reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 15 - Unauthorized Insurers › Section 59A-15-15 - Purpose.

The purpose of the Health Care Benefits Jurisdiction Act [59A-15-14 to 59A-15-19 NMSA 1978] is to assure the superintendent's jurisdiction over providers of health care benefits in this state; to indicate how each provider of health care benefits may demonstrate under which regulatory jurisdiction it falls; to allow for examinations by the superintendent if the provider of health care benefits is unable to demonstrate that it is subject to another regulatory jurisdiction; and to require disclosure to purchasers of such plans information as to whether the plans are fully insured.
History:
1978 Comp., § 59A-15-15, enacted by Laws 1991, ch. 125, § 21.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 15 - Unauthorized Insurers › Section 59A-15-16 - Jurisdiction over health care benefits providers presumed.

Notwithstanding any other provision of law and except as provided in the Health Care Benefits Jurisdiction Act [59A-15-14 to 59A-15-19 NMSA 1978], any person who provides coverage in this state for health benefits, including coverage for medical, surgical, hospital, osteopathic, acupuncture and oriental medicine, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental or optometric expenses, whether such coverage is by direct payment, reimbursement or otherwise, shall be presumed to be subject to the provisions of the Insurance Code and the jurisdiction of the superintendent unless the person provides evidence satisfactory to the superintendent that he is subject exclusively to the jurisdiction of another agency of this state or the federal government.
History:
1978 Comp., § 59A-15-16, enacted by Laws 1991, ch. 125, § 22; 1993, ch. 158, § 3.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
The 1993 amendment,
effective June 18, 1993, substituted "who provides coverage" for "that provides coverage" near the beginning, "acupuncture and oriental medicine, chiropractic, physical therapy," for "acupuncture, chiropractic, physical therapy," near the middle, and "he is subject exclusively" for "it is subject exclusively" near the end.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 15 - Unauthorized Insurers › Section 59A-15-17 - Demonstrating jurisdiction.

Any person providing coverage for health care benefits as described in Section 59A-15-16 NMSA 1978 may demonstrate that it is subject to the jurisdiction of another agency of this state or the federal government by providing to the superintendent:
A. the appropriate certificate, license or other document issued by the other governmental agency that permits or qualifies it to provide such coverage; or
B. other evidence satisfactory to the superintendent, after consultation with the other governmental agency, if necessary, that the provider is acting pursuant to a federal or state law that grants exclusive jurisdiction to a federal agency or another agency of this state.
History:
1978 Comp., § 59A-15-17, enacted by Laws 1991, ch. 125, § 23.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 15 - Unauthorized Insurers › Section 59A-15-18 - Examination.

Any person providing coverage for health care benefits as described in Section 59A-15-16 NMSA 1978 who is unable to demonstrate under Section 59A-15-17 NMSA 1978 that he is subject to the exclusive jurisdiction of another agency of this state or the federal government shall submit to an examination by the superintendent in accordance with Chapter 59A, Article 4 NMSA 1978 to determine the organization and financial condition of the provider and his compliance with the applicable provisions of the Insurance Code.
History:
1978 Comp., § 59A-15-18, enacted by Laws 1991, ch. 125, § 24.
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 15 - Unauthorized Insurers › Section 59A-15-19 - Disclosure.

Any agent or administrator that advertises, sells, transacts or administers coverage in this state as described in Section 59A-15-16 NMSA 1978 shall, if the coverage is not fully insured or otherwise fully covered by an authorized insurer, advise every purchaser, prospective purchaser and covered person of the lack of insurance or other coverage. Any administrator that advertises or administers such coverage in this state shall inform any producing agency of the elements of the coverage including the amount of any applicable stop-loss insurance and the insurer affording it.
History:
1978 Comp., § 59A-15-19, enacted by Laws 1991, ch. 125, § 25.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 15 - Unauthorized Insurers › Section 59A-15-20 - Multiple-employer welfare arrangements; regulations.

