Chapter 59A — Chapter 59A

A. If a covered person pays a nonparticipating provider more than the in-network cost-sharing amount for services provided under circumstances giving rise to a surprise bill, the nonparticipating provider shall refund to the covered person within forty-five calendar days of recei…

prohibition. A nonparticipating provider shall not, either directly or indirectly, knowingly waive, rebate, give, pay or offer to waive, rebate, give or pay all or part of a cost-sharing amount owed by a covered person pursuant to the terms of the covered person's health benefits…

billing. A. The superintendent shall convene appropriate stakeholders, including rural providers, insurers and consumer advocates, and review the reimbursement rate for surprise bills annually to ensure fairness to providers and to evaluate the impact on health insurance premiums…

Nothing in the Surprise Billing Protection Act shall be construed to prohibit a health insurance carrier from appropriately using reasonable health care cost management techniques. History: Laws 2019, ch. 227, § 9.

Chapter 59A, Article 58 NMSA 1978 may be cited as the "Service Contract Regulation Act". History: Laws 2001, ch. 206, § 1; 2017, ch. 125, § 1.

A. A service contract shall: (1) be written in language that is understandable and printed in a typeface that is easy to read; (2) include the amount, if applicable, of any deductible that the holder is required to pay; (3) include the name, address and telephone number of the pr…

A. A provider shall not include an automatic renewal provision within a service contract offered in this state unless the provider discloses the terms of the automatic renewal provision in a clear and conspicuous manner, or in the case of an offer conveyed by voice, in temporal p…

A. A provider shall provide a receipt for, or other written evidence of, the purchase of a service contract. B. The provider shall furnish a copy of the service contract to the holder within a reasonable time after the contract is purchased. History: Laws 2001, ch. 206, § 11.

A. No service contract that has been in effect for at least seventy days may be canceled by the provider before the expiration of the agreed term or one year after the effective date of the service contract, whichever occurs first, except on any of the following grounds: (1) fail…

A. Except as otherwise provided in this section, a provider shall not include in the name of his business: (1) the words "insurance", "casualty", "surety", "mutual" or any other word or term that implies that he is engaged in the business of transacting insurance or is a surety c…

a condition of loan approval or purchase of property. No person may require the purchase of a service contract as a condition for the approval of a loan or the purchasing of property. History: Laws 2001, ch. 206, § 14.

A. A provider shall maintain records of the transactions governed by the Service Contract Regulation Act. The records of a provider shall include: (1) a copy of each type of service contract that the provider issues, sells or offers for sale; (2) the name and address of each hold…

superintendent. A. The superintendent may conduct examinations to enforce the provisions of the Service Contract Regulation Act pursuant to Chapter 59A, Article 4 NMSA 1978 at such times as he deems necessary. B. A provider shall, upon the request of the superintendent, make avai…

A person who violates any provision of the Service Contract Regulation Act or an order or rule of the superintendent issued or adopted pursuant thereto may be assessed a civil penalty by the superintendent of not more than five thousand dollars ($5,000) for each act or violation,…

The superintendent may adopt rules necessary to carry out the provisions of the Service Contract Regulation Act. History: Laws 2001, ch. 206, § 18.

As used in the Service Contract Regulation Act: A. "administrator" means a person who is responsible for administering a service contract that is issued, sold or offered for sale by a provider or sold by a seller; B. "automatic renewal provision" means a provision within a servic…

The provisions of the Service Contract Regulation Act do not apply to: A. a warranty; B. a maintenance agreement; C. a service contract provided by a public utility on its transmission device if the service contract is regulated by the public regulation commission; D. a service c…

A provider shall not issue, sell or offer for sale service contracts in this state unless the provider has been registered with the superintendent pursuant to the provisions of the Service Contract Regulation Act. However, an administrator or seller of a service contract is not r…

A. A provider who wishes to issue, sell or offer for sale service contracts in this state must submit to the superintendent: (1) a registration application on a form prescribed by the superintendent; (2) proof that the provider has complied with the requirements for security purs…

A. To ensure the faithful performance of a provider's obligations to the provider's service contract holders, a provider shall comply with the requirements of one of the following: (1) maintain a deposit with the superintendent as provided in this paragraph: (a) a provider of a s…

The premium tax imposed pursuant to Chapter 59A, Article 6 NMSA 1978 does not apply to any business transacted pursuant to the provisions of the Service Contract Regulation Act. History: Laws 2001, ch. 206, § 7.

exceptions. A. Except as otherwise provided in the Service Contract Regulation Act, the marketing, issuance, sale, offering for sale, making, proposing to make and administration of service contracts are not subject to the provisions of the New Mexico Insurance Code [Chapter 59A …

A. A service contract is void and a provider shall refund to the holder the purchase price of the service contract if the holder has not made a claim under the service contract and the holder returns the service contract to the provider: (1) within twenty days after the date the …

This act [59A-59-1 to 59A-59-4 NMSA 1978] may be cited as the "Prescription Drug Uniform Information Card Act". History: Laws 2003, ch. 373, § 1.

