Chapter 59A, Chapter 59A

A. There is created a nonprofit entity to be known as the "New Mexico medical insurance pool". All insurers shall organize and remain members of the pool as a condition of their authority to transact insurance business in this state. The board is a governmental entity for purpose…

The plan of operation submitted by the board to the superintendent shall: A. establish procedures for the handling and accounting of assets and money of the pool; B. establish regular times and places for meetings of the board; C. establish procedures for records to be kept of al…

A. Every insurer shall provide a notice and an application for coverage by the pool to any person who receives: (1) a rejection of coverage for health insurance or health care services; (2) a notice that the rate for health insurance or coverage for health care services provided …

The board shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact health insurance business. In addition, the board shall have the specific authority to: A. enter into contracts as are necessary or proper to car…

A. The board may establish a prescription drug program, in whole or in part, including a pilot or phase-in program, to offer selected eligible persons the ability to purchase prescription drugs. The board may establish varying levels of eligibility and cost-sharing criteria as ne…

The board may: A. establish a health plan to offer selected eligible individuals the ability to purchase or enroll in a program pursuant to federal law that provides expanded coverage for state high-risk pools; B. establish eligibility and coverage criteria as needed for selected…

The pool shall be subject to and responsible for examination by the superintendent. Not later than June 1 of each year, the board shall submit to the superintendent an audited financial report for the preceding calendar year in a form approved by the superintendent. History: 1978…

All policy forms issued by the pool shall conform in substance to prototype forms developed by the pool and shall be filed with and approved by the superintendent before they are issued. History: 1978 Comp., § 59A-54-9, enacted by Laws 1987, ch. 154, § 9; 1991, ch. 200, § 6.

Sections 1 through 26 [59A-55-1 to 59A-55-26 NMSA 1978] of this act may be cited as the "Risk Retention and Purchasing Group Act". History: Laws 1988, ch. 125, § 1.

The superintendent may require risk retention groups to provide notice to purchasers concerning the limitation of regulatory oversight of risk retention groups and the lack of insolvency guaranty fund protection. History: Laws 1988, ch. 125, § 10.

The following acts by a risk retention group are prohibited: A. the solicitation or sale of insurance by a risk retention group to any person who is not eligible for membership in such group; and B. the solicitation or sale of insurance by, or operation of, a risk retention group…

No risk retention group shall be allowed to do business in this state if an insurance company is directly or indirectly a member or owner of such risk retention group, other than in the case of a risk retention group all of whose members are insurance companies. History: Laws 198…

The terms of any insurance policy issued by any risk retention group shall not provide or be construed to provide coverage prohibited generally by statute of this state or declared unlawful by the highest court of this state whose law applies to such policy. History: Laws 1988, c…

A risk retention group not having a New Mexico certificate of authority that is doing business in New Mexico shall comply with a lawful order issued in a voluntary dissolution proceeding or in a delinquency proceeding commenced by a state superintendent if there has been a findin…

A risk retention group that violates any provision of the Risk Retention and Purchasing Group Act shall be subject to fines and penalties, including revocation of its right to do business in New Mexico, applicable to licensed insurers generally. History: Laws 1988, ch. 125, § 15.

In addition to complying with the requirements of the Risk Retention and Purchasing Group Act, any risk retention group operating in New Mexico prior to enactment of that act shall, within thirty days after the effective date of that act, comply with the provisions of Section 4 o…

A. No risk retention group shall be required or permitted to join or contribute financially to any insurance insolvency guaranty fund or similar mechanism in New Mexico nor shall any risk retention group or its insureds or claimants against its insureds receive any benefit from a…

A purchasing group and its insurer or insurers shall be subject to all applicable laws of this state, except that a purchasing group and its insurer or insurers shall be exempt in regard to liability insurance for the purchasing group from any law that would: A. prohibit the esta…

groups. A. A purchasing group which intends to do business in New Mexico shall, prior to doing business, furnish notice to the superintendent. The notice shall contain all information requested by the superintendent. B. The purchasing group shall register with and designate the s…

The purpose of the Risk Retention and Purchasing Group Act is to regulate the formation and operation of risk retention groups and purchasing groups in New Mexico formed pursuant to the provisions of the federal Liability Risk Retention Act of 1986 to the extent permitted by that…

groups. A. A purchasing group may not purchase insurance from a risk retention group that is not chartered in a state or from an insurer not admitted in the state in which the purchasing group is located, unless the purchase is effected through a licensed agent or broker acting p…

retention groups and purchasing groups. The superintendent is authorized to make use of any of the powers established under the New Mexico Insurance Code to enforce the laws of New Mexico not specifically preempted by the Risk Retention Act of 1986 including the superintendent's …

A risk retention group that violates any provision of the Risk Retention and Purchasing Group Act shall be subject to fines and penalties applicable to licensed insurers generally, including revocation of its certificate of authority or the right to do business in New Mexico, or …

A. No person, firm, association or corporation shall act or aid in any manner in soliciting, negotiating or procuring liability insurance in New Mexico from a risk retention group unless such person, firm, association or corporation is licensed as an insurance producer pursuant t…

court. An order issued by any district court of the United States enjoining a risk retention group from soliciting or selling insurance or operating in any state upon a finding that such a group is in hazardous financial or financially impaired condition shall be enforceable in t…

The superintendent may establish and from time to time amend such regulations relating to risk retention groups and purchasing groups as may be necessary or desirable to carry out the provisions of the Risk Retention and Purchasing Group Act. History: Laws 1988, ch. 125, § 26.