A. The superintendent, after a public hearing, shall, no later than October 1, 2001, adopt reasonable rules and regulations governing any employee welfare benefit plan that is a multiple-employer welfare arrangement. The regulations at a minimum shall provide for:
(1) registration of all such plans and standards requiring the maintenance of specified levels of reserves;
(2) minimum solvency requirements;
(3) accounting standards and reporting requirements;
(4) standards for appropriate investment of assets;
(5) standards for excess or stop-loss insurance coverage;
(6) specified levels of contributions that any such plan, or any trust established under such a plan, must meet;
(7) methods for equitable assessment of member employers for any funding shortfall; and
(8) standards for adequate governance.
B. The rules and regulations shall provide for compliance with the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978] and provide standards for minimum benefits, including coverage of all benefits required of health insurance under other sections of the Insurance Code [Chapter 59A NMSA 1978].
C. The rules and regulations shall provide that all employees or association members shall be eligible for participation in the plan.
D. Any standards for determining or assuring solvency shall not be applicable to plans that are fully insured by carriers authorized to transact insurance in New Mexico. If at any time a plan does not meet the standards established, the superintendent may take action pursuant to the Insurance Code.
History:
1978 Comp., § 59A-15-20, enacted by Laws 1991, ch. 125, § 26; 2001, ch. 223, § 1.
ANNOTATIONS
The 2001 amendment,
effective June 15, 2001, added the Subsection A designation, and in that Subsection, substituted "after a public hearing, shall, no later than October 1, 2001, adopt" for "after a hearing thereon, shall make", added the Paragraph (1) designation, and added Paragraphs (2) to (8); added Subsections B and C; added the Subsection D designation, and in that subsection, substituted "the superintendent may take action pursuant to the Insurance Code" for "no benefits may be paid under the plan."
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 15 - Unauthorized Insurers › Section 59A-15-21 - Short title.

Chapter 59A, Article 15 NMSA 1978 may be cited as the "Unauthorized Insurers Law".
History:
1978 Comp., § 59A-15-21, enacted by Laws 1993, ch. 320, § 55.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-2 - Purpose of article.

A purpose of this article is to regulate trade practices in the insurance business and related businesses in accordance in part with the intent of Congress as expressed in the Act of Congress approved March 9, 1945, being c. 20, 59 Stat. 33, also designated as 15 U.S.C. Secs. 1011 to 1015, inclusive, by defining, or providing for determination of, practices in this state which constitute unfair methods of competition or unfair or deceptive acts or practices so defined or determined.
History:
Laws 1984, ch. 127, § 270.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-3 - Practices and acts prohibited, in general.

No person shall engage in this state in any practice which in this article is defined or prohibited as, or determined to be, an unfair method of competition, or unfair or deceptive act or practice, or fraudulent.
History:
Laws 1984, ch. 127, § 271.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 932.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-5 - False information, advertising.

No person shall make, publish, disseminate, circulate or place before the public, or cause, directly or indirectly, to be made, published, disseminated, circulated or placed before the public, in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, any advertisement, announcement or statement containing any assertion, representation or statement with respect to any business subject to the superintendent's supervision under the Insurance Code, or with respect to any person in the conduct of such business, which is untrue, deceptive or misleading.
History:
Laws 1984, ch. 127, § 273.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
Disclosures related to modal premium charges.
— Under both the Unfair Practices Act and the Unfair Insurance Practices Act, an insurer may have a duty to disclose information about "finance charges" and "APR" rates when insureds pay modal premium charges, depending on the materiality of the facts.
Azar v. Prudential Ins. Co.
, 2003-NMCA-062, 133 N.M. 669, 68 P.3d 909, cert. denied, 133 N.M. 539, 65 P.3d 1094.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Liability for false obituary or news report of death, 85 A.L.R.4th 813.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-6 - "Twisting" prohibited.

No person shall make or issue, or cause to be made or issued in any manner, any written or oral statement misrepresenting or making misleading comparison as to the terms, conditions, benefits or advantages of any policy for the purpose of inducing or attempting or tending to induce any other person to lapse, forfeit, surrender, borrow against, retain, exchange, convert or otherwise deal with or dispose of any policy.
History:
Laws 1984, ch. 127, § 274.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-7 - Replacement of life insurance.

In addition to other powers of the superintendent in respect thereto, the superintendent shall by regulation require persons who replace or offer or propose to replace existing life insurance with other life insurance, to disclose to the policyholder all information the superintendent deems relevant in a form and manner and at a time set by the superintendent.
History:
Laws 1984, ch. 127, § 275.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-8 - Falsification, omission of records; misleading financial statements.