It is the intent of the legislature to improve care for patients by enacting the Prescription Drug Uniform Information Card Act to minimize confusion, eliminate unnecessary paperwork, decrease administrative burdens and streamline dispensing of prescription products paid for by t…

A. A health benefit plan that provides coverage for prescription drugs and that issues, uses or requires a card for prescription claims submission and adjudication, and third-party administrators for self-insured plans and state-administered plans, or the plan's agents or contrac…

A. All health benefit plans issued or renewed on or after July 1, 2003 shall comply with the Prescription Drug Uniform Information Card Act no later than two years after July 1, 2003. For purposes of that act, renewal of a health benefit policy, contract or plan is presumed to oc…

This act [59A-59A-1 to 59A-59A-8 NMSA 1978] may be cited as the "Prescription Drug Price Transparency Act". History: Laws 2024, ch. 33, § 1.

As used in the Prescription Drug Price Transparency Act: A. "authorized health insurer" means an entity holding a valid certificate of authority issued pursuant to the insurance laws of this state, including a health insurance company, health maintenance organization, hospital or…

reporting requirements. A. By May 1, 2025, and annually thereafter, each manufacturer shall submit data to the superintendent, in a form and manner prescribed by the superintendent, that includes the name and national drug code for each prescription drug product that has a wholes…

reporting requirements. A. By June 30, 2025, and annually thereafter, except as provided by Subsection B of this section, each pharmacy services administrative organization that represents a pharmacy or chain of pharmacies that do business in this state shall submit data to the s…

A. By May 1, 2025, and annually thereafter, each authorized health insurer shall submit data to the superintendent, in a form and manner prescribed by the superintendent, that includes: (1) a list of the twenty-five most frequently prescribed prescription drug products; (2) a lis…

A. By May 1, 2025, and annually thereafter, each pharmacy benefits manager shall provide data to the superintendent that includes the following information for the previous calendar year that is attributable to patient utilization of prescription drug products covered by authoriz…

A. By December 31, 2025, and annually thereafter, the superintendent shall submit to the legislative finance committee and the legislative health and human services committee a report that includes: (1) aggregate market trends for prescription drug products across the state and c…

A. A manufacturer, pharmacy services administrative organization, authorized health insurer or pharmacy benefits manager may be subject to a penalty imposed by the superintendent in accordance with Section 59A-1-18 NMSA 1978 for: (1) failing to submit information or data; (2) fai…

Sections 4 through 10 [59A-60-1 to 59A-60-7 NMSA 1978] of this act may be cited as the "Portable Electronics Insurance Act". History: Laws 2013, ch. 140, § 4.

As used in the Portable Electronics Insurance Act: A. "customer" means a person who purchases portable electronics or services; B. "enrolled customer" means a customer who elects coverage under a portable electronics insurance policy issued to a vendor of portable electronics; C.…

A. A vendor is required to hold a limited agent's license pursuant to Section 59A-12- 18 NMSA 1978 to sell or offer coverage under a policy of portable electronics insurance. B. A limited agent's license issued to a vendor shall authorize any employee or authorized representative…

A. At every location where portable electronics insurance is offered to customers, brochures or other written materials shall be made available to a prospective customer that: (1) disclose that portable electronics insurance may provide a duplication of coverage already provided …

A. The employees and authorized representatives of vendors may sell or offer portable electronics insurance to customers and shall not be subject to licensure as insurance agents under any other provision of the Insurance Code, provided that: (1) the vendor obtains a limited agen…

A person who violates any provision of the Portable Electronics Insurance Act may, after notice and hearing, be subject to: A. fines not to exceed one thousand dollars ($1,000) per violation and not to exceed a total of ten thousand dollars ($10,000); or B. as the superintendent …

Notwithstanding any other provision of law: A. an insurer may terminate or otherwise change the terms and conditions of a policy of portable electronics insurance only upon providing the policyholder and enrolled customers with at least thirty days' notice; B. if the insurer chan…

Chapter 59A, Article 61 NMSA 1978 may be cited as the "Pharmacy Benefits Manager Regulation Act". History: Laws 2014, ch. 14, § 1; 2017, ch. 16, § 1.

As used in the Pharmacy Benefits Manager Regulation Act: A. "maximum allowable cost" means the maximum amount that a pharmacy benefits manager will reimburse a pharmacy for the cost of a generic drug; B. "maximum allowable cost list" means a searchable, electronic and internet-ba…

revocation. A. A person shall not operate as a pharmacy benefits manager unless licensed by the superintendent in accordance with the Pharmacy Benefits Manager Regulation Act and applicable federal and state laws. A licensee shall renew the licensee's pharmacy benefits manager li…

appeals process required. A. A pharmacy benefits manager shall determine a reimbursement amount for a generic drug based on objective and verifiable sources. B. A pharmacy benefits manager shall reimburse a pharmacy an amount no less than the amount that the pharmacy benefits man…

prohibited; certain disclosures required upon request. A. A pharmacy benefits manager shall not require that a pharmacy participate in one contract in order to participate in another contract. B. A pharmacy benefits manager shall provide to a pharmacy by electronic mail, facsimil…

A pharmacy benefits manager licensed pursuant to the Pharmacy Benefits Manager Regulation Act shall be subject to Section 61-11-18.2 NMSA 1978. A pharmacy benefits manager shall not reduce or eliminate payment on an adjudicated claim except as permitted by Section 61-11-18.2 NMSA…

A. A pharmacy benefits manager shall not charge a pharmacy a fee related to the adjudication of a claim, including: (1) the receipt and processing of a pharmacy claim; (2) the development or management of a claim processing or adjudication network; or (3) participation in a claim…

organizations required. A pharmacy services administrative organization shall register with the superintendent on a form and in a time frame and method of submission specified by the superintendent. History: Laws 2019, ch. 269, § 7.