0001| HOUSE BILL 832 | 0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997 | 0003| INTRODUCED BY | 0004| M. MICHAEL OLGUIN | 0005| | 0006| | 0007| | 0008| FOR THE HEALTH CARE REFORM COMMITTEE | 0009| | 0010| AN ACT | 0011| RELATING TO INSURANCE; ENACTING THE HEALTH INSURANCE | 0012| PORTABILITY ACT TO COMPLY WITH FEDERAL REQUIREMENTS; AMENDING | 0013| PROVISIONS OF THE NEW MEXICO INSURANCE CODE TO BE CONSISTENT | 0014| WITH FEDERAL REQUIREMENTS AND THAT ACT; PROVIDING FOR INCREASED | 0015| PORTABILITY, ACCESS AND RENEWABILITY OF HEALTH INSURANCE; | 0016| DECLARING AN EMERGENCY. | 0017| | 0018| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0019| Section 1. A new section of the New Mexico Insurance Code | 0020| is enacted to read: | 0021| "[NEW MATERIAL] SHORT TITLE.--Sections 1 through 17 of | 0022| this act may be cited as the "Health Insurance Portability | 0023| Act"." | 0024| Section 2. A new section of the New Mexico Insurance Code | 0025| is enacted to read: | 0001| "[NEW MATERIAL] DEFINITIONS.--As used in the Health | 0002| Insurance Portability Act: | 0003| A. "affiliation period" means a period that must | 0004| expire before health insurance coverage offered by a health | 0005| maintenance organization becomes effective; | 0006| B. "beneficiary" means that term as defined in | 0007| Section 3(8) of the Employee Retirement Income Security Act of | 0008| 1974; | 0009| C. "bona fide association" means an association | 0010| that: | 0011| (1) has been actively in existence for five or | 0012| more years; | 0013| (2) has been formed and maintained in good | 0014| faith for purpose other than obtaining insurance; | 0015| (3) does not condition membership in the | 0016| association on any health status related factor relating to an | 0017| individual, including an employee or a dependent of an | 0018| employee; | 0019| (4) makes health insurance coverage offered | 0020| through the association available to all members regardless of | 0021| any health status related factor relating to the members or | 0022| individuals eligible for coverage through a member; and | 0023| (5) does not offer health insurance coverage | 0024| to an individual through the association except in connection | 0025| with a member of the association; | 0001| D. "church plan" means that term as defined | 0002| pursuant to Section 3(33) of the Employee Retirement Income | 0003| Security Act of 1974; | 0004| E. "COBRA" means the federal Consolidated Omnibus | 0005| Budget Reconciliation Act of 1985; | 0006| F. "COBRA continuation provision" means: | 0007| (1) Section 4980 of the Internal Revenue Code | 0008| of 1986, except for Subsection (f)(1) of that section as it | 0009| relates to pediatric vaccines; | 0010| (2) Part 6 of Subtitle B of Title 1 of the | 0011| Employee Retirement Income Security Act of 1974 except for | 0012| Section 609 of that part; or | 0013| (3) Title 22 of the federal Health Insurance | 0014| Portability and Accountability Act of 1996; | 0015| G. "creditable coverage" means, with respect to an | 0016| individual, coverage of the individual pursuant to: | 0017| (1) a group health plan; | 0018| (2) health insurance coverage; | 0019| (3) Part A or Part B of Title 18 of the Social | 0020| Security Act; | 0021| (4) Title 19 of the Social Security Act except | 0022| coverage consisting solely of benefits pursuant to Section 1928 | 0023| of that title; | 0024| (5) 10 USCA Chapter 55; | 0025| (6) a medical care program of the Indian | 0001| health service or of an Indian nation, tribe or pueblo; | 0002| (7) the Comprehensive Health Insurance Pool | 0003| Act; | 0004| (8) a health plan offered pursuant to 5 USCA | 0005| Chapter 89; | 0006| (9) a public health plan as defined in federal | 0007| regulations; or | 0008| (10) a health benefit plan offered pursuant to | 0009| Section 5(e) of the federal Peace Corps Act; | 0010| H. "eligible individual" means, with respect to a | 0011| health insurance issuer that offers health insurance coverage | 0012| to a small employer in connection with a group health plan in | 0013| the small group market, an individual whose eligibility shall | 0014| be determined: | 0015| (1) in accordance with the terms of the plan; | 0016| (2) as provided by the issuer under the rules | 0017| of the issuer that are uniformly applicable in the state to | 0018| small employers in the small group market; and | 0019| (3) in accordance with state laws governing | 0020| the issuer and the small group market; | 0021| I. "employee" means that term as defined in Section | 0022| 3(6) of the Employee Retirement Income Security Act of 1974; | 0023| J. "employer" means that term as defined in Section | 0024| 3(5) of the Employee Retirement Income Security Act of 1974 but | 0025| to be an "employer", a person must employ two or more | 0001| employees; | 0002| K. "employer contribution rule" means a requirement | 0003| relating to the minimum level or amount of employer | 0004| contribution toward the premium for enrollment of participants | 0005| and beneficiaries; | 0006| L. "enrollment