A. No person shall make or cause to be made any false entry in any book, report or statement of any insurer with intent to injure or defraud the insurer or any other person, or to deceive any officer of the insurer, or the superintendent or any examiner appointed to examine the affairs of the insurer. Any person who violates this subsection, or with like intent aids or abets any such violation is guilty of a felony.
B. No person shall with intent to deceive the insurer, or the superintendent or any examiner appointed to examine into the insurer's affairs, omit to make a true entry of any material fact pertaining to the insurer's business in any book, report or statement of the insurer. A violation of this subsection shall be subject to the same penalty as prescribed in Subsection A.
C. No person shall knowingly file with any supervisory or other public officer, or make, publish, disseminate, circulate or deliver to any person, or place before the public, or cause directly or indirectly, to be made, published, disseminated, circulated, delivered to any person, or placed before the public, any false statement of the financial condition of an insurer.
D. No person shall advertise the capital or assets of an insurer without the same advertisement setting forth the amount of the insurer's liabilities.
History:
Laws 1984, ch. 127, § 276.
ANNOTATIONS
Cross references.
— For general penalty provision,
see
59A-1-18 NMSA 1978.
For penalty for felonies,
see
31-18-15 NMSA 1978.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 931.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-9 - Publication of nonstatutory financial statements.

Any other provision of the Insurance Code to the contrary notwithstanding, an insurer may, subject to requirements of regulations promulgated by the superintendent, for proper special purposes prepare and publish financial statements or information based on financial statements prepared on bases which are in accordance with requirements of the Securities and Exchange Commission or other such competent authority, and which differ from the bases of statements filed with the superintendent.
History:
Laws 1984, ch. 127, § 277.
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 16 - Trade Practices and Frauds › Section 59A-16-10 - Defamation.

A. No person shall make, publish, disseminate or circulate, directly or indirectly, or aid, abet, counsel, procure or encourage the making, publishing, disseminating, transmission or circulation to another, of any oral or written statement or any pamphlet, circular, article or literature which is false, or maliciously critical of, or derogatory as to financial condition or otherwise as to an insurer or organization proposing to become an insurer, and which is calculated to injure such insurer, or proposed insurer, or any person engaged or proposing to engage in any of the business of or with an insurer.
B. Any person who violates this section shall be guilty of a misdemeanor and is subject to the penalties prescribed by Section 18 [59A-1-18 NMSA 1978] (general penalty) of the Insurance Code.
History:
Laws 1984, ch. 127, § 278.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-11 - Unfair discrimination prohibited; life and health insurance.

No insurer or person shall make or permit any unfair discrimination:
A. between individuals of the same class and equal expectation of life in rates charged for any contract of life insurance or of life annuity, or in dividends or other benefits payable thereon, or in any other of the terms and conditions of such contract; or
B. between individuals and risks of the same class and of essentially the same hazard, in amount of premium, fees or rates charged for any policy or contract of health insurance or in the benefits payable thereunder, or in any of the terms or conditions of such policy or contract, or in any other manner whatever.
History:
Laws 1984, ch. 127, § 279.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
State regulation of insurer's right to classify insureds for premium or other underwriting purposes by occupation, 57 A.L.R.4th 625.
The Propriety, under ERISA (29 USCS § 1001 et seq.) and the Americans With Disabilities Act (42 USCS § 12101 et seq.), of Capping Health Insurance Coverage for HIV-Related Claims, 131 A.L.R. Fed. 191.
44 C.J.S. Insurance § 362.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-11.1 - Medical Insurance Pool Act; unfair referral.

It is an unfair trade practice for an insurer or other person to refer an individual employee or an employee's eligible dependent to the plan offered pursuant to the Medical Insurance Pool Act [Chapter 59A, Article 54 NMSA 1978] or to arrange for an individual employee or an employee's eligible dependent to apply to the plan, for the purpose of separating that employee or dependent from group health insurance coverage provided in connection with the employee's employment.
History:
Laws 2001, ch. 352, § 14.
ANNOTATIONS
Effective dates.
— Laws 2001, ch. 352 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 15, 2001, 90 days after adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-12 - Discrimination in insurance.

No insurer shall, on the basis of the race, color, religion or national origin of any individual or group of persons:
A. refuse to make insurance available to any applicant for insurance; or
B. treat any such applicant or insured differently than any other applicant or insured with respect to the terms, conditions, rates, benefits or requirements of any such insurance contract.
This section shall not apply to life insurance contracts or annuities entered into prior to the section's effective date. This section shall not be construed to affect criteria for acceptance into membership of any fraternal benefit society.
History:
Laws 1984, ch. 127, § 279.1.
ANNOTATIONS
Compiler's notes.
— The phrase "section's effective date" means January 1, 1985, the effective date of Laws 1984, Chapter 127.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
44 C.J.S. Insurance § 362.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-12.1 - Discrimination on the basis of deterioration in health.

