HOUSE BILL 142

54th legislature - STATE OF NEW MEXICO - first session, 2019

INTRODUCED BY

Patricia Roybal Caballero

 

 

 

 

 

AN ACT

RELATING TO HEALTH INSURANCE; AMENDING THE HEALTH MAINTENANCE ORGANIZATION LAW, THE NONPROFIT HEALTH CARE PLAN LAW AND OTHER SECTIONS OF THE NMSA 1978 TO PROVIDE FOR GUARANTEED ISSUE OF HEALTH COVERAGE WITHOUT EXCLUSION OF COVERAGE FOR PREEXISTING CONDITIONS.

 

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

     SECTION 1. A new section of Chapter 59A, Article 22 NMSA

1978 is enacted to read:

     "[NEW MATERIAL] HEALTH INSURERS--GUARANTEED ISSUE--

PREEXISTING CONDITIONS.--

          A. Effective January 1, 2020, a health insurer that provides individual health insurance pursuant to Chapter 59A, Article 22 NMSA 1978 shall issue coverage without exclusion of coverage for a preexisting condition to any individual who requests and offers to purchase the coverage.

          B. For the purposes of this section, "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for health insurance within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition for federally defined individuals."

     SECTION 2. A new section of Chapter 59A, Article 23 NMSA

1978 is enacted to read:

     "[NEW MATERIAL] HEALTH INSURERS--GUARANTEED ISSUE--

PREEXISTING CONDITIONS.--

          A. Effective January 1, 2020, a health insurer that provides group or blanket health insurance pursuant to Chapter 59A, Article 23 NMSA 1978 shall issue coverage without exclusion of coverage for a preexisting condition to any individual who is eligible to enroll in that group or blanket coverage and who offers to pay any premium required for enrollment in the group coverage.

          B. For the purposes of this section:

                (1) "health insurer" means a person duly authorized to transact the business of health insurance in the state pursuant to the Insurance Code but does not include a person that only issues a limited-benefit policy intended to supplement major medical coverage, including medicare supplement, long-term care, disability income, disease-specific, accident-only or hospital-indemnity-only insurance policies; and

                (2) "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for health insurance within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition."

     SECTION 3. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] HEALTH MAINTENANCE ORGANIZATIONS--GUARANTEED ISSUE--PREEXISTING CONDITIONS.--

          A. Effective January 1, 2020, a health maintenance organization that provides coverage for health care services pursuant to the Health Maintenance Organization Law shall issue coverage without exclusion of coverage for a preexisting condition to an individual who:

                (1) requests an individual contract and offers to purchase the coverage; or

                (2) is eligible to enroll in a group contract and offers to pay any premium required for enrollment under the group contract.

          B. For the purposes of this section, "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for a health maintenance organization contract within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition."

     SECTION 4. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] NONPROFIT HEALTH CARE PLANS--GUARANTEED ISSUE--PREEXISTING CONDITIONS.--

          A. Effective January 1, 2020, a health care plan that provides coverage pursuant to the Nonprofit Health Care Plan Law shall issue coverage without exclusion of coverage for a preexisting condition to an individual who:

                (1) requests a subscriber contract and offers to purchase the health care plan coverage; or

                (2) is eligible to enroll in a health care plan under a group subscriber contract and offers to pay any premium required for enrollment under the group subscriber contract.

          B. For the purposes of this section, "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for a health care plan within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition."

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