minimum qualifications or standards for medicaid service providers.
C. Medicaid recipients and applicants retain their right to appeal decisions adversely affecting their medicaid benefits to the human services department [health care authority department], pursuant to the Public Assistance Appeals Act [27-3-1 to 27-3-5 NMSA 1978]. Notwithstanding other provisions of the Patient Protection Act, a medicaid recipient or applicant who files an appeal to the human services department [health care authority department] pursuant to the Public Assistance Appeals Act may not file an appeal on the same issue to the superintendent pursuant to the Patient Protection Act, unless the human services department [health care authority department] refuses to hear the appeal. The superintendent may refer to the human services department [health care authority department] any appeal filed with the superintendent pursuant to the Patient Protection Act if the complainant is a medicaid beneficiary and the matter in dispute is subject to the provisions of the Public Assistance Appeals Act.
D. Any managed health care plan participating in the medicaid managed care program as of the effective date of the Patient Protection Act and that is in compliance with contractual and regulatory requirements applicable to that program shall be deemed to comply with any requirements established in accordance with that act until July 1, 1999; provided that, from the effective date of that act, any rights established under that act beyond those under requirements of the human services department [health care authority department] shall apply to enrollees in medicaid managed health care plans.
History:
Laws 1998, ch. 107, § 10.
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.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 57 - Patient Protection › Section 59A-57-11 - Penalty.

In addition to any other penalties provided by law, a civil administrative penalty of up to ten thousand dollars ($10,000) may be imposed for each violation of the Patient Protection Act. An administrative penalty shall be imposed by written order of the superintendent made after holding a hearing as provided for in Chapter 59A, Article 4 NMSA 1978.
History:
Laws 1998, ch. 107, § 11.