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1,724 sections in this chapter.
NMSA 1978, § 59A-22-34.5 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 that is delivered, issued for delivery or renewed in this state shall provide coverage for a hearing aid and any related service for the full cost of one hearing aid per hearing…
NMSA 1978, § 59A-22-35 Maternity transport required
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All individual and group health insurance policies delivered or issued for delivery in this state which provide maternity coverage on an expense-incurred basis, shall also provide, where necessary to protect the life of the infant or mother, coverage for transportation, including…
NMSA 1978, § 59A-22-36 Home health care service option required
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A. Each insurer which delivers or issues for delivery in this state an individual or group hospital expense or major medical expense insurance policy shall make available to the policyholder the option of home health care coverage which includes benefits for the services describe…
NMSA 1978, § 59A-22-38 Individual health insurance; policy provisions relating to
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individuals who are eligible for medical benefits under the medicaid program. A. Each individual health insurance policy that is delivered, issued for delivery or renewed in this state shall include provisions that require benefits paid on behalf of a child or other insured perso…
NMSA 1978, § 59A-22-39 Coverage for mammograms
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Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for low-dose screening mammograms for determining the presence of breast cancer. Such coverage shall make …
NMSA 1978, § 59A-22-39.1 Mastectomies and lymph node dissection; minimum
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hospital stay coverage required. A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for not less than forty-eight hours of inpatient care following a mast…
NMSA 1978, § 59A-22-39.2 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 insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior …
NMSA 1978, § 59A-22-39.3 Diagnostic and supplemental breast examinations
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A. An individual or group health insurance policy, health care plan or certificate of insurance 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 …
NMSA 1978, § 59A-22-4 Entire contract; changes
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There shall be a provision as follows: This policy, including the endorsements and attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurance company and unless such approv…
NMSA 1978, § 59A-22-40 Coverage for cytologic and human papillomavirus
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screening. A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for cytologic and human papillomavirus screening for determining the presence of precancerou…
NMSA 1978, § 59A-22-40.1 Coverage for the human papillomavirus vaccine
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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 shall provide coverage for the human papillomavirus vaccine in accordance with the current standards of the feder…
NMSA 1978, § 59A-22-41 Coverage for individuals with diabetes
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A. Each individual and group health insurance policy, health care plan, certificate of health insurance and managed health care plan delivered or issued for delivery in this state shall provide coverage for individuals with insulin-using diabetes, with non-insulin- using diabetes…
NMSA 1978, § 59A-22-41.1 Coverage for medical diets for genetic inborn errors of
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metabolism. A. As of July 1, 2003, each individual and group health insurance policy, health care plan, certificate of health insurance and managed health care plan delivered, issued for delivery, renewed, extended or modified in this state shall provide coverage for the treatmen…
NMSA 1978, § 59A-22-42 Coverage for prescription contraceptive drugs or
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devices. A. Each individual and group health insurance policy, health care plan and certificate of health insurance 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 produ…
NMSA 1978, § 59A-22-43 Required coverage of patient costs incurred in cancer
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clinical trials. A. A health plan shall provide coverage for routine patient care costs incurred as a result of the patient's participation in a cancer clinical trial if: (1) the clinical trial is undertaken for the purposes of the prevention of or the prevention of reoccurrence …
NMSA 1978, § 59A-22-44 Coverage for smoking cessation treatment
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A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered or issued for delivery in this state and that offers maternity benefits shall offer coverage for smoking cessation treatment. B. Coverage for smoking cessation…
NMSA 1978, § 59A-22-45 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-22-46 Coverage of part-time employees
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An insurer that provides group health insurance pursuant to Chapter 59A, Article 22 NMSA 1978 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 of at least …
NMSA 1978, § 59A-22-47 Coverage of colorectal cancer screening
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A. An individual or group health insurance policy, health care plan and 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 condit…
NMSA 1978, § 59A-22-48 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 that is delivered, issued for delivery or renewed in this state shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory s…
NMSA 1978, § 59A-22-49 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 that is delivered, issued for delivery or renewed in this state shall provide coverage to an insured for: (1) well-baby and well-child screening for diagnosing the pr…
NMSA 1978, § 59A-22-49.1 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-22-49.2 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-22-49.3 Coverage for telemedicine services
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A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for services provided via telemedicine to the same extent that the health insurance plan, …
NMSA 1978, § 59A-22-49.4 Prescription drugs; prohibited formulary changes;
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notice requirements. A. As of January 1, 2014, 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 prescription drug benefits categorized or tiered fo…
NMSA 1978, § 59A-22-5 Time limit on certain defenses