date" means, with respect to an | 0007| individual covered under a group health plan or health | 0008| insurance coverage, the date of enrollment of the individual in | 0009| the plan or coverage or, if earlier, the first day of the | 0010| waiting period for enrollment; | 0011| M. "excepted benefits" means benefits furnished | 0012| pursuant to the following: | 0013| (1) coverage only accident or disability | 0014| income insurance; | 0015| (2) coverage issued as a supplement to | 0016| liability insurance; | 0017| (3) liability insurance; | 0018| (4) workers' compensation or similar | 0019| insurance; | 0020| (5) automobile medical payment insurance; | 0021| (6) credit-only insurance; | 0022| (7) coverage for on-site medical clinics; | 0023| (8) other similar insurance coverage specified | 0024| in regulations under which benefits for medical care are | 0025| secondary or incidental to other benefits; | 0001| (9) the following benefits if offered | 0002| separately: | 0003| (a) limited scope dental or vision | 0004| benefits; | 0005| (b) benefits for long-term care, nursing | 0006| home care, home health care, community-based care or any | 0007| combination of those benefits; and | 0008| (c) other similar limited benefits | 0009| specified in regulations; | 0010| (10) the following benefits, offered as | 0011| independent noncoordinated benefits: | 0012| (a) coverage only for a specified | 0013| disease or illness; or | 0014| (b) hospital indemnity or other fixed | 0015| indemnity insurance; and | 0016| (11) the following benefits if offered as a | 0017| separate insurance policy: | 0018| (a) medicare supplemental health | 0019| insurance as defined pursuant to Section 1882(g)(1) of the | 0020| Social Security Act; and | 0021| (b) coverage supplemental to the | 0022| coverage provided pursuant to Chapter 55 of Title 10 USCA and | 0023| similar supplemental coverage provided to coverage pursuant to | 0024| a group health plan; | 0025| N. "federal governmental plan" means a governmental | 0001| plan established or maintained for its employees by the United | 0002| States government or an instrumentality of that government; | 0003| O. "governmental plan" means that term as defined | 0004| in Section 3(32) of the Employee Retirement Income Security Act | 0005| of 1974 and includes a federal governmental plan; | 0006| P. "group health insurance coverage" means health | 0007| insurance coverage offered in connection with a group health | 0008| plan; | 0009| Q. "group health plan" means an employee welfare | 0010| benefit plan as defined in Section 3(1) of the Employee | 0011| Retirement Income Security Act of 1974 to the extent that the | 0012| plan provides medical care and includes items and services paid | 0013| for as medical care to employees or their dependents as defined | 0014| under the terms of the plan directly or through insurance, | 0015| reimbursement or otherwise; | 0016| R. "group participation rule" means a requirement | 0017| relating to the minimum number of participants or beneficiaries | 0018| that must be enrolled in relation to a specified percentage or | 0019| number of eligible individuals or employees of an employer; | 0020| S. "health insurance coverage" means benefits | 0021| consisting of medical care provided directly, through insurance | 0022| or reimbursement, or otherwise, and items, including items and | 0023| services paid for as medical care, pursuant to any hospital or | 0024| medical service policy or certificate, hospital or medical | 0025| service plan contract or health maintenance organization | 0001| contract offered by a health insurance issuer; | 0002| T. "health insurance issuer" means an insurance | 0003| company, insurance service or insurance organization, including | 0004| a health maintenance organization, that is licensed to engage | 0005| in the business of insurance in the state and that is subject | 0006| to state law that regulates insurance within the meaning of | 0007| Section 514(b)(2) of the Employee Retirement Income Security | 0008| Act of 1974, but "health insurance issuer" does not include a | 0009| group health plan; | 0010| U. "health maintenance organization" means: | 0011| (1) a federally qualified health maintenance | 0012| organization; | 0013| (2) an organization recognized pursuant to | 0014| state law as a health maintenance organization; or | 0015| (3) a similar organization regulated pursuant | 0016| to state law for solvency in the same manner and to the same | 0017| extent as a health maintenance organization defined in | 0018| Paragraph (1) or (2) of this subsection; | 0019| V. "health status related factor" means any of the | 0020| factors described in Section 2702(a)(1) of the federal Health | 0021| Insurance Portability and Accountability Act of 1996; | 0022| W. "individual health insurance coverage" means | 0023| health insurance coverage offered to an individual in the | 0024| individual market, but "individual health insurance coverage" | 0025| does not include short-term limited duration insurance; | 0001| X. "individual market" means