Chapter 59A — Chapter 59A
1,829 sections in this chapter.
NMSA 1978, § 59A-23E-1 Short title
0.1K chars
Chapter 59A, Article 23E NMSA 1978 may be cited as the "Health Insurance Portability Act". History: Laws 1997, ch. 243, § 1; 1998, ch. 41, § 5.
NMSA 1978, § 59A-23E-10 Group health plan; group health insurance; use of
1.3K chars
affiliation period by health maintenance organizations as alternative to preexisting condition exclusion. A. A health maintenance organization that offers health insurance coverage in connection with a group health plan and does not impose any preexisting condition exclusion allo…
NMSA 1978, § 59A-23E-11 Prohibiting discrimination based on health status
1.0K chars
against individual participants and beneficiaries. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not establish rules for eligibility or continued eligibility of any individual to enroll or continue to participate in…
NMSA 1978, § 59A-23E-12 Prohibiting discrimination based on health status
1.4K chars
against individual participants and beneficiaries in premium contributions. A. A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not require an individual as a condition of enrollment or continued enrollment under the p…
NMSA 1978, § 59A-23E-13 Health insurance issuers; guaranteed availability of
4.0K chars
coverage; exceptions for network plans, insufficient financial capacity and bona fide associations; employer contribution rules. A. Except as provided in Subsections C through E of this section, a health insurance issuer that offers health insurance coverage in the individual or …
NMSA 1978, § 59A-23E-14 Health insurance issuers; guaranteed availability of
3.6K chars
coverage. A. Except as provided in Subsections B through F of this section, a health insurance issuer that offers health insurance coverage in the individual or group markets shall renew or continue that coverage in force at the option of the plan sponsor or the individual. B. A …
NMSA 1978, § 59A-23E-15 Disclosure of information by health insurance issuers
1.5K chars
A. A health insurance issuer when offering health insurance coverage to an employer or individual shall: (1) make a reasonable disclosure to the small employer or individual as part of its solicitation and sales materials, of the availability of information described in Subsectio…
NMSA 1978, § 59A-23E-16 Exclusions, limitations and exceptions for certain
3.2K chars
group health plans and group health insurance. A. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and 59A-23E-18 NMSA 1978 do not apply to any group retiree health plan and health insurance coverage offered in connection with a group retiree health plan if, …
NMSA 1978, § 59A-23E-17 Treatment of partners and self-employed individuals in
1.1K chars
connection with group health plans. A. Any plan, fund or program that would not be an employee welfare benefit plan, except for the provisions of this section, that is established or maintained by a partnership, to the extent that the plan, fund or program provides medical care t…
NMSA 1978, § 59A-23E-18 Requirement for mental health benefits in an individual
0.8K chars
or group health plan, or group health insurance offered in connection with the plan, for a plan year of an employer. A. A group health plan or group or individual health insurance shall not impose treatment limitations or financial restrictions, limitations or requirements on the…
NMSA 1978, § 59A-23E-19 Individual health insurance coverage; guaranteed
4.0K chars
renewability; exceptions. A. Except as otherwise provided in this section, a health insurance issuer that provides individual health insurance coverage to an individual shall renew or continue that coverage in force at the option of the individual. B. A health insurance issuer ma…
NMSA 1978, § 59A-23E-2 Definitions
11.3K chars
As used in the Health Insurance Portability Act: A. "affiliation period" means a period that must expire before health insurance coverage offered by a health maintenance organization becomes effective; B. "beneficiary" means that term as defined in Section 3(8) of the federal Emp…
NMSA 1978, § 59A-23E-20 Certification of coverage by issuers in the individual
0.4K chars
market. The provisions of Section 59A-23E-7 NMSA 1978 [repealed] apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as it applies to health insurance coverage offered by a health insurance issuer in connection with …
NMSA 1978, § 59A-23E-3 Limitation on preexisting condition exclusion period
0.6K chars
A health insurance issuer or health benefits plan offering group health insurance, blanket health insurance or individual health insurance shall not impose any preexisting condition exclusion with respect to that health insurance plan or coverage. A health insurance issuer or hea…
NMSA 1978, § 59A-23E-4 Repealed
0.1K chars
History: Laws 1997, ch. 243, § 4; 1998, ch. 41, § 8; repealed by Laws 2019, ch. 259, § 22.
NMSA 1978, § 59A-23E-5 Repealed
0.1K chars
History: Laws 1997, ch. 243, § 5; 1998, ch. 41, § 9; 2008, ch. 87, § 3; repealed by Laws 2019, ch. 259, § 22.
NMSA 1978, § 59A-23E-6 Repealed
0.1K chars
History: Laws 1997, ch. 243, § 6; 1998, ch. 41, § 10; repealed by Laws 2019, ch. 259, § 22.
