0001| AN ACT | 0002| RELATING TO INSURANCE; AMENDING CERTAIN SECTIONS OF THE NEW MEXICO | 0003| INSURANCE CODE. | 0004| | 0005| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0006| Section 1. Section 59A-37-2 NMSA 1978 (being Laws 1984, Chapter | 0007| 127, Section 617, as amended) is amended to read: | 0008| "59A-37-2. DEFINITIONS.--As used in Chapter 59A, Article 37 NMSA | 0009| 1978: | 0010| A. "acquire" means to come into possession or control of, | 0011| and "acquisition" means any agreement, arrangement or activity the | 0012| consummation of which results in a person acquiring directly or | 0013| indirectly the control of another person and includes the acquisition | 0014| of voting securities or assets, bulk reinsurance and mergers; | 0015| B. "affiliate" means a person that directly or indirectly | 0016| is controlled by, is under common control with or controls another | 0017| person; | 0018| C. "control" means the possession of the power to direct or | 0019| cause the direction of the management and policies of a person, | 0020| whether directly or indirectly, through the ownership of voting | 0021| securities, through licensing or franchise agreements, by contract | 0022| other than a commercial contract for goods or nonmanagement services, | 0023| or otherwise, unless the power is the result of an official position | 0024| with or corporate office held by an individual. Control shall be | 0025| presumed to exist if any person, directly or indirectly, owns, | 0001| controls, holds with the power to vote or holds ten or more percent of | 0002| the voting securities of any other person. This presumption may be | 0003| rebutted by a showing, in the manner provided by Section 59A-37-19 | 0004| NMSA 1978, that control does not in fact exist. The superintendent | 0005| may determine, after furnishing all persons in interest notice and an | 0006| opportunity to be heard, that control exists in fact, notwithstanding | 0007| the absence of a presumption to that effect, provided that the | 0008| determination is based on specific findings of fact in its support; | 0009| D. "insurance holding company" is a person that controls an | 0010| insurer; "insurance holding company system" means a combination of two | 0011| or more affiliated persons, at least one of which is an insurer; | 0012| E. "insurer" means a person that undertakes, under | 0013| contract, to indemnify a person against loss, damage or liability | 0014| arising from an unknown or contingent future event. The term does not | 0015| include agencies, authorities or instrumentalities of the United | 0016| States, its possessions or territories, the commonwealth of Puerto | 0017| Rico, the District of Columbia, a state or any of its political | 0018| subdivisions, a fraternal benefit society or a nonprofit medical and | 0019| hospital service association; | 0020| F. "person" means an individual, corporation, association, | 0021| partnership, joint stock company, trust, unincorporated organization | 0022| or any similar entity or combination of entities; | 0023| G. "securityholder" means the owner of any security of a | 0024| person, including common stock, preferred stock, debt obligations and | 0025| any other security convertible into or evidencing the right to acquire | 0001| any of the foregoing; | 0002| H. "subsidiary" means an affiliate of a person controlled | 0003| by the person either directly or indirectly through one or more | 0004| intermediaries; | 0005| I. "voting security" means a certificate evidencing the | 0006| ownership or indebtedness of a person, to which is attached a right to | 0007| vote on the management or policymaking of that person and includes any | 0008| security convertible into or evidencing a right to acquire such a | 0009| voting security; and | 0010| J. "health maintenance organization" means any person that | 0011| undertakes to provide or arrange for the delivery of basic health care | 0012| services to enrollees on a prepaid basis, except for enrollee | 0013| responsibility for co-payments or deductibles." | 0014| Section 2. Section 59A-46-30 NMSA 1978 (being Laws 1993, Chapter | 0015| 266, Section 29) is amended to read: | 0016| "59A-46-30. STATUTORY CONSTRUCTION AND RELATIONSHIP TO OTHER | 0017| LAWS.