reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-16 - Optional provisions.

Except as provided in Section 424 [59A-22-3 NMSA 1978] of this article, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in Sections 438 to 446 [59A-22-17 to 59A-22-25 NMSA 1978], inclusive, of this article, unless such provisions are in the words in which the same appear in the applicable such section; except, that the insurer may, at its option, use in lieu of any such provision a corresponding provision of different wording approved by the superintendent which is not less favorable in any respect to the insured or the beneficiary. Any such provisions contained in the policy shall be preceded individually by the appropriate caption appearing with the section in which the provision is set forth or, at the insurer's option, by such appropriate individual or group captions or subcaptions as the superintendent may approve.
History:
Laws 1984, ch. 127, § 437.
ANNOTATIONS
Cross references.
— For existing forms and filings,
see
notes following 59A-5-21 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-17 - Change of occupation.

There may be a provision as follows:
If the insured be injured or contract sickness after having changed his occupation to one classified by the insurance company as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurance company will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurance company for such more hazardous occupation. If the insured changes his occupation to one classified by the insurance company as less hazardous than that stated in this policy, the insurance company, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess premium calculated on a basis approved by the superintendent from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification for occupational risk and the premium rates shall be used as have been last filed by the insurance company prior to the occurrence of the loss for which the insurance company is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurance company in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation.
History:
Laws 1984, ch. 127, § 438.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-18 - Misstatement of age.

There may be a provision as follows:
If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.
History:
Laws 1984, ch. 127, § 439.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-19 - Other insurance in this insurance company.

There may be a provision as follows:
If an accident or sickness or accident and sickness policy or policies previously issued by the insurance company to the insured be in force concurrently herewith, making the aggregate indemnity for . . . . . . . . . . . . . . . . . . (insert type of coverage or coverages) in excess of $. . . . . . . . . (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate, or, in lieu thereof:
Insurance effective at any one time on the insured under a like policy or policies in this insurance company is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurance company will return all premiums paid for all other such policies.
History:
Laws 1984, ch. 127, § 440.
ANNOTATIONS
"Other insurance" provision not against public policy.
— Apart from statutory authority a provision such as that in the second paragraph of Subsection C of former 59-18-5 NMSA 1978 was not against public policy. Where plaintiff was covered by an individual policy and a family policy, both issued by the same insurer, the provisions of which were identical, the court properly held the "other insurance" provision valid.
Bell v. Weinacker
, 1975-NMCA-134, 88 N.M. 557, 543 P.2d 1185.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance §§ 774 to 778.
Insured's receipt of or right to workmen's compensation benefits as affecting recovery under accident, hospital, or medical expense policy, 40 A.L.R.3d 1012.
Resolution of conflicts, in non-automobile liability insurance policies, between excess or pro-rata "other insurance" clauses, 12 A.L.R.4th 993.
Allocation of defense costs between primary and excess insurance carriers, 19 A.L.R.4th 107.
Priority and apportionment of liability between medical and hospital expense insurers, 25 A.L.R.4th 1022.
46 C.J.S. Insurance § 1367 et seq.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-22 - Relation of earnings to insurance.

There may be a provision as follows:
If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurance company will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of two hundred ($200.00) dollars, or the sum of the monthly benefits specified in such coverages, whichever is the lesser, not [nor] shall it operate to reduce benefits other than those payable for loss of time.
(The foregoing policy provision may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date of issue. The insurance company may, at its option, include in this provision a definition of "valid loss of time coverage," approved as to form by the superintendent, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the superintendent or any combination of such coverages. In the absence of such definition such term shall not include any coverage provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute) or benefits provided by union welfare plans or by employer or employee benefit organizations.)
History:
Laws 1984, ch. 127, § 443.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-23 - Unpaid premium.

There may be a provision as follows:
Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.
History:
Laws 1984, ch. 127, § 444.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-24 - Cancellation.

There may be a provision as follows:
The insurance company may cancel this policy only pursuant to the provisions of Section 59A-23E-19 NMSA 1978.
History:
Laws 1984, ch. 127, § 445; 1998, ch. 41, § 2.
ANNOTATIONS
The 1998 amendment,
effective March 6, 1998, substituted "pursuant to the provisions of Section 59A-23E-19 NMSA 1978" for the language beginning with "at the expiration of any term" in the middle of the section.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-25 - Conformity with state statutes.