NMSA 1978, § 59A-23E-7 Repealed
0.1K chars
History: Laws 1997, ch. 243, § 7; 1998, ch. 41, § 11; repealed by Laws 2019, ch. 259, § 22.
NMSA 1978, § 59A-23E-8 Group health plan; group health insurance; special
2.9K chars
enrollment periods for individuals losing other coverage. A. group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan shall permit an employee who is eligible but not enrolled for coverage under the terms of t…
NMSA 1978, § 59A-23E-9 Group health plan; special enrollment periods for
1.7K chars
dependent beneficiaries. A. A group health plan shall provide for a dependent special enrollment period described in Subsection B of this section during which a person may be enrolled under the plan as a dependent of the individual, and in the case of the birth or adoption of a c…
NMSA 1978, § 59A-23F-1 Short title
0.1K chars
Chapter 59A, Article 23F NMSA 1978 may be cited as the "New Mexico Health Insurance Exchange Act". History: Laws 2013, ch. 54, § 1; 2020, ch. 35, § 1.
NMSA 1978, § 59A-23F-10 Reporting
1.1K chars
The board shall make reports publicly available as follows: A. during all exchange open enrollment periods beginning on or after October 1, 2021, the board shall produce weekly reports that include information on: (1) applications; (2) plan selections; (3) new enrollees; (4) enro…
NMSA 1978, § 59A-23F-11 Health care affordability fund
3.7K chars
A. The "health care affordability fund" is created in the state treasury. The fund consists of distributions, appropriations, gifts, grants and donations. Money in the fund at the end of a fiscal year shall not revert to any other fund. The health care authority shall administer …
NMSA 1978, § 59A-23F-12 Health care affordability plan; rulemaking; reporting
3.6K chars
requirements. A. Rules covering the following provisions may be amended as the health care authority determines: (1) providing enhanced premium and cost-sharing assistance to individuals and families for the purchase of qualified health plans on the New Mexico health insurance ex…
NMSA 1978, § 59A-23F-2 Definitions
5.2K chars
As used in the New Mexico Health Insurance Exchange Act: A. "board" means the board of directors of the exchange; B. "bronze plan" means a level of coverage that is designed to provide benefits that are actuarially equivalent to sixty percent of the full actuarial value of the be…
NMSA 1978, § 59A-23F-3 New Mexico health insurance exchange created; board
10.6K chars
created. A. The "New Mexico health insurance exchange" is created as a nonprofit public corporation to provide qualified individuals and qualified employers with increased access to health insurance in the state and shall be governed by a board of directors constituted pursuant t…
NMSA 1978, § 59A-23F-4 Board of directors; powers
2.6K chars
The board may: A. seek and receive grant funding from federal, state or local governments or private philanthropic organizations to defray the costs of operating the exchange; B. generate funding, including charging assessments or fees, to support its operations in accordance wit…
NMSA 1978, § 59A-23F-5 Plan of operation
1.8K chars
A. No later than September 1, 2020, the board, in coordination with insurance producers appointed and compensated by the insurance industry, shall review its plan of operation and approve amendments to it as appropriate to ensure that the exchange is operated using best practices…
NMSA 1978, § 59A-23F-6 Board duties; reporting
1.0K chars
The board shall: A. between July 1, 2013 and January 1, 2015, provide quarterly reports to the legislature, the governor and the superintendent on the implementation of the exchange and report annually and upon request thereafter; B. keep an accurate accounting of all of the acti…
NMSA 1978, § 59A-23F-6.1 Board; additional duties and powers
3.6K chars
In addition to other duties and powers in the New Mexico Health Insurance Exchange Act, the board shall: A. in consultation with the superintendent: (1) establish policies and procedures for the review and recommendation of health benefits plans to be offered on the exchange; (2)…
NMSA 1978, § 59A-23F-7 Superintendent of insurance; rulemaking
0.3K chars
The superintendent shall coordinate with the board to promulgate rules necessary to implement and carry out the provisions of the New Mexico Health Insurance Exchange Act, including rules to establish the criteria for certification of qualified health plans. History: Laws 2013, c…
NMSA 1978, § 59A-23F-8 Funding
0.8K chars
A. To fund the planning, implementation and operation of the exchange, the board shall contract with the human services department [health care authority department] or any other state agency that receives federal funds allocated, appropriated or granted to the state for purposes…
NMSA 1978, § 59A-23F-9 Standardized health plans
1.9K chars
A. The board may establish no more than three standardized health plans for each of three levels of coverage with increasing benefits, designated bronze, silver and gold plans. B. In establishing standardized health plans, the board may design those plans to: (1) limit increases …
NMSA 1978, § 59A-23G-1 Short title
0.2K chars
Chapter 59A, Article 23G NMSA 1978 may be cited as the "Short-Term Health Plan and Excepted Benefit Act". History: Laws 2019, ch. 235, § 1; 2023, ch. 169, § 6.
