2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 46 - Health Maintenance Organizations › Section 59A-46-38.1 - Coverage of children.

A. An insurer shall not deny enrollment of a child under the health plan of the child's parent on the grounds that the child:
(1) was born out of wedlock;
(2) is not claimed as a dependent on the parent's federal tax return; or
(3) does not reside with the parent or in the insurer's service area.
B. When a child has health coverage through an insurer of a noncustodial parent, the insurer shall:
(1) provide such information to the custodial parent as may be necessary for the child to obtain benefits through that coverage;
(2) permit the custodial parent or the provider, with the custodial parent's approval, to submit claims for covered services without the approval of the noncustodial parent; and
(3) make payments on claims submitted in accordance with Paragraph (2) of this subsection directly to the custodial parent, the provider or the state medicaid agency.
C. When a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage, the insurer shall be required:
(1) to permit the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions;
(2) if the parent is enrolled but fails to make application to obtain coverage for the child, to enroll the child under family coverage upon application of the child's other parent, the state agency administering the medicaid program or the state agency administering 42 U.S.C. Sections 651 through 669, the child support enforcement program; and
(3) not to disenroll or eliminate coverage of the child unless the insurer is provided satisfactory written evidence that:
(a) the court or administrative order is no longer in effect; or
(b) the child is or will be enrolled in comparable health coverage through another insurer that will take effect not later than the effective date of disenrollment.
D. An insurer shall not impose requirements on a state agency that has been assigned the rights of an individual eligible for medical assistance under the medicaid program and covered for health benefits from the insurer that are different from requirements applicable to an agent or assignee of any other individual so covered.
E. An insurer shall provide coverage for children, from birth through three years of age, for or under the family, infant, toddler program administered by the early childhood education and care department, provided eligibility criteria are met, for a maximum benefit of three thousand five hundred dollars ($3,500) annually for medically necessary early intervention services provided as part of an individualized family service plan and delivered by certified and licensed personnel who are working in early intervention programs approved by the early childhood education and care department. No payment under this subsection shall be applied against any maximum lifetime or annual limits specified in the policy, health benefits plan or contract.
History:
1978 Comp., § 59A-46-38.1, enacted by Laws 1994, ch. 64, § 9; 2005, ch. 157, § 4; 2019, ch. 48, § 32.
ANNOTATIONS
The 2019 amendment,
effective July 1, 2020, deleted references to the department of health and added references to the early childhood education and care department; and in Subsection E, after "administered by the", added "early childhood education and care", after "department", deleted "of health", after "licensed personnel", deleted "as defined in 7.30.8 NMAC", after "programs approved by the", added "early childhood education and care", and after "department", deleted "of health".
The 2005 amendment,
effective July 1, 2005, added Subsection E to require coverage for children from birth through three years of age under the family, infant, toddler program for a maximum benefit of $3,500 for medically necessary early intervention services.