As used in the Risk Retention and Purchasing Group Act: A. "completed operations liability" means liability arising out of the installation, maintenance or repair of any product at a site which is not owned or controlled by: (1) any person who performs that work; or (2) any perso…

A. A risk retention group seeking a New Mexico certificate of authority shall, pursuant to the provisions of the New Mexico Insurance Code, be licensed to write only liability insurance pursuant to the Risk Retention and Purchasing Group Act and, except as provided elsewhere in t…

of authority. A. Risk retention groups chartered and licensed in states other than New Mexico and seeking to do business as a risk retention group in New Mexico shall provide to the superintendent before engaging in the business of insurance in New Mexico: (1) a notice of operati…

A. Each risk retention group shall report to the superintendent the net premium written for risks resident or located within New Mexico. B. To the extent a licensed insurance producer is utilized pursuant to Section 59A- 55-24 NMSA 1978, the licensed insurance producer shall repo…

All risk retention groups doing business in New Mexico and their agents and representatives shall comply with the provisions of Section 59A-16-20 NMSA 1978. History: Laws 1988, ch. 125, § 7.

All risk retention groups doing business in New Mexico shall comply with the laws contained in the New Mexico Insurance Code regarding deceptive, false or fraudulent acts or practices. History: Laws 1988, ch. 125, § 8.

Each risk retention group shall submit to an examination by the superintendent to determine its financial condition if the superintendent of the jurisdiction in which the group is chartered and licensed has not initiated an examination or does not initiate an examination within s…

Chapter 59A, Article 57 NMSA 1978 may be cited as the "Patient Protection Act". History: Laws 1998, ch. 107, § 1; 2003, ch. 327, § 1.

A. Except as otherwise provided in this section, the provisions of the Patient Protection Act apply to the medicaid program operation in the state. A managed health care plan offered through the medicaid program shall grant enrollees and providers the same rights and protections …

In addition to any other penalties provided by law, a civil administrative penalty of up to ten thousand dollars ($10,000) may be imposed for each violation of the Patient Protection Act. An administrative penalty shall be imposed by written order of the superintendent made after…

The purpose of the Patient Protection Act is to regulate aspects of health insurance by specifying patient and provider rights and confirming and clarifying the authority of the department to adopt regulations to provide protections to persons enrolled in managed health care plan…

As used in the Patient Protection Act: A. "continuous quality improvement" means an ongoing and systematic effort to measure, evaluate and improve a managed health care plan's process in order to improve continually the quality of health care services provided to enrollees; B. "c…

comprehensive health care services; grievance procedure; utilization review program; continuous quality program. A. Each covered person enrolled in a managed health care plan has the right to be treated fairly. A managed health care plan shall arrange for the delivery of good qua…

compensation. A. The superintendent may appoint one or more qualified individuals to review external grievance appeals. B. The superintendent shall fix the reasonable compensation of each appointee based upon, but not limited to, compensation amounts suggested by national or stat…

ombudsman office; reports to consumers; superintendent's orders to protect consumers. A. Each managed health care plan shall establish and adequately staff a consumer assistance office. The purpose of the consumer assistance office is to respond to consumer questions and concerns…

grievance procedure for providers. A. No managed health care plan may: (1) adopt a gag rule or practice that prohibits a health care provider from discussing a treatment option with an enrollee even if the plan does not approve of the option; (2) include in any of its contracts w…

A. Except as otherwise provided in this section, the department may require a plan that offers a point-of-service plan or open plan to include in any managed health care plan it offers an option for a point-of-service plan or open plan to the extent that the department determines…

The department shall adopt regulations to ensure that both the administrative costs and the direct costs of providing health care services of each managed health care plan are fully and fairly disclosed to consumers in a uniform manner that allows meaningful cost comparisons amon…

insurance rights; enrollee as third-party beneficiary to enforce rights. A. A person who suffers a loss as a result of a violation of a right protected pursuant to the provisions of the Patient Protection Act, its regulations or a managed health care plan may bring an action to r…

Sections 1 through 13 [59A-57A-1 to 59A-57A-13 NMSA 1978] of this act may be cited as the "Surprise Billing Protection Act". History: Laws 2019, ch. 227, § 1.

Except as provided in Subsection C of Section 6 [59A-57A-6 NMSA 1978] of the Surprise Billing Protection Act, nothing in that act shall be construed to create or imply a private cause of action for a violation of that act. History: Laws 2019, ch. 227, § 10.

The superintendent: A. may require that health insurance carriers report the annual percentage of claims and expenditures paid to nonparticipating providers for health care services; and B. may require by rule a report on changes to the percent of claims paid as an emergency clai…

The provisions of the Surprise Billing Protection Act apply to the following types of health coverage delivered or issued for delivery in this state: A. group health coverage governed by the provisions of the Health Care Purchasing Act [Chapter 13, Article 7 NMSA 1978]; B. indivi…

As used in the Surprise Billing Protection Act: A. "allowed amount" means the maximum portion of a billed charge that a health insurance carrier will pay, including any applicable covered person cost-sharing responsibility, for a covered health care service or item rendered by a …