NMSA 1978, § 59A-23G-10 Dental plan; erroneously paid claims; restrictions on
1.2K chars
recovery. A. A dental plan shall establish policies and procedures for payment recovery, including providing: (1) notice to the provider that identifies the error made in the processing or payment of the claim; (2) an explanation of the recovery being sought; and (3) an opportuni…
NMSA 1978, § 59A-23G-11 Dental plan; methods of payment
1.1K chars
A. For purposes of this section, "credit card payment" means a type of electronic funds transfer whereby: (1) a health insurance carrier issues a single-use series of numbers associated with the payment of services rendered by the provider and chargeable to a predetermined amount…
NMSA 1978, § 59A-23G-12 Dental plan; provider network leasing
3.2K chars
A. For purposes of this section: (1) "contracting entity" means any person or entity that enters into direct contracts with a provider for the delivery of services in the ordinary course of business; (2) "provider" means a person acting within the scope of licensure to provide de…
NMSA 1978, § 59A-23G-13 Dental plan; provider credentialing; requirements;
7.1K chars
deadline. 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 dentists and dental hygienists. B. A …
NMSA 1978, § 59A-23G-2 Definitions
4.0K chars
As used in the Short-Term Health Plan and Excepted Benefit Act: A. "bona fide association" means an association that has been in existence for not less than five years and that exists for purposes other than the business of insurance; B. "excepted benefits" means benefits furnish…
NMSA 1978, § 59A-23G-3 Short-term plans; excepted benefits; standards for
1.6K chars
policy provisions. A. The superintendent shall adopt and promulgate rules to establish specific standards: (1) that set the manner, content and required disclosure for the sale of short- term plans and excepted benefits plans, including standards for full and fair disclosure; and…
NMSA 1978, § 59A-23G-4 Benefits; minimum standards
0.6K chars
A. The superintendent shall adopt and promulgate rules to establish minimum standards for benefits provided by short-term plans and excepted benefits plans that are subject to the Short-Term Health Plan and Excepted Benefit Act. B. Rules of the superintendent shall require short-…
NMSA 1978, § 59A-23G-5 Rates; medical loss ratios
0.3K chars
The superintendent shall adopt and promulgate rules to establish standards for rates, including medical loss ratios, of short-term plans and excepted benefits plans. Rules relating to rates shall be based on generally recognized and current actuarial standards. History: Laws 2019…
NMSA 1978, § 59A-23G-6 Prohibition; association, trust or multiple employer
0.3K chars
welfare arrangement plans. No insurer shall issue, and no association, trust or multiple employer welfare arrangement shall offer, a short-term or excepted benefits plan to a resident of the state unless through a bona fide association. History: Laws 2019, ch. 235, § 6.
NMSA 1978, § 59A-23G-7 Exclusion prohibition not applicable to excepted benefit
2.0K chars
plans or policies. A. Notwithstanding any other provisions of law, an excepted benefits policy or plan shall not exclude coverage for losses incurred for a preexisting condition more than twelve months from the effective date of coverage. The policy or plan shall not define a pre…
NMSA 1978, § 59A-23G-8 Dental plan; prior authorization
2.3K chars
A. For purposes of this section, "prior authorization" means a written communication indicating whether a specific service is covered or multiple services are covered and reimbursable at a specific amount, subject to applicable coinsurance and deductibles, and issued in response …
NMSA 1978, § 59A-23G-9 Dental plan; designation of payment
0.5K chars
A. A dental plan shall provide for the direct payment of covered benefits to a provider, specified by a covered person, regardless of the provider's network or contractual status with the dental plan. B. A dental plan shall provide for the direct payment of covered benefits to a …
NMSA 1978, § 59A-23H-1 Short title
0.1K chars
Chapter 59A, Article 23H NMSA 1978 may be cited as the "Easy Enrollment Act". History: Laws 2022, ch. 33, § 1; 2024, ch. 39, § 128.
NMSA 1978, § 59A-23H-2 Definitions
2.1K chars
As used in the Easy Enrollment Act: A. "authority" or "department" means the health care authority; B. "exchange" means the New Mexico health insurance exchange; C. "health coverage program" means medicaid, health care coverage available through the federal children's health insu…
NMSA 1978, § 59A-23H-3 Easy enrollment program; establishment; purpose
0.7K chars
The "easy enrollment program" is established to, in accordance with the provisions of the Easy Enrollment Act: A. facilitate identification of taxpayers and members of the taxpayers' households who are uninsured; B. provide taxpayers with a method to consent to the taxation and r…
NMSA 1978, § 59A-23H-4 Taxation and revenue department duties; income tax
1.3K chars
form revision; taxpayer consent. A. The state income tax form shall allow a taxpayer to: (1) identify whether the taxpayer or members of the taxpayer's household are uninsured; (2) provide the taxpayer's consent to provide to the department and the exchange: (a) the taxpayer's in…