A. No insurer shall cancel or change the premiums, benefits or conditions of an individual health insurance policy or contract as to one insured solely because of a deterioration in the health of that insured occurring after the issuance or delivery of the policy or contract.
B. No conversion of a group health insurance policy that provides hospital, surgical and medical expense benefits shall be made to a conversion policy that has not been approved and found by the superintendent to provide benefits and conditions closely approximating the coverage of the policy from which conversion is exercised.
History:
1978 Comp., § 59A-16-12.1, enacted by Laws 1991, ch. 111, § 12.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-13 - Prohibiting sex discrimination in insurance.

No insurer shall refuse to insure, refuse to continue to insure or limit the amount of coverage available to an individual because of the sex of the individual.
History:
Laws 1984, ch. 127, § 279.2.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
44 C.J.S. Insurance § 362.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-13.1 - Craniomandibular and temporomandibular joint disorders.

No insurer or other provider of health care benefits regulated under Articles 22, 23, 24A, 44, 46, 47 or 54 of the Insurance Code shall, after July 1, 1989, issue, deliver or execute in this state any policy, plan, contract or certificate of health, medical, hospitalization, accident or sickness coverage unless the policy, plan, contract, certificate or other evidence of coverage provides for surgical and nonsurgical treatment of temporomandibular joint disorders and craniomandibular disorders, subject to the same conditions, limitations, prior review and referral procedures as are applicable to treatment of any other joint in the body and treatable by any practitioner of the healing arts as defined in Section 59A-22-32 NMSA 1978. The health care coverage for craniomandibular and temporomandibular joint disorders required by this section may be subject to reasonable copayments or coinsurance provisions and need not include coverage for orthodontic appliances and treatment, crowns, bridges and dentures unless the disorder is trauma related.
History:
1978 Comp., § 59A-16-13.1, enacted by Laws 1989, ch. 304, § 1; 1999, ch. 289, § 22.
ANNOTATIONS
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
The 1999 amendment,
effective June 18, 1999, substituted "24A" for "24" in the list of Articles in the first sentence.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-13.2 - Discrimination on the basis of blindness.

A. No insurer, including health maintenance organizations, nonprofit health care plans and fraternal benefit societies, shall refuse to insure, or refuse to continue to insure, or limit the amount, extent or kind of coverage available to an individual, or charge an individual a different rate for the same coverage solely because of blindness, including partial blindness.
B. With respect to the underlying cause of the blindness, persons who are blind shall be subject to the same standards of sound actuarial principles or actual or reasonably anticipated experience as are sighted persons, and blindness may be considered as evidence of the severity or progression of the underlying cause.
C. Refusal to insure includes denial by an insurer of disability insurance coverage on the grounds that the policy defines "disability" as being presumed in the event that the insured loses his eyesight. However, an insurer may exclude from coverage disabilities consisting solely of blindness when such condition exists at the time the policy is issued.
History:
1978 Comp., § 59A-16-13.2, enacted by Laws 1993, ch. 126, § 1.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-15 - Discrimination; rebates and certain inducements prohibited; life, health and annuity contracts.

Except as otherwise expressly provided by law, no person shall directly or indirectly, as an inducement to any contract of life, annuity or health insurance:
A. offer, pay or accept any special favor or advantage, any rebate of premiums or any valuable consideration or promise whatsoever; or
B. promise any returns or profits, interest or dividends not specified in the contract.
History:
Laws 1984, ch. 127, § 281; 2021, ch. 108, § 9.
ANNOTATIONS
The 2021 amendment,
effective July 1, 2021, clarified provisions related to the prohibition of inducements to any contract of life, annuity or health insurance; in the section heading, added "Discrimination"; after "no person shall", deleted "knowingly" and added "directly or indirectly, as an inducement to any contract of life, annuity or health insurance"; and completely rewrote Subsections A and B.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Insurance anti-rebate statutes: validity and construction, 90 A.L.R.4th 213.
43 Am. Jur. 2d Insurance §§ 831, 832.
45 C.J.S. Insurance § 484.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-18 - Receipt of rebates and inducements; penalty.

