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1,724 sections in this chapter.
NMSA 1978, § 59A-47-27 Coverage for newly born children, maternity transport,
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home health care. Subscriber contracts of a health care plan shall also be subject to coverage as required of health insurers under Sections 59A-22-34 through 59A-22-36 NMSA 1978. History: Laws 1984, ch. 127, § 879.25; 1987, ch. 259, § 31.
NMSA 1978, § 59A-47-27.1 Coverage of circumcision for newborn males
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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, § 10.
NMSA 1978, § 59A-47-28 Coverage for service of chiropractor
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All individual and group subscriber contracts delivered or issued for delivery in New Mexico, which, on a service basis or on an indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall …
NMSA 1978, § 59A-47-28.1 Coverage for service of certified nurse-midwives and
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registered lay midwives. A. Any individual and group subscriber contracts delivered in New Mexico which provide for obstetrical and/or maternity benefits on a service basis or an indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of …
NMSA 1978, § 59A-47-28.2 Doctor of oriental medicine discrimination prohibited
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All individual and group subscriber contracts delivered or issued for delivery in New Mexico by a nonprofit health care plan that, on a service or indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or menta…
NMSA 1978, § 59A-47-28.3 Provider discrimination prohibited
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All individual and group subscriber contracts delivered or issued for delivery in New Mexico that, on a prepaid, service or indemnity basis, or all of them, provide for treatment of persons for the prevention, cure or correction of an illness or physical or mental condition shall…
NMSA 1978, § 59A-47-28.4 Coverage for collaborative practice; dental therapists;
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dental hygienists. An individual or group subscriber contract delivered or issued for delivery in New Mexico that, on a prepaid, service or indemnity basis, provides for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition sha…
NMSA 1978, § 59A-47-29 Settlement of disputes; appeal
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The parties to a dispute between a health care plan and a purveyor arising out of a health care expense payments contract may submit the dispute to the superintendent for his final decision and his final decision shall then be binding upon the parties to the contract. A party to …
NMSA 1978, § 59A-47-3 Definitions
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A. "acquisition expenses" includes all expenses incurred in connection with the solicitation and enrollment of subscribers; B. "administration expenses" means all expenses of the health care plan other than the cost of health care expense payments and acquisition expenses; C. "ag…
NMSA 1978, § 59A-47-30 Licensed insurance producers required; qualifications,
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licensing procedures and conditions. A. Solicitation of subscriberships for a health care plan shall be made only by insurance producers of the plan who are duly qualified, appointed and licensed as such under the Insurance Code. This provision shall not apply to salaried officer…
NMSA 1978, § 59A-47-31 Rehabilitation, liquidation or dissolution
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If the superintendent finds that expenses incurred by a health care plan for acquisition of business or administration exceed the limits prescribed under Section 879.17 [59A-47-19 NMSA 1978] of this article, or that the health care plan is at any time unable or prospectively unab…
NMSA 1978, § 59A-47-32 Unauthorized contract or adjustment transactions;
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penalty. A. Any person writing or attempting to write, solicit or procure health care plan contracts within this state without a certificate of authority or license duly issued in accordance with the Insurance Code and then required and subsisting, and any person adjusting, settl…
NMSA 1978, § 59A-47-33 Other provisions applicable
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The provisions of the Insurance Code [Chapter 59A NMSA 1978] other than Chapter 59A, Article 47 NMSA 1978 shall not apply to health care plans except as expressly provided in the Insurance Code and that article. To the extent reasonable and not inconsistent with the provisions of…
NMSA 1978, § 59A-47-34 Continuation of coverage and conversion rights; health
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care plans. A. Every individual or group contract entered into by a health care plan that provides for health care expense payments on a service benefit basis or an indemnity benefit basis or both and that is delivered, issued for delivery or renewed in this state on or after Jul…
NMSA 1978, § 59A-47-35 Alcohol dependency coverage
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A. Each health care plan that delivers or issues for delivery in this state a group contract providing for health care expense payments on a service benefit basis or an indemnity benefit basis or both shall offer and make available benefits for the necessary care and treatment of…
NMSA 1978, § 59A-47-36 Nonprofit health care plans; contract or certificate
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provisions relating to individuals who are eligible for medical benefits under the medicaid program. A. Each individual or group contract for health care expense payments or certificate therefor that is delivered, issued for delivery or renewed in this state by a health care plan…
NMSA 1978, § 59A-47-37 Coverage of children
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A. An insurer shall not deny enrollment of a child under the health plan of the child's parent on the grounds that the child: (1) was born out of wedlock; (2) is not claimed as a dependent on the parent's federal tax return; or (3) does not reside with the parent or in the insure…
NMSA 1978, § 59A-47-37.1 Hearing aid coverage for children required
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A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery 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…
NMSA 1978, § 59A-47-38 Coverage for medical diets for genetic inborn errors of
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metabolism. As of July 1, 2003, subscriber contracts of a health care plan shall also be subject to coverage for special medical diets for genetic inborn errors of metabolism as required of health insurers in Chapter 59A, Article 22 NMSA 1978. History: Laws 2003, ch. 192, § 3.
NMSA 1978, § 59A-47-39 Employer utilization and loss experience availability
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Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 47 NMSA 1978 shall be made available by the carrier only upon the written request of and to employers of subscribers with such coverage within thirty …
NMSA 1978, § 59A-47-4 Organization; profit corporations prohibited; merger and
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consolidation of health care plans. A. A corporation may be organized under the laws of this state which provide for the organization of nonprofit corporations, as a nonprofit corporation organized for making health care expense payments on a service benefit basis or an indemnity…
NMSA 1978, § 59A-47-40 Maximum age of dependent
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An individual or group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers coverage of an insured's dependent shall not terminate coverage of an unmarried dependent by reason of the dependent's ag…
NMSA 1978, § 59A-47-41 Coverage of alpha-fetoprotein IV screening test
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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 t…
NMSA 1978, § 59A-47-41.1 Prior authorization for gynecological or obstetrical
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ultrasounds prohibited. 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 and that provides coverage for gynecological or obstetrical ultrasounds shall not require…
NMSA 1978, § 59A-47-42 Coverage of part-time employees
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A health care plan that provides coverage for health care pursuant to the Nonprofit Health Care Plan Law 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 o…
NMSA 1978, § 59A-47-43 Coverage of colorectal cancer screening
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A. An individual or group health policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for colorectal screening for determining the presence of precancerous or cancerous conditions and ot…
NMSA 1978, § 59A-47-44 General anesthesia and hospitalization for dental
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surgery. A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center fo…
NMSA 1978, § 59A-47-45 Coverage for autism spectrum disorder diagnosis and
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treatment. A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall provide coverage to a subscriber for: (1) well-baby and well-child screening for diagnosing the presence of autis…
NMSA 1978, § 59A-47-45.1 Coverage for orally administered anticancer
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medications; limits on patient costs. 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 and that provides coverage for cancer treatment shall provide coverage for …
NMSA 1978, § 59A-47-45.10 Calculating a subscriber's cost-sharing obligation
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for prescription drug coverage. A. When calculating a subscriber's cost-sharing obligation for covered prescription drugs, pursuant to an individual or group health insurance policy, health care plan or certificate of health insurance issued for delivery or renewed in this state,…
NMSA 1978, § 59A-47-45.2 Coverage of prescription eye drop refills
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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 and that provides coverage for prescription eye drops shall not deny coverage for a renewal of prescription eye d…
NMSA 1978, § 59A-47-45.3 Coverage for telemedicine services
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A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall provide coverage for services provided via telemedicine to the same extent the health care plan covers the same services whe…
NMSA 1978, § 59A-47-45.4 Prescription drugs; prohibited formulary changes;
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notice requirements. A. As of January 1, 2014, an individual or group health care plan that is delivered, issued for delivery or renewed in this state and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsuranc…
NMSA 1978, § 59A-47-45.5 Coverage for contraception
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A. A health care plan delivered or issued for delivery in this state that provides a prescription drug benefit shall provide, at a minimum, the following coverage: (1) at least one product or form of contraception in each of the contraceptive method categories identified by the f…
NMSA 1978, § 59A-47-45.6 Coverage exclusion. (Contingent repeal. See note.)
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Coverage of vasectomy and male condoms pursuant to Section 9 [59A-47-45.5 NMSA 1978] of this 2019 act is excluded for high-deductible health care plans with health savings accounts until a covered person's deductible has been met. History: Laws 2019, ch. 263, § 10.
NMSA 1978, § 59A-47-45.7 Heart artery calcium scan coverage
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A. A group health care plan, other than a small group health care plan, that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible subscribers to receive a heart artery calcium scan. B. Coverage provided pursuant to this section shall: (1)…
NMSA 1978, § 59A-47-45.8 Coverage for individuals with diabetes
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A. Each health care plan delivered or issued for delivery in this state shall provide coverage for individuals with diabetes who use insulin, individuals with diabetes who do not use insulin and with elevated blood glucose levels induced by pregnancy. This coverage shall be a bas…
NMSA 1978, § 59A-47-45.9 Biomarker testing coverage
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A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state shall provide coverage for subscribers to receive biomarker testing. B. Coverage provided pursuant to this section shall be for the purposes of diagnosis, treatment, appropr…
NMSA 1978, § 59A-47-47 Prescription drug prior authorization protocols
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A. After January 1, 2014, a health care plan shall accept the uniform prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61- 11-6.2 NMSA 1978] of this 2013 act as sufficient to request prior authorization for prescription drug benefits. B. No l…
NMSA 1978, § 59A-47-47.1 Prescription drug coverage; step therapy protocols;
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clinical review criteria; exceptions. A. Each individual or group nonprofit health care plan contract delivered or issued for delivery in this state that provides a prescription drug benefit for which any step therapy protocols are required shall establish clinical review criteri…
NMSA 1978, § 59A-47-47.2 Pharmacist prescriptive authority services;
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reimbursement parity. A health care plan shall reimburse a participating provider that is a certified pharmacist clinician or pharmacist certified to provide a prescriptive authority service who provides a service pursuant to a subscriber at the same rate that the carrier reimbur…
NMSA 1978, § 59A-47-48 Pharmacy benefit; prescription synchronization
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A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state and that provides a prescription drug benefit shall allow a subscriber to fill or refill a prescription for less than a thirty-day supply of the prescription drug, and apply…
NMSA 1978, § 59A-47-49 Provider credentialing; requirements; deadline
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A. The superintendent shall adopt and promulgate rules to provide for a uniform and efficient provider credentialing process. The superintendent shall approve no more than two forms of application to be used for the credentialing of providers. B. A health care plan shall not requ…
NMSA 1978, § 59A-47-5 Qualifications for health care plan authority
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The superintendent shall not authorize any proposed health care plan to solicit preliminary applications from subscribers or to transact business as a health care plan unless he finds after such investigation and hearings as he deems advisable that the proposed health care plan i…
NMSA 1978, § 59A-47-50 Physical rehabilitation services; limits on cost sharing
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A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsura…
NMSA 1978, § 59A-47-51 Behavioral health services; elimination of cost sharing
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A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health services in network. B. For the purposes of this section: (1) "be…
NMSA 1978, § 59A-47-52 Anatomical gift nondiscrimination
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A. For purposes of this section: (1) "covered person" means a policyholder or other person covered by a health benefit plan; and (2) "organ transplant" includes parts or the whole of organs, eyes or tissue. B. All individual and group health insurance policies delivered or issued…
NMSA 1978, § 59A-47-53 Diagnostic and supplemental breast examinations
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A. An individual or group health care plan 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 provisio…
NMSA 1978, § 59A-47-54 Chiropractic physician services; limits on cost sharing
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and coinsurance. A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state that offers coverage of the services of a chiropractic physician shall not impose a copayment or coinsurance on those chiropractic physician services that e…
NMSA 1978, § 59A-47-55 Sexually transmitted infection care; cost sharing
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eliminated. A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state that offers coverage for preventive care or treatment of sexually transmitted infections shall not impose cost sharing on eligible subscribers. B. Pursuant to th…