-- | 0018| A. The provisions of the Insurance Code other than Chapter | 0019| 59A, Article 46 NMSA 1978 shall not apply to health maintenance | 0020| organizations except as expressly provided in the Insurance Code and | 0021| that article. To the extent reasonable and not inconsistent with the | 0022| provisions of that article, the following articles and provisions of | 0023| the Insurance Code shall also apply to health maintenance | 0024| organizations and their promoters, sponsors, directors, officers, | 0025| employees, agents, solicitors and other representatives. For the | 0001| purposes of such applicability, a health maintenance organization may | 0002| therein be referred to as an "insurer": | 0003| (1) Chapter 59A, Article 1 NMSA 1978; | 0004| (2) Chapter 59A, Article 2 NMSA 1978; | 0005| (3) Chapter 59A, Article 3 NMSA 1978; | 0006| (4) Chapter 59A, Article 4 NMSA 1978; | 0007| (5) Subsection C of Section 59A-5-22 NMSA 1978; | 0008| (6) Sections 59A-6-2 through 59A-6-4 and 59A-6-6 NMSA | 0009| 1978; | 0010| (7) Chapter 59A, Article 8 NMSA 1978; | 0011| (8) Chapter 59A, Article 10 NMSA 1978; | 0012| (9) Section 59A-12-22 NMSA 1978; | 0013| (10) Chapter 59A, Article 16 NMSA 1978; | 0014| (11) Chapter 59A, Article 18 NMSA 1978; | 0015| (12) Chapter 59A, Article 19 NMSA 1978; | 0016| (13) Chapter 59A, Article 23B NMSA 1978; | 0017| (14) Sections 59A-34-9 through 59A-34-13, 59A-34-17, | 0018| 59A-34-23, 59A-34-36 and 59A-34-37 NMSA 1978; and | 0019| (15) Chapter 59A, Article 37 NMSA 1978. | 0020| B. Solicitation of enrollees by a health maintenance | 0021| organization granted a certificate of authority, or its | 0022| representatives, shall not be construed as violating any provision of | 0023| law relating to solicitation or advertising by health professionals, | 0024| but health professionals shall be individually subject to the laws, | 0025| rules, regulations and ethical provisions governing their individual | 0001| professions. | 0002| C. Any health maintenance organization authorized under the | 0003| provisions of the Health Maintenance Organization Law shall not be | 0004| deemed to be practicing medicine and shall be exempt from the | 0005| provisions of laws relating to the practice of medicine." | 0006| Section 3. Section 59A-47-33 NMSA 1978 (being Laws 1984, Chapter | 0007| 127, Section 879.32, as amended by Laws 1994, Chapter 64, Section 10 | 0008| and also by Laws 1994, Chapter 75, Section 34) is amended to read: | 0009| "59A-47-33. OTHER PROVISIONS APPLICABLE.--The provisions of the | 0010| Insurance Code other than Chapter 59A, Article 47 NMSA 1978 shall not | 0011| apply to health care plans except as expressly provided in the | 0012| Insurance Code and that article. To the extent reasonable and not | 0013| inconsistent with the provisions of that article, the following | 0014| articles and provisions of the Insurance Code shall also apply to | 0015| health care plans, their promoters, sponsors, directors, officers, | 0016| employees, agents, solicitors and other representatives; and, for the | 0017| purposes of such applicability, a health care plan may therein be | 0018| referred to as an "insurer": | 0019| A. Chapter 59A, Article 1 NMSA 1978; | 0020| B. Chapter 59A, Article 2 NMSA 1978; | 0021| C. Chapter 59A, Article 4 NMSA 1978; | 0022| D. Subsection C of Section 59A-5-22 NMSA 1978; | 0023| E. Sections 59A-6-2 through 59A-6-4 and | 0024| 59A-6-6 NMSA 1978; | 0025| F. Section 59A-7-11 NMSA 1978; | 0001| G. Chapter 59A, Article 8 NMSA 1978; | 0002| H. Chapter 59A, Article 10 NMSA 1978; | 0003| I. Section 59A-12-22 NMSA 1978; | 0004| J. Chapter 59A, Article 16 NMSA 1978; | 0005| K. Chapter 59A, Article 18 NMSA 1978; | 0006| L. Chapter 59A, Article 19 NMSA 1978; | 0007| M. Subsections B through E of Section | 0008| 59A-22-5 NMSA 1978; | 0009| N. Section 59A-22-34.1 NMSA 1978; | 0010| O. Section 59A-22-39 NMSA 1978; | 0011| P. Section 59A-22-40 NMSA 1978; | 0012| Q. Sections 59A-34-9 through 59A-34-13, 59A-34-17 and | 0013| 59A-34-23 NMSA 1978; | 0014| R. Chapter 59A, Article 37 NMSA 1978, except Section | 0015| 59A-37-7 NMSA 1978; and | 0016| S. Section 59A-46-15 NMSA 1978." |