Any person not a licensed agent, broker, solicitor or other representative, who at any time knowingly receives any rebate of any premium specified in any insurance policy or coverage, or any special favor or advantage of any kind or nature whatsoever not plainly designated in the policy, or receive any dividends or profits, except dividends on participating policies, or agrees to receive such dividends or profits or anything of value whatsoever not specified in the policy other than matters exempted under Sections 282 and 283 [59A-16-16 and 59A-16-17 NMSA 1978] of this article, shall upon conviction thereof be guilty of a misdemeanor punishable by a fine of not over one thousand dollars ($1,000).
History:
Laws 1984, ch. 127, § 284.
ANNOTATIONS
One object of section is to prevent splitting of commissions
with the insured or some friend of the prospect who may assist the agent in "bringing him through". It was not intended that any contract of insurance made in its violation should be invalid, but merely that the practice should be discouraged by a forfeiture of the license of anyone violating the statute.
Douglass v. Mutual Benefit Health & Accident Ass'n
, 1937-NMSC-097, 42 N.M. 190, 76 P.2d 453.
Liability for payment of premium.
— Since the insurance company could not have avoided liability on its policy because of a rebate illegally given to insured, neither could insured escape payment of the premium represented by the note on such grounds; to excuse him would result in his being permitted to take advantage of his own criminal act.
Southern States Life Ins. Co. v. McCauley
, 1970-NMSC-010, 81 N.M. 114, 464 P.2d 404.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance §§ 831, 832.
Insurance anti-rebate statutes: validity and construction, 90 A.L.R.4th 213.
44 C.J.S. Insurance § 85 et seq.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-19 - Monopolistic practices prohibited.

No person shall enter into any agreement to commit, or by any concerted action commit, any act of boycott, coercion or intimidation resulting or tending to result in unreasonable restraint of, or monopoly in, the business of insurance in this state, or in the business of health care services, prepaid dental services, motor clubs or bail bondsmen.
History:
Laws 1984, ch. 127, § 285.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-20.1 - Homeowner's casualty insurance; premium rate and policy; protection after natural disaster.

A. A homeowner's casualty insurance policy shall not be canceled or denied renewal because of a homeowner's claim made as a result of damages caused by a natural disaster to the homeowner's private residence, provided that the homeowner's policy expressly provides for such coverage.
B. The provisions of this section apply to all insurance carriers authorized under the Insurance Code [Chapter 59A NMSA 1978] to transact homeowner's casualty insurance policies. For the purposes of this section, "natural disaster" means any hurricane, tornado, storm, flood, high water, wind-driven water, earthquake, landslide, mudslide, snowstorm, drought, fire, explosion or other catastrophe that results in substantial damage to property, hardship, suffering or loss of life.
History:
Laws 1993, ch. 350, § 1; 2007, ch. 282, § 10.
ANNOTATIONS
The 2007 amendment,
effective June 15, 2007, defined "natural disaster".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-21.2 - Health benefits plans; prohibition; unlicensed health benefits plans; unapproved health benefits plans.

A. No person or entity shall sell or issue, or cause to be sold or issued, a health benefits plan that is unlicensed or unapproved for sale or delivery in the state.
B. No person or entity shall sell or issue, or cause to be sold or issued, health insurance coverage that is not permitted health insurance coverage.
C. As used in this section:
(1) "health benefits plan" means a policy or agreement entered into, offered or issued by a health insurance carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services; and
(2) "health insurance carrier" means an entity subject to the insurance laws and regulations of this state, including a health insurance company, a health maintenance organization, a hospital and health services corporation, a provider service network, a nonprofit health care plan or any other entity that contracts or offers to contract, or enters into agreements to provide, deliver, arrange for, pay for or reimburse any costs of health care services, or that provides, offers or administers health benefits plans or managed health care plans in this state.
History:
Laws 2019, ch. 235, § 7.
ANNOTATIONS
Effective dates.
— Laws 2019, ch. 235 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 14, 2019, 90 days after the adjournment of the legislature.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-21.4 - Unfair trade practices on the basis of disability prohibited. (Effective January 1, 2024.)

A. Any of the following practices with respect to a health benefits plan are defined as unfair and deceptive practices and are prohibited:
(1) canceling or changing the premiums, benefits or conditions of a health benefits plan on the basis of an insured's actual or perceived disability;
(2) denying a prosthetic or orthotic benefit for an individual with limb loss or absence that would otherwise be covered for a non-disabled person seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity;
(3) failure to apply the most recent version of treatment and fit criteria developed by the professional association with the most relevant clinical specialty when performing a utilization review for a request for coverage of prosthetic or orthotic benefits; and
(4) failure to apply medical necessity review standards developed by the professional association with the most relevant clinical specialty when conducting utilization management review or processing appeals regarding benefit denial.
B. For purposes of this section, "health benefits plan" means a policy or agreement entered into, offered or issued by a health insurance carrier to provide, deliver, arrange for, pay for or reimburse the costs of health care services; provided that "health benefits plan" does not include the following:
(1) an accident-only policy;
(2) a credit-only policy;
(3) a long- or short-term care or disability income policy;
(4) a specified disease policy;
(5) coverage provided pursuant to Title 18 of the federal Social Security Act, as amended;
(6) coverage provided pursuant to Title 19 of the federal Social Security Act and the Public Assistance Act;
(7) a federal TRICARE policy, including a federal civilian health and medical program of the uniformed services supplement;
(8) a fixed or hospital indemnity policy;
(9) a dental-only policy;
(10) a vision-only policy;
(11) a workers' compensation policy;
(12) an automobile medical payment policy; or
(13) any other policy specified in rules of the superintendent.
History:
Laws 2023, ch. 196, § 2.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 196, § 7 made Laws 2023, ch. 196, § 2 effective January 1, 2024.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-21.5 - Health benefits plan disclosure.

Each producer, plan administrator or pharmacy benefits manager licensed in this state shall not produce a health benefits plan for sale or pharmacy benefits services for contract without prior disclosure to the purchaser of the plan or services of the option to contract for pharmaceutical drug cost-sharing protections.
History:
Laws 2023, ch. 206, § 2.
ANNOTATIONS
Effective dates.
— Laws 2023, ch. 206 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.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-22 - Record of complaints required.

An insurer shall maintain a complete record of all complaints it has received during the next preceding three (3) years, or since date of last examination by the superintendent or other similar supervisory authority, whichever period is shorter. The record shall show the total number of complaints, classification by line of coverage, nature of each complaint, disposition of the complaint and time it took to process each complaint. For purposes of this section "complaint" means any written communication primarily expressing a grievance.
History:
Laws 1984, ch. 127, § 288.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-23 - False applications, claims, proofs of loss.

A. An agent, broker, solicitor, examining physician, applicant or other person shall not knowingly or willfully:
(1) make a false or fraudulent statement or representation as to a material fact in or with reference to an application for insurance or other coverage;
(2) for the purpose of obtaining money or benefit, present or cause to be presented a false or fraudulent claim or proof in support of such a claim for payment of loss under a policy;
(3) prepare, make or subscribe a false or fraudulent account, certificate, affidavit or proof of loss or other document with intent that the same may be presented or used in support of such a claim; or
(4) make a false or fraudulent statement or representation on or relative to an application for a policy for the purpose of obtaining a fee, commission or benefit from an insurer, agent, broker or individual.
B. A false statement or representation made under oath shall constitute and be punishable as perjury. A violation of the provisions of this section when the purported loss or potential loss to the victim insurer is:
(1) two hundred fifty dollars ($250) or less is a petty misdemeanor;
(2) over two hundred fifty dollars ($250) but not more than five hundred dollars ($500) is a misdemeanor;
(3) over five hundred dollars ($500) but not more than two thousand five hundred dollars ($2,500) is a fourth degree felony;
(4) over two thousand five hundred dollars ($2,500) but not more than twenty thousand dollars ($20,000) is a third degree felony; or
(5) over twenty thousand dollars ($20,000) is a second degree felony.
History:
Laws 1984, ch. 127, § 290; 2006, ch. 29, § 27.
ANNOTATIONS
The 2006 amendment,
effective July 1, 2006, added Paragraph (1) of Subsection B to provide that if the loss is $250 or less, the crime is a petty misdemeanor; added Paragraph (2) of Subsection A to provide that if the loss is more than $250, but not more than $500, the crime is a misdemeanor; added Paragraph (3) of Subsection A to provide that if the loss is more than $500, but not more than $2,500, the crime is a fourth degree felony; added Paragraph (4) of Subsection A to provide that if the damage is more than $2,500 but not more than $20,000, the crime is a third degree felony; and added Paragraph (5) of Subsection B to provide that if the damage is more than $20,000, the crime is a second degree felony.
Insurance agent did not violate Subsection A
by listing "draperies sales" as the type of business insured, after inspecting the premises and seeing that drapery sales, as well as manufacturing, took place there.
Corbin v. State Farm Ins. Co.
, 1990-NMSC-014, 109 N.M. 589, 788 P.2d 345.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Negligent misrepresentation as "accident" or "occurrence" warranting insurance coverage, 58 A.L.R.5th 483.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-25 - Knowledge of insurer of prohibited acts.

An insurer shall be held guilty of having committed any of the acts prohibited by this article by reason of the act of any agent, solicitor or employee not an officer, director or department head thereof, if an officer, director or department head of the insurer has authorized or knowingly permitted such act or has had prior knowledge thereof.
History:
Laws 1984, ch. 127, § 292.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-26 - Insurer name; deceptive use prohibited.

No person who is not an insurer shall assume or use in this state any name which deceptively implies or suggests that it is an insurer.
History:
Laws 1984, ch. 127, § 293.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-27 - Desist orders for prohibited practices.

A. If the superintendent has cause to believe that any unfair method of competition or act or practice defined or prohibited in Chapter 59A, Article 16 NMSA 1978 is being engaged in by any person, he shall order such person to cease and desist therefrom. The superintendent shall deliver such order to such person directly or by certified mail. If the person fails to comply therewith within twenty days after receipt of the cease and desist order, and does not make written request for a hearing thereon within such twenty days, he shall be subject to the penalties referred to in Section 59A-16-29 NMSA 1978, for each violation committed theretofore or thereafter. In any event, if the person does not make a written request for hearing thereon within such twenty days the order shall be final and not subject to review or appeal.
B. If a hearing is so requested, the superintendent shall hold a hearing, and proceed as provided under Chapter 59A, Article 4 NMSA 1978 as to hearings in general.
C. If after such a hearing the violation is confirmed by final order of the superintendent, the violator shall be subject to the penalty referred to in Subsection A of this section, together with payment of the costs of the hearing as determined by the superintendent.
D. If the alleged violator fails to comply with the superintendent's order after expiration of the twenty-day period to request a hearing referred to in Subsection A of this section or after hearing referred to in Subsection C of this section, the superintendent may cause an action for injunction to be filed in the district court of the county in which the violation occurred.
E. No order of the superintendent pursuant to this section or order of court to enforce it, shall in any way relieve or absolve any person affected by such order from any other liability, penalty or forfeiture applicable under law.
F. Nothing in this section shall be construed as relieving any violator from penalties prescribed in Section 59A-16-29 NMSA 1978 whether or not such a cease and desist order is issued or other action hereunder taken by the superintendent.
History:
Laws 1984, ch. 127, § 294; 1993, ch. 320, § 56.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, added the last sentence in Subsection A, rewrote Subsection D, and made stylistic changes throughout the section.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance §§ 56, 59.
44 C.J.S. Insurance § 74.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-28 - Procedure as to undefined practices.

A. If the superintendent believes that any person engaged in any business which is subject to the superintendent's supervision under the Insurance Code, is in the conduct of such business engaging in this state in any method of competition or in any act or practice not defined in this article which is unfair or deceptive and that a proceeding by him in respect thereto would be in the public interest, the superintendent shall, after a hearing of which notice and of the charges against such person are given him, make a written report of his findings of fact relative to such charges and serve a copy thereof upon such person and any intervenor at the hearing.
B. If such report charges a violation of this article and if such method of competition, act or practice has not been discontinued, the superintendent may at any time after twenty (20) days after the service of such report cause an action to be instituted in the district court of the county wherein the person resides or has his principal place of business to enjoin and restrain such person from engaging in such method, act or practice. The court shall have jurisdiction of the proceeding and shall have power to make and enter appropriate orders in connection therewith and to issue such writs or orders as are ancillary to its jurisdiction or necessary in its judgment to prevent injury to the public pendente lite; but the state of New Mexico shall not be required to give security before the issuance of any such order or injunction under this section. A certified transcript of the record of the proceedings in the hearing before the superintendent, including all evidence taken and the report and findings, shall be received in evidence in such action.
C. If the court finds that:
(1) the method of competition complained of is unfair or deceptive; and
(2) the proceedings of the superintendent with respect thereto are to the interest of the public; and
(3) the findings of the superintendent are supported by the weight of the evidence, it shall issue its order enjoining and restrainting [restraining] the continuance of such method of competition, act or practice.
D. Either party may appeal from such final judgment or order or decree of court in a like manner as provided for appeals in civil cases.
E. If the superintendent's report or order on hearing made under Subsection A does not charge a violation of this article, then any intervenor in the proceedings may appeal therefrom within the time and in the manner provided in the Insurance Code for appeals from the superintendent generally.
History:
Laws 1984, ch. 127, § 295.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and it is not part of the law.
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16 - Trade Practices and Frauds › Section 59A-16-29 - Penalties.

In addition to any applicable suspension, revocation or refusal to continue any certificate of authority or license under the Insurance Code, a penalty for violation of any provision of this article may be imposed by the superintendent in accordance with Section 59A-1-18 NMSA 1978.
History:
1978 Comp., § 59A-16-29, enacted by Laws 1991, ch. 111, § 13.
ANNOTATIONS
Repeals and reenactments.
— Laws 1991, ch. 111, § 13 repealed former 59A-16-29 NMSA 1978, as enacted by Laws 1984, ch. 127, § 296, relating to penalties, and enacted a new section, effective July 1, 1991.
Cross references.
— For the Insurance Code,
see
59A-1-1 NMSA 1978 and notes thereto.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 59.
Value of insured's assets as limitation, in action by insured or insured's assignee for liability insurer's wrongful failure to defend, on recovery of amount of judgment against insured in excess of policy amount, 36 A.L.R.4th 922.
44 C.J.S. Insurance §§ 96, 97.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16A - Insurance Fraud Reporting Immunity (Repealed.) › Section 59A-16A-1 to 59A-16A-4 - Repealed.

