New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 9 - MINIMUM HEALTHCARE PROTECTION › Section 13.10.9.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
Policies or plans issued pursuant to the Minimum Healthcare
				  Protection Act which contain the following terms shall define such terms in the
				  following manner:
A.
"Group"
means a group of fewer than twenty members at initial
				enrollment formed for purposes other than obtaining insurance coverage. Where a
				group is an employer, group shall mean any person, firm, corporation,
				partnership or association actively engaged in business which, on at least
				fifty percent of its working days during the preceding year, employed fewer
				than twenty employees.
B.
"Home healthcare"
as defined in Section 59A-22-36D NMSA 1978,
				means health services provided on a part-time, intermittent basis to an
				individual confined to his or her home due to physical illness.
C.
"Hospital"
means a facility
				which is maintained by the state or any political subdivision of the state or
				any place which is currently licensed as an acute care hospital by the
				department of health and has accommodations for resident bed patients, a
				licensed professional registered nurse always on duty or call, a laboratory and
				an operating room where surgical operations are performed, but the term does
				not include convalescent, nursing or rest homes or facilities primarily for the
				treatment of substance abuse.
D.
"Medicare"
means the federal Health Insurance for the Aged
				Act.
E.
"Nurse
				midwife"
means any person licensed by the board of nursing as a
				registered nurse who is registered with the public health division of the
				department of health as a certified nurse midwife.
F.
"Nurse practitioner"
means
				any person licensed by the board of nursing as a registered nurse approved for
				expanded practice as a certified nurse practitioner pursuant to the Nursing
				Practice Act.
G.
"Physician"
means any person who holds a license provided for in
				Chapter 61, Article 6 or 10 NMSA 1978 authorizing the licensee to offer or
				undertake to diagnose, treat, operate on or prescribe for any human pain,
				injury, disease, deformity or physical condition.
H.
"Physician assistant"
means
				an individual duly qualified under the laws of New Mexico and the rules of the
				medical examiners board who is in good standing with that board and is
				registered to practice under the direction and supervision of a board-approved
				physician.
I.
"Policy or
				plan"
as defined in Section 59A-23B-3A NMSA 1978, means a healthcare
				benefit policy or healthcare benefit plan that the insurer, fraternal benefit
				society, health maintenance organization or nonprofit healthcare plan chooses
				to offer to individuals, families or groups of fewer than twenty members formed
				for purposes other than obtaining insurance coverage and that meets the
				requirements of Section 59A-23B-3B NMSA 1978. For purposes of this rule, policy
				or plan shall not mean a healthcare policy or healthcare benefit plan that an
				insurer, health maintenance organization, fraternal benefit society or
				nonprofit healthcare plan chooses to offer outside the authority of the Minimum
				Healthcare Protection Act.