the market for health | 0002| insurance coverage offered to individuals other than in | 0003| connection with a group health plan; | 0004| Y. "large employer" means, in connection with a | 0005| group health plan and with respect to a calendar year and a | 0006| plan year, an employer who employed an average of at least | 0007| fifty-one employees on business days during the preceding | 0008| calendar year and who employs at least two employees on the | 0009| first day of the plan year; | 0010| Z. "large group market" means the health insurance | 0011| market under which individuals obtain health insurance coverage | 0012| on behalf of themselves and their dependents through a group | 0013| health plan maintained by a large employer; | 0014| AA. "late enrollee" means, with respect to coverage | 0015| under a group health plan, a participant or beneficiary who | 0016| enrolls under the plan other than during: | 0017| (1) the first period in which the individual | 0018| is eligible to enroll under the plan; or | 0019| (2) a special enrollment period pursuant to | 0020| Sections 8 and 9 of the Health Insurance Portability Act; | 0021| BB. "medical care" means amounts paid for: | 0022| (1) the diagnosis, cure, mitigation, treatment | 0023| or prevention of disease or for the purpose of affecting any | 0024| structure or function of the body; | 0025| (2) transportation primarily for and essential | 0001| to medical care; and | 0002| (3) insurance covering medical care; | 0003| CC. "network plan" means health insurance coverage | 0004| of a health insurance issuer under which the financing and | 0005| delivery of medical care are provided through a defined set of | 0006| providers under contract with the issuer; | 0007| DD. "nonfederal governmental plan" means a | 0008| governmental plan that is not a federal governmental plan; | 0009| EE. "participant" means that term as defined in | 0010| Section 3(7) of the Employee Retirement Income Security Act of | 0011| 1974; | 0012| FF. "placed for adoption" means a child has been | 0013| placed with a person who assumes and retains a legal obligation | 0014| for total or partial support of the child in anticipation of | 0015| adoption of the child; | 0016| GG. "plan sponsor" means that term as defined in | 0017| Section 3(16)(B) of the Employee Retirement Income Security Act | 0018| of 1974; | 0019| HH. "preexisting condition exclusion" means a | 0020| limitation or exclusion of benefits relating to a condition | 0021| based on the fact that the condition was present before the | 0022| date of the coverage for the benefits whether or not any | 0023| medical advice, diagnosis, care or treatment was recommended | 0024| before that date, but genetic information is not included as a | 0025| preexisting condition for the purposes of limiting or excluding | 0001| benefits in the absence of a diagnosis of the condition related | 0002| to the genetic information; | 0003| II. "small employer" means, in connection with a | 0004| group health plan and with respect to a calendar year and a | 0005| plan year, an employer who employed an average of least two but | 0006| not more than fifty employees on business days during the | 0007| preceding calendar year and who employs at least two employees | 0008| on the first day of the plan year; | 0009| JJ. "small group market" means the health insurance | 0010| market under which individuals obtain health insurance coverage | 0011| through a group health plan maintained by a small employer; | 0012| KK. "state law" means laws, decisions, rules, | 0013| regulations or state action having the effect of law; and | 0014| LL. "waiting period" means, with respect to a group | 0015| health plan and an individual who is a potential participant or | 0016| beneficiary in the plan, the period that must pass with respect | 0017| to the individual before the individual is eligible to be | 0018| covered for benefits under the terms of the plan." | 0019| Section 3. A new section of the New Mexico Insurance Code | 0020| is enacted to read: | 0021| "[NEW MATERIAL] LIMITATION ON PREEXISTING CONDITION | 0022| EXCLUSION PERIOD--CREDITING FOR PERIODS OF PREVIOUS COVERAGE.-- | 0023| Except as provided in Section 4 of the Health Insurance | 0024| Portability Act, a group health plan and a health insurance | 0025| issuer offering group health insurance coverage may, with | 0001| respect to a participant or beneficiary, impose a preexisting | 0002| condition exclusion only if: | 0003| A. the exclusion relates to a condition, physical | 0004| or mental, regardless of the cause of the condition, for which | 0005| medical advice, diagnosis, care or treatment was recommended or | 0006| received within the six-month period ending on the enrollment | 0007| date; | 0008| B. the exclusion extends for a period of not more | 0009| than twelve months, or eighteen months in the case of a late | 0010| enrollee, after the enrollment date; and | 0011| C. the period of the exclusion is reduced by the | 0012| aggregate of the periods of creditable coverage applicable to | