AN ACT

RELATING TO INSURANCE; PROVIDING FOR ASSIGNMENT OF HEALTH CARE AND DENTAL CLAIMS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:     Section 1. Section 59A-12A-10 NMSA 1978 (being Laws 1989, Chapter 374, Section 10) is amended to read:

     "59A-12A-10. PAYMENT OF CLAIMS.--

          A. Except as provided in Subsection B of this section, all claims paid by the administrator from funds collected on behalf of the insurer shall be paid only on drafts of and as authorized by the insurer.

          B. Dental hygiene claims paid by an administrator for a dental insurer shall be paid on the basis of assignment to the provider of the dental health care. No dental insurer may refuse to honor an assignment of a claim for payment of benefits for dental hygiene. The provider may collect from the insured any copayment, coinsurance, deductible or other amount that the insured is liable for under the dental health care plan.

          C. For the purpose of this section, "dental insurer" means a person licensed by the state to issue health insurance that offers coverage for services provided in the practice of dental hygiene as defined in Subsections B, D and E of Section 61-5A-4 NMSA 1978."

     Section 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "DENTAL HYGIENE COVERAGE CLAIMS PAYMENT.--

          A. An individual or group hospital or medical expense insurance policy delivered or issued for delivery in this state that provides dental hygiene coverage shall pay claims for benefits provided under that coverage on the basis of assignment to the provider of the dental hygiene care. The provider may collect from the insured any copayment, coinsurance, deductible or other amount that the insured is liable for under the policy.

          B. For the purposes of this section, "dental hygiene coverage" means health insurance coverage of services provided in the practice of dental hygiene as defined in Subsections B, D and E of Section 61-5A-4 NMSA 1978.

          C. The provisions of this section do not apply to nonprofit health care plans issued pursuant to Chapter 59A, Article 47 NMSA 1978."

     Section 3. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "DENTAL HYGIENE COVERAGE CLAIMS PAYMENT.--

          A. Each insurer that delivers or issues for delivery in this state a group health insurance policy that provides dental hygiene coverage shall pay claims for benefits provided under that coverage on the basis of assignment to the provider of the dental hygiene care. The provider may collect from the insured any copayment, coinsurance, deductible or other amount that the insured is liable for under the policy.

          B. For the purposes of this section, "dental hygiene coverage" means health insurance coverage of services provided in the practice of dental hygiene as defined in Subsections B, D and E of Section 61-5A-4 NMSA 1978.

          C. The provisions of this section do not apply to nonprofit health care plans issued pursuant to Chapter 59A, Article 47 NMSA 1978."

     Section 4. A new section of the Prepaid Dental Plan Law is enacted to read:

     "ASSIGNMENT OF HEALTH CLAIMS.--

          A. Claims shall be paid on the basis of assignment to the provider of the prepaid dental services. The provider shall not collect any payment from the member except a copayment, coinsurance, deductible or other amount that the member is liable for under the membership coverage.

          B. A prepaid dental plan organization shall not refuse to honor an assignment of a claim. An insurance policy or contract issued or renewed after June 30, 2005 shall not contain a restriction on the member's right to assign a claim to a provider of prepaid dental services.

          C. Claims shall be paid pursuant to the Insurance Code.

          D. As used in this section:

                (1) "assignment" means the transfer from a member of the right to collect a claim payment to the provider who rendered the prepaid dental services; and

                (2) "claim" means a demand for prepaid dental services payment."

     Section 5. A new section of the Prepaid Dental Plan Law is enacted to read:

     "PROVIDER DISCRIMINATION PROHIBITED--DENTAL HEALTH CARE.--All individual and group subscriber contracts delivered or issued for delivery in New Mexico by a prepaid dental 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 mental condition shall not contain any provisions that exclude a person licensed pursuant to the Dental Health Care Act and shall not discriminate in the reimbursement levels for same or similar

services provided by other providers."