ANNOTATIONS
Repeals.
— Laws 1998, ch. 115, § 18 repealed 59A-16A-1 to 59A-16A-4 NMSA 1978, amended by Laws 1991, ch. 86, §§ 1-4, relating to Insurance Fraud Reporting Immunity Act, effective July 1, 1998. For provisions of former sections,
see
the 1997 NMSA 1978 on
NMOneSource.com
. For new similar provisions,
see
Chapter 59A, Article 16C NMSA 1978.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16B - Domestic Abuse Insurance Protection › Section 59A-16B-1 - Short title.

Sections 1 through 10 [59A-16B-1 to 59A-16B-10 NMSA 1978] of this act may be cited as the "Domestic Abuse Insurance Protection Act".
History:
Laws 1997, ch. 141, § 1.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16B - Domestic Abuse Insurance Protection › Section 59A-16B-2 - Purpose of act.

The purpose of the Domestic Abuse Insurance Protection Act is to prohibit insurers from unlawfully discriminating on the basis of domestic abuse by using the fact of domestic abuse or the insurer's determination of a person's abuse status as an insurance criterion or rating factor. The Domestic Abuse Insurance Protection Act protects victims of domestic abuse, domestic abuse shelters and others from being unlawfully discriminated against in insurance matters.
History:
Laws 1997, ch. 141, § 2.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16B - Domestic Abuse Insurance Protection › Section 59A-16B-5 - Justification of adverse insurance underwriting decisions.

An insurer that takes an underwriting action that adversely affects a victim of domestic abuse on the basis of a medical condition, claims history or other underwriting information that the insurer knows is abuse-related shall explain the reason for its action to the applicant or insured in writing and, upon request, shall be able to demonstrate that its action and any applicable plan provision:
A. does not treat abuse status as a medical condition or underwriting criterion;
B. is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar condition or claims history without regard to whether the condition, history or claim is abuse-related; and
C. is based on a determination, made in conformance with sound actuarial principles and supported by reasonable statistical evidence, or related to actual or reasonably anticipated experience, that there is a correlation between the medical condition, claims history or other underwriting information and a material increase in insurance risk.
History:
Laws 1997, ch. 141, § 5.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16B - Domestic Abuse Insurance Protection › Section 59A-16B-6 - Insurance company procedures to protect the safety and privacy of victims of domestic abuse.

The superintendent, in consultation with public safety officials who specialize in domestic abuse matters or with a recognized domestic abuse advocacy group, shall adopt regulations that specify procedures to be followed by an insurer's employees, contractors, agents and brokers for the purpose of protecting the safety and privacy of victims of domestic abuse involved in an insurance action, including claims investigation and subrogation.
History:
Laws 1997, ch. 141, § 6.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16B - Domestic Abuse Insurance Protection › Section 59A-16B-7 - Rules and regulations.

The superintendent may adopt, in accordance with Section 59A-2-9 NMSA 1978, rules and regulations necessary to administer provisions of the Domestic Abuse Insurance Protection Act.
History:
Laws 1997, ch. 141, § 7.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 16B - Domestic Abuse Insurance Protection › Section 59A-16B-9 - Applicability.

The provisions of the Domestic Abuse Insurance Protection Act apply to all insurers as defined in that act, including the following:
A. fraternal benefit societies pursuant to Chapter 59A, Article 44 NMSA 1978;
B. health maintenance organizations and their promoters, sponsors, directors, officers, employees, agents, solicitors and other representatives pursuant to Chapter 59A, Article 46 NMSA 1978;
C. health care plans and their promoters, sponsors, directors, officers, employees, agents, solicitors and other representatives pursuant to Chapter 59A, Article 47 NMSA 1978;
D. prepaid dental plan organizations and their sponsors, directors, officers, personnel and representatives and member contracts pursuant to Chapter 59A, Article 48 NMSA 1978; and
E. motor clubs and their sponsors, directors, officers, representatives, personnel and operations pursuant to Chapter 59A, Article 50 NMSA 1978.
History:
Laws 1997, ch. 141, § 9.