There may be a provision as follows:
Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes.
History:
Laws 1984, ch. 127, § 446.
ANNOTATIONS
Cross references.
— For existing forms and filings,
see
notes following 59A-5-21 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-26 - Order of certain policy provisions.

The provisions which are the subject of Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the insurer's option, any such provision may appear as a unit in any part of the policy with other provisions to which it may logically be related, provided that the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse or likely to mislead a person to whom the policy is offered, delivered or issued.
History:
Laws 1984, ch. 127, § 447.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-27 - Third party ownership.

The word "insured" as used in this article shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein.
History:
Laws 1984, ch. 127, § 448.
ANNOTATIONS
Insurable interest must exist at time of loss.
Universal C.I.T. Corp. v. Foundation Reserve Ins. Co.
, 1969-NMSC-013, 79 N.M. 785, 450 P.2d 194.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-28 - Requirements of other jurisdictions.

A. Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this article, and which is prescribed or required by the law of the state or country in which the insurer is domiciled.
B. Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such state or country.
History:
Laws 1984, ch. 127, § 449.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-29 - Conforming to statute.

A. Other policy provisions. No policy provision which is not subject to Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this article.
B. Policy conflicting with this article. A policy delivered or issued for delivery in this state in violation of this article shall be held valid but shall be construed as provided in this article. When any provision in a policy subject to this article is in conflict with any provision of this article, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this article.
History:
Laws 1984, ch. 127, § 450.
ANNOTATIONS
Cross references.
— For existing forms and filings,
see
notes following 59A-5-21 NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-30 - Age limit.

If any such policy contains a provision establishing, as an age limit or otherwise, a date after which coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
History:
Laws 1984, ch. 127, § 451.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Age requirement of disability policy as to proof of disability before reaching specified age as barring recovery where disability occurs before, but proof is made after, attainment of such age, 18 A.L.R.2d 1061.
Clause in health and accident, or similar, policy reducing amount of, or terminating, periodic payments after insured reaches specified age, as applicable to disability incurred before such age was reached, 53 A.L.R.2d 552.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-30.1 - Maximum age of dependent.

An individual or group health policy or certificate of insurance delivered, issued for delivery or renewed in New Mexico that provides coverage for an insured's dependent shall not terminate coverage of an unmarried dependent by reason of the dependent's age before the dependent's twenty-sixth birthday, regardless of whether the dependent is enrolled in an educational institution.
History:
Laws 2005, ch. 41, § 1; 2021, ch. 108, § 17.
ANNOTATIONS
Cross references.
— For age of dependents
see
59A-22-2 and 59A-22-34.2 NMSA 1978.
The 2021 amendment,
effective July 1, 2021, after "before the dependent's", changed "twenty-fifth" to "twenty-sixth".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-31 - Industrial health insurance.

A. The term "industrial health insurance" as used herein means sickness and accident insurance under individual policies for which the premium is payable weekly, and includes any such policy which covers sickness only or accident only.
B. Any insurer authorized to write health insurance in this state shall have the power to issue industrial health policies.
C. No policy of industrial health insurance may be delivered or issued for delivery in the state unless it has printed thereon the words "industrial policy."
D. Each such policy shall be subject to the provisions of this article except that no such policy shall be required to contain any of the policy provisions set forth in Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article, other than the provisions relating to the presence of a preexisting disease or physical condition; provided, however, that no such policy shall contain any provision relative to notice or proof of loss, or the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the superintendent is less favorable to the insured than would be permitted by such policy provisions; and provided further, that such policy may contain a provision that upon proper written request, a named beneficiary shall be designated in or by endorsement on the policy to receive the proceeds thereof on the death of the insured, and there shall be reserved to the insured the power to change the beneficiary at any time by written notice to the insurer at its home office, accompanied by the policy for endorsement of the change thereon by the insurer; the insurer shall have the right to refuse to designate a beneficiary if evidence satisfactory to the insurer of such beneficiary's insurable interest in the life of the insured is not furnished on request. Any such policy may provide in substance that any payment thereunder may be made to the insured or the insured's estate or to any relative by blood or connection by marriage of the insured, or, to the extent of such portion of any payment under the policy as may reasonably appear to the insurer to be due to such person, to any other person equitably entitled thereto by reason of having incurred expense occasioned by the maintenance or illness or burial of the insured; provided that, if the policy shall be in force at the death of the insured, the proceeds thereof shall be payable to the named beneficiary if living, but upon the expiration of fifteen (15) days after the death of the insured, unless proof of the claim in the manner and form required by the policy, accompanied by the policy for surrender, has theretofore been made by such beneficiary, the insurer may pay to any other person permitted by the policy.
History:
Laws 1984, ch. 127, § 452.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
46 C.J.S. Insurance §§ 1367, 1518.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-32.1 - Freedom of choice.