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A. There shall be a provision for comprehensive major medical policies as follows: As of the date of issue of this policy, no misstatements, except willful or fraudulent misstatements, made by the applicant in the application for this policy shall be used to void the policy or to…
NMSA 1978, § 59A-22-50 Health insurers; direct services
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A. A health insurer shall reimburse direct services as follows: (1) for small groups, at no less than eighty percent of aggregate premiums for all such products; and (2) for large groups, at no less than eighty-five percent of aggregate premiums for all such products. B. Reimburs…
NMSA 1978, § 59A-22-51 Dental insurance plan; dental fees not covered;
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severability. A. As used in this section: (1) "covered services" means dental care services for which a reimbursement is available under an enrollee's plan contract or for which a reimbursement would be available but for the application of contractual limitations such as deductib…
NMSA 1978, § 59A-22-52 Prescription drug prior authorization protocols
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A. After January 1, 2014, a health insurer 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 lat…
NMSA 1978, § 59A-22-53 Pharmacy benefits; prescription synchronization
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A. An individual 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 a prescription drug benefit shall allow an insured to fill or refill a prescription for less than a thir…
NMSA 1978, § 59A-22-53.1 Prescription drug coverage; step therapy protocols;
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clinical review criteria; exceptions. A. Each individual health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit for which any step therapy protocols are required shall …
NMSA 1978, § 59A-22-53.2 Pharmacist prescriptive authority services;
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reimbursement parity. An insurer 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 health insurance plan, policy or certificate of health insur…
NMSA 1978, § 59A-22-53.3 Calculating an insured's cost-sharing obligation for
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prescription drug coverage. A. When calculating an insured'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 that is delivered, issued for delivery or renewed i…
NMSA 1978, § 59A-22-54 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. An insurer shall not require a pr…
NMSA 1978, § 59A-22-55 Coverage exclusion. (Contingent repeal. See note.)
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Coverage of vasectomy and male condoms pursuant to Section 3 [59A-22-42 NMSA 1978] of this 2019 act is excluded for high-deductible individual and group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for …
NMSA 1978, § 59A-22-56 Physical rehabilitation services; limits on cost sharing
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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 shall not impose a member cost share for physical rehabilitation services that is greater than that for primary c…
NMSA 1978, § 59A-22-57 Behavioral health services; elimination of cost sharing
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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 that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health servi…
NMSA 1978, § 59A-22-58 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-22-59 Chiropractic physician services; limits on cost sharing
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and coinsurance. 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 that offers coverage of the services of a chiropractic physician shall not impose a copayment or…
NMSA 1978, § 59A-22-6 Grace period
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There shall be a provision as follows: A grace period of . . . . . . . . (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the f…
NMSA 1978, § 59A-22-60 Sexually transmitted infection care; cost sharing
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eliminated. 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 that offers coverage for preventive care or treatment of sexually transmitted infections shall not im…
NMSA 1978, § 59A-22-61 Biomarker testing coverage
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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 shall provide coverage for insureds to receive biomarker testing for the purposes of diagnosis, treatment, approp…
NMSA 1978, § 59A-22-62 Medical necessity and nondiscrimination standards for
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coverage of prosthetic devices, custom orthotic devices or complex rehabilitation technology devices. A. An individual health plan that is delivered, issued for delivery or renewed in this state that offers coverage for prosthetic devices, custom orthotic devices or complex rehab…
NMSA 1978, § 59A-22-7 Reinstatement
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There shall be a provision as follows: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurance company to accept such premium, without requiring in conne…
NMSA 1978, § 59A-22-8 Notice of claim
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There shall be a provision as follows: Written notice of claim must be given to the insurance company within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the in…
NMSA 1978, § 59A-22-9 Claim forms
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There shall be a provision as follows: The insurance company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice t…
NMSA 1978, § 59A-22A-1 Short title
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Chapter 59A, Article 22A NMSA 1978 shall be known and may be cited as the "Preferred Provider Arrangements Law". History: 1978 Comp., § 59A-22A-1, enacted by Laws 1993, ch. 320, § 59.
NMSA 1978, § 59A-22A-2 Purpose
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The purpose of the Preferred Provider Arrangements Law is to encourage health care cost containment while preserving quality of care by allowing health care insurers to enter into preferred provider arrangements in accordance with minimum standards for preferred provider arrangem…
NMSA 1978, § 59A-22A-3 Definitions
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As used in the Preferred Provider Arrangements Law: A. "covered person" means any person on whose behalf the health care insurer is obligated to pay for or to provide health benefit services; B. "covered services" means health care services which the health care insurer is obliga…
NMSA 1978, § 59A-22A-4 Preferred provider arrangements
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Notwithstanding any provisions of law to contrary, any health care insurer may enter into preferred provider arrangements. A. Such arrangements shall: (1) establish the amount and manner of payment to the preferred provider. Such amount and manner of payment may include capitatio…
