SENATE PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR

SENATE BILL 48

51st legislature - STATE OF NEW MEXICO - first session, 2013

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING NEW SECTIONS OF THE NMSA 1978 TO PROVIDE FOR LARGE EMPLOYER PARTICIPATION IN ANY STATE HEALTH INSURANCE EXCHANGE; PROVIDING FOR A PREMIUM STUDY; PROVIDING FOR A CONTINGENT EFFECTIVE DATE.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. [NEW MATERIAL] STATE HEALTH INSURANCE EXCHANGE--LARGE EMPLOYER PARTICIPATION--PREMIUM STUDY.--

          A. As of January 1, 2017, a large employer shall be permitted to participate as a qualified employer on a state health insurance exchange.

          B. The superintendent of insurance shall conduct a study of premium growth in the large group market both in and outside of the state health insurance exchange and make a comparison of the large group market premium rates in and outside of the exchange to determine whether there has been excessive premium growth in the exchange. By November 1, 2015, the superintendent of insurance shall report the results of this study and comparison to the legislative health and human services committee and to the legislative finance committee.

          C. As used in this section:

                (1) "large employer" means a person actively engaged in business that, on at least fifty percent of its working days during either of the two preceding years, employed no fewer than fifty employees eligible for employer-sponsored health coverage; provided that:

                     (a) in determining the number of eligible employees, the spouse or dependent of an employee may, at the employer's discretion, be counted as a separate employee;

                     (b) persons that are affiliated persons or that are eligible to file a combined tax return for purposes of state income taxation shall be considered one employer;

                     (c) in the case of an employer that was not in existence throughout a preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that the employer is reasonably expected to employ on working days in the current calendar year; and

                     (d) the employer does not self-insure; and

                (2) "state health insurance exchange" means an entity established pursuant to state and federal law to provide qualified health plans to qualified individuals and qualified employers on the individual, small group or large group health insurance market.

     SECTION 2. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] STATE HEALTH INSURANCE EXCHANGE--LARGE EMPLOYER PARTICIPATION.--

          A. As of January 1, 2017, a large employer shall be permitted to participate as a qualified employer on a state health insurance exchange.

          B. As used in this section:

                (1) "large employer" means a person actively engaged in business that, on at least fifty percent of its working days during either of the two preceding years, employed no fewer than fifty employees eligible for employer-sponsored health coverage; provided that:

                     (a) in determining the number of eligible employees, the spouse or dependent of an employee may, at the employer's discretion, be counted as a separate employee;

                     (b) persons that are affiliated persons or that are eligible to file a combined tax return for purposes of state income taxation shall be considered one employer;

                     (c) in the case of an employer that was not in existence throughout a preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that the employer is reasonably expected to employ on working days in the current calendar year; and

                     (d) the employer does not self-insure; and

                (2) "state health insurance exchange" means an entity established pursuant to state and federal law to provide qualified health plans to qualified individuals and qualified employers on the individual, small group or large group health insurance market."

     SECTION 3. CONTINGENT EFFECTIVE DATE.--The provisions of this act shall be effective when the superintendent of insurance certifies to the legislative council service and the New Mexico compilation commission that premium rates in the state health insurance exchange's large group health insurance market have not risen excessively in comparison to premium rates in the large group health insurance market outside of the state health insurance exchange.

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