A. Within the area and limits of coverage offered an insured and selected by him in the application for insurance, the right of any person to exercise full freedom of choice in the selection of any independent social worker as defined in Subsection B of this section, for treatment within his scope of practice shall not be restricted under any new policy of health insurance, contract or health care plan issued after July 1, 1989 in this state or in the processing of any claim thereunder. Any person insured or claiming benefits under any such health insurance policy, contract or health care plan providing within its coverage for payment of service benefits or indemnity for treatment of persons for the cure or correction of any mental condition shall be deemed to have complied with the requirements of the policy, contract or health care plan as to submission of proof of loss upon submitting written proof supported by any independent social worker.
B. As used in this section "independent social worker" means a person licensed as an independent social worker by the board of social work examiners pursuant to the Social Work Practice Act [61-31-1 to 61-31-24 NMSA 1978].
History:
Laws 1989, ch. 51, § 25.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-33 - Children with disabilities; coverage continued.

An individual or group hospital or medical expense insurance policy delivered or issued for delivery in this state that provides that coverage of a dependent child of an insured, or of an employee or other member of the covered group, shall terminate upon attainment of the limiting age for dependent children specified in the policy shall also provide, in substance, that attainment of the limiting age shall not operate to terminate the coverage of a child while the child is, and continues to be both incapable of self-sustaining employment, by reason of intellectual or developmental disability or physical disability, and chiefly dependent upon the policyholder for support and maintenance. However, proof of the incapacity and dependency of the child must be furnished to the insurer by the insured employee or member within thirty-one days of the child's attainment of the limiting age and subsequently, as may be required by the insurer, but not more frequently than annually after the two-year period following the child's attainment of the limiting age.
History:
Laws 1984, ch. 127, § 455; 2021, ch. 108, § 18.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, revised terms used in the section; in the section heading, deleted "Handicapped" and added "with disabilities"; and after "by reason of", deleted "mental retardation" and added "intellectual or developmental disability", and after "or physical", deleted "handicap" and added "disability".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-34 - Newly born children coverage.

A. All individual and group health insurance policies delivered or issued for delivery in this state and which provide coverage on an expense-incurred basis for a family member of the insured shall, as to such family members' coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured from the moment of birth.
B. All individual and group health insurance policies delivered or issued for delivery in this state that do not provide coverage for a family member of the insured shall provide for an option to add to the coverage any newly born child of the insured provided that the requirements of Subsection D of this section have been met.
C. The coverage for newly born children shall consist of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, where necessary to protect the life of the infant, transportation, including air transport, to the nearest available tertiary care facility for newly born infants.
D. If payment of a specific premium is required to provide coverage for a child, the policy may require that a notification of birth of a newly born child and payment of the required premium must be furnished to the insurer within thirty-one days after the date of birth in order to have the coverage from birth.
E. As used in this section and in Section 59A-22-35 NMSA 1978, "tertiary care facility" means a hospital unit which provides complete perinatal care and intensive care of intrapartum and perinatal high-risk patients with responsibilities for coordination of transport, communication, education and data analysis systems for the geographic area served.
History:
Laws 1984, ch. 127, § 456; 1993, ch. 169, § 1.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, substituted "basis" for "bases" in Subsection A; added Subsection B; redesignated former Subsections B through D as present Subsections C through E; in Subsection D, substituted "from birth" for "continue beyond such thirty-one day period" and made a minor stylistic change; and substituted "Section 59A-22-35 NMSA 1978" for "Section 457 of this article" in Subsection E.
Applicability.
— Laws 1993, ch. 169, § 3 provides that the provisions of the act apply to policies, plans, contracts and certificates delivered or issued for delivery or renewed, extended or amended in the state on or after July 1, 1993.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Unborn child as insured or injured person within meaning of insurance policy, 15 A.L.R.4th 548.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-34.1 - Coverage for adopted children.

A. No individual or group health insurance policy or contract or health care plan shall be offered, issued or renewed in New Mexico on or after July 1, 1988, unless the policy, plan or contract covers adopted children of the insured, subscriber or enrollee on the same basis as other dependents.
B. The coverage required by this section is effective from the date of placement for the purpose of adoption and continues unless the placement is disrupted prior to legal adoption and the child is removed from placement. Coverage shall include the necessary care and treatment of medical conditions existing prior to the date of placement.
C. As used in this section, "placement" means in the physical custody of the adoptive parent.
History:
Laws 1978 Comp., § 59A-22-34.1, enacted by Laws 1988, ch. 89, § 1.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-34.3 - Childhood immunization coverage required.

