2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-16 - Exclusions, limitations and exceptions for certain group health plans and group health insurance.

A. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and 59A-23E-18 NMSA 1978 do not apply to any group retiree health plan and health insurance coverage offered in connection with a group retiree health plan if, on the first day of the plan year, the plan has fewer than two employees who are current employees.
B. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and 59A-23E-18 NMSA 1978 shall not apply with respect to a group health plan or group retiree health plan that is a nonfederal governmental plan if the plan sponsor makes an election under the provisions of this subsection in conformity with regulations of the federal secretary of health and human services. The period of an election for exclusion made pursuant to this subsection is for a single specified plan year or, in the case of a plan provided pursuant to a collective bargaining agreement, for the term of the agreement. The plan for which an election is made shall provide under the terms of the election for:
(1) notice to enrollees on an annual basis and at the time of enrollment of the facts and consequences of the election; and
(2) certification and disclosure of creditable coverage under the plan with respect to enrollees in accordance with Section 59A-23E-7 NMSA 1978 [repealed].
C. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and 59A-23E-18 NMSA 1978 do not apply to a group health plan and group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in Paragraph (9) of Subsection L of Section 59A-23E-2 NMSA 1978 if the benefits are:
(1) provided under a separate policy, certificate or contract of insurance; or
(2) otherwise not an integral part of the plan.
D. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and 59A-23E-18 NMSA 1978 do not apply to any group health plan and group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in Paragraph (10) of Subsection L of Section 59A-23E-2 NMSA 1978 if:
(1) the benefits are provided under a separate policy, certificate or contract of insurance;
(2) there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor; and
(3) the benefits are paid with respect to an event without regard to whether benefits are provided with respect to that event under any group health plan maintained by the same plan sponsor.
E. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and 59A-23E-18 NMSA 1978 do not apply to any group health plan and group health insurance coverage offered in connection with a group health plan in relation to its provision of excepted benefits described in Paragraph (11) of Subsection L of Section 59A-23E-2 NMSA 1978 if the benefits are provided under a separate policy, certificate or contract of insurance.
History:
Laws 1997, ch. 243, § 16; 1998, ch. 41, § 20; 2019, ch. 259, § 15.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law. Laws 2019, ch. 259, § 22 repealed 59A-23E-7 NMSA 1978, effective June 14, 2019.
The 2019 amendment,
effective June 14, 2019, provided an exemption for group retiree health plans from the requirements of certain sections of the Insurance Code; in Subsection A, after each occurrence of "group", added "retiree"; and in Subsection B, after "group health plan", added "or group retiree health plan.
The 1998 amendment,
effective March 6, 1998, inserted "group health" and "and group health insurance" near the end of the section heading; substituted "59A-23E-3 through 59A-23E-15 NMSA 1978" for "3 through 15 of the Health Insurance Portability Act" and "59A-23E-2 NMSA 1978" for "2 of the Health Insurance Portability Act" throughout the section; substituted "fewer" for "less" near the end of Subsection A; substituted "59A-23E-7 NMSA 1978" for "7 of the Health Insurance Portability Act" at the end of Paragraph B(2); substituted "L" for "M" near the end of Subsections C, D, and E; and inserted "plan" near the end of Paragraphs D(2) and (3).