A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for childhood immunizations, as well as coverage for medically necessary booster doses of all immunizing agents used in child immunizations, in accordance with the current schedule of immunizations recommended by the American academy of pediatrics.
B. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies.
C. Coverage for childhood immunizations and necessary booster doses may be subject to deductibles and co-insurance consistent with those imposed on other benefits under the same policy, plan or certificate.
History:
1978 Comp., § 59A-22-34.3, enacted by Laws 1997, ch. 250, § 1.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-34.4 - Coverage of circumcision for newborn males.

An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for circumcision for newborn males.
History:
Laws 2004, ch. 122, § 4.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 122, § 13 made Laws 2004, ch. 122, § 4 effective July 1, 2004.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-34.5 - Hearing aid coverage for children required.

A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for a hearing aid and any related service for the full cost of one hearing aid per hearing-impaired ear up to two thousand two hundred dollars ($2,200) every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery or renews in this state an individual or group health insurance policy, health care plan or certificate of health insurance may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.
C. Hearing aid coverage offered shall include fitting and dispensing services, including providing ear molds as necessary to maintain optimal fit, provided by an audiologist, a hearing aid dispenser or a physician, licensed in New Mexico.
D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies.
E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid" means durable medical equipment that is of a design and circuitry to optimize audibility and listening skills in the environment commonly experienced by children.
History:
Laws 2007, ch. 356, § 2.
ANNOTATIONS
Effective dates.
— Laws 2007, ch. 356, § 6 made Laws 2007, ch. 356, § 2 effective July 1, 2007.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-35 - Maternity transport required.

All individual and group health insurance policies delivered or issued for delivery in this state which provide maternity coverage on an expense-incurred basis, shall also provide, where necessary to protect the life of the infant or mother, coverage for transportation, including air transport, for the medically high-risk pregnant woman with an impending delivery of a potentially viable infant to the nearest available tertiary care facility (as defined in Section 456 [59A-22-34 NMSA 1978] of this article) for newly-born infants.
History:
Laws 1984, ch. 127, § 457.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
46 C.J.S. Insurance §§ 1367, 1518.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-36 - Home health care service option required.

A. Each insurer which delivers or issues for delivery in this state an individual or group hospital expense or major medical expense insurance policy shall make available to the policyholder the option of home health care coverage which includes benefits for the services described in this section.
B. Home health care coverage offered shall include:
(1) services provided by a registered nurse or a licensed practical nurse;
(2) health services provided by physical, occupational and respiratory therapists and speech pathologists;
(3) health services provided by a home health aide; and
(4) medical supplies, drugs and medicines and laboratory services, to the extent they would have been covered if provided to the insured on an in-patient basis.
C. Home health care coverage may be limited to:
(1) services provided on the written order of a licensed physician, provided such order is renewed at least every sixty (60) days;
(2) services provided, directly or through contractual agreements, by a home health agency licensed in the state in which the home health services are delivered; and
(3) services, as set forth in Subsection B of the section, without which the insured would have to be hospitalized.
D. Coverage shall be provided for at least one hundred (100) home visits per insured per year, with each home visit including up to four (4) hours of home health care services.
E. For the purposes of this section, "home health care" means health services provided on a part-time, intermittent basis to an individual confined to his home due to physical illness.
History:
Laws 1984, ch. 127, § 458.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-37 - Repealed.

History:
Laws 1984, ch. 127, § 459; 1987, ch. 259, § 22; repealed by Laws 2019, ch. 259, § 22.
ANNOTATIONS
Repeals.
— Laws 2019, ch. 259, § 22 repealed 59A-22-37 NMSA 1978, as enacted by Laws 1984, ch. 127, § 459, relating to "franchise" insurance, effective June 14, 2019. For provisions of former section,
see
the 2018 NMSA 1978 on
NMOneSource.com
.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-39 - Coverage for mammograms.

Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for low-dose screening mammograms for determining the presence of breast cancer. Such coverage shall make available one baseline mammogram to persons age thirty-five through thirty-nine, one mammogram biennially to persons age forty through forty-nine and one mammogram annually to persons age fifty and over. After July 1, 1992, coverage shall be available only for screening mammograms obtained on equipment designed specifically to perform low-dose mammography in imaging facilities that have met American college of radiology accreditation standards for mammography. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).
History:
1978 Comp., § 59A-22-39, enacted by Laws 1990, ch. 5, § 2; 2023, ch. 12, § 6.
ANNOTATIONS
The 2023 amendment,
effective June 16, 2023, removed a provision stating that coverage for mammograms may be subject to deductibles and coinsurance, and provided an exception to the requirement that certain health benefit plans shall provide coverage for low-dose screening mammograms; and deleted former Subsections B and C, and added "The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2).".
Applicability.
— Laws 2023, ch. 12, § 8 provided that Laws 2023, ch. 12 apply to health insurance policies, health care plans, certificates of health insurance and health maintenance organization contracts that are delivered, issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-39.1 - Mastectomies and lymph node dissection; minimum hospital stay coverage required.

A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for not less than forty-eight hours of inpatient care following a mastectomy and not less than twenty-four hours of inpatient care following a lymph node dissection for the treatment of breast cancer.
B. Nothing in this section shall be construed as requiring the provision of inpatient coverage where the attending physician and patient determine that a shorter period of hospital stay is appropriate.
C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies.
D. Coverage for minimum inpatient hospital stays for mastectomies and lymph node dissections for the treatment of breast cancer may be subject to deductibles and co-insurance consistent with those imposed on other benefits under the same policy, plan or certificate.
History:
1978 Comp., § 59A-22-39.1, enacted by Laws 1997, ch. 249, § 1.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-39.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

A. An individual or group health insurance policy, health care plan or certificate of insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds.
B. Nothing in this section shall be construed to require payment for a gynecological or obstetrical ultrasound that is not:
(1) medically necessary; or
(2) a covered benefit.
C. As used in this section, "prior authorization" means advance approval that is required by a health insurance policy, health care plan or certificate of insurance as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits.
History:
Laws 2019, ch. 182, § 3.
ANNOTATIONS
Emergency clauses.
— Laws 2019, ch. 182, § 7 contained an emergency clause and was approved April 3, 2019.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-39.3 - Diagnostic and supplemental breast examinations.

A. An individual or group health insurance policy, health care plan or certificate of insurance that is delivered, issued for delivery or renewed in this state that provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing for diagnostic and supplemental breast examinations.
B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law.
C. As used in this section:
(1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;
(2) "diagnostic breast examination" means a medically necessary and clinically appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:
(a) seen or suspected from a screening examination for breast cancer; or
(b) detected by another means of examination; and
(3) "supplemental breast examination" means a medically necessary and clinically appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:
(a) used to screen for breast cancer when there is no abnormality seen or suspected; and
(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer.
History:
Laws 2023, ch. 12, § 2.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 12 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature.
Applicability.
— Laws 2023, ch. 12, § 8 provided that Laws 2023, ch. 12 apply to health insurance policies, health care plans, certificates of health insurance and health maintenance organization contracts that are delivered, issued for delivery or renewed in this state on or after January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-40 - Coverage for cytologic and human papillomavirus screening.

A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for cytologic and human papillomavirus screening for determining the presence of precancerous or cancerous conditions and other health problems. The coverage shall make available cytologic screening, as determined by the health care provider in accordance with national medical standards, for women who are eighteen years of age or older and for women who are at risk of cancer or at risk of other health conditions that can be identified through cytologic screening. The coverage shall make available human papillomavirus screening once every three years for women aged thirty and older.
B. Coverage for cytologic and human papillomavirus screening may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies.
D. For the purposes of this section:
(1) "cytologic screening" means a Papanicolaou test and a pelvic exam for asymptomatic as well as symptomatic women;
(2) "health care provider" means any person licensed within the scope of his practice to perform cytologic and human papillomavirus screening, including physicians, physician assistants, certified nurse midwives and certified nurse practitioners; and
(3) "human papillomavirus screening" means a test approved by the federal food and drug administration for detection of the human papillomavirus.
History:
1978 Comp., § 59A-22-40, enacted by Laws 1992, ch. 56, § 2; 2005, ch. 133, § 2.
ANNOTATIONS
The 2005 amendment,
effective June 17, 2005, provided in Subsection A that health insurance provide coverage for human papillomavirus and shall make available human papillomavirus screening every three years for women aged thirty and older; in Subsection B, provided that coverage for human papillomavirus screening may be subject to deductibles and coinsurance; and in Subsection D, defined "health care provider" to include any person who performs human papillomavirus screening and "human papillomavirus screening" to mean a test for detection of human papillomavirus.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-40.1 - Coverage for the human papillomavirus vaccine.

A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for the human papillomavirus vaccine in accordance with the current standards of the federal centers for disease control and prevention.
B. Coverage for the human papillomavirus vaccine may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies.
D. For the purposes of this section, "human papillomavirus vaccine" means a vaccine approved by the federal food and drug administration used for the prevention of human papillomavirus infection and cervical precancers.
History:
Laws 2007, ch. 278, § 1; 2021, ch. 108, § 19.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, revised age-related guidelines for coverage for the human papillomavirus; and in Subsection A, after "human papillomavirus vaccine", deleted "to females nine to fourteen years of age", and added "in accordance with the current standards of the federal centers for disease control and prevention".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-41.1 - Coverage for medical diets for genetic inborn errors of metabolism.

A. As of July 1, 2003, each individual and group health insurance policy, health care plan, certificate of health insurance and managed health care plan delivered, issued for delivery, renewed, extended or modified in this state shall provide coverage for the treatment of genetic inborn errors of metabolism that involve amino acid, carbohydrate and fat metabolism and for which medically standard methods of diagnosis, treatment and monitoring exist.
B. Coverage shall include expenses of diagnosing, monitoring and controlling disorders by nutritional and medical assessment, including clinical services, biochemical analysis, medical supplies, prescription drugs, corrective lenses for conditions related to the genetic inborn error of metabolism, nutritional management and special medical foods used in treatment to compensate for the metabolic abnormality and to maintain adequate nutritional status.
C. Services required to be covered pursuant to this section are subject to the terms and conditions of the applicable individual or group policy or plan that establishes durational limits, dollar limits, deductibles and co-payments as long as the terms are not less favorable than for physical illness generally.
D. As used in this section:
(1) "genetic inborn error of metabolism" means a rare, inherited disorder that:
(a) is present at birth;
(b) if untreated, results in intellectual or developmental disability or death; and
(c) causes the necessity for consumption of special medical foods;
(2) "special medical foods" means nutritional substances in any form that are:
(a) formulated to be consumed or administered internally under the supervision of a physician;
(b) specifically processed or formulated to be distinct in one or more nutrients present in natural food;
(c) intended for the medical and nutritional management of patients with limited capacity to metabolize ordinary foodstuffs or certain nutrients contained in ordinary foodstuffs or who have other specific nutrient requirements as established by medical evaluation; and
(d) essential to optimize growth, health and metabolic homeostasis; and
(3) "treatment" means medical services provided by licensed health care professionals, including physicians, dieticians and nutritionists, with specific training in managing patients diagnosed with genetic inborn errors of metabolism.
History:
Laws 2003, ch. 192, § 1; 2021, ch. 108, § 20.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, revised a term used in the section; in Subsection D, in Subparagraph D(1)(b), after "results in", deleted "mental retardation" and added "intellectual or developmental disability".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-44 - Coverage for smoking cessation treatment.

A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered or issued for delivery in this state and that offers maternity benefits shall offer coverage for smoking cessation treatment.
B. Coverage for smoking cessation treatment may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies.
History:
Laws 2003, ch. 337, § 1.
ANNOTATIONS
Effective dates.
— Laws 2003, ch. 337 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.
Applicability.
— Laws 2003, ch. 337 § 7 made the provisions of the act apply on or after July 1, 2003.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-45 - Coverage of alpha-fetoprotein IV screening test.

An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for an alpha-fetoprotein IV screening test for pregnant women, generally between sixteen and twenty weeks of pregnancy, to screen for certain genetic abnormalities in the fetus.
History:
Laws 2004, ch. 122, § 3.
ANNOTATIONS
Effective dates.
— Laws 2004, ch. 122, § 13 made the act effective July 1, 2004.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-46 - Coverage of part-time employees.

An insurer that provides group health insurance pursuant to Chapter 59A, Article 22 NMSA 1978 shall make available, upon an employer's request prior to issuance, delivery or renewal, coverage for regular part-time employees who work or are expected to work an average of at least twenty hours per week over a six-month period. Nothing in this section shall be construed to require an employer to offer or provide coverage for regular part-time employees.
History:
Laws 2005, ch. 42, § 1.
ANNOTATIONS
Effective dates.
— Laws 2005, ch. 42, § 5 made Laws 2005, ch. 42, § 1 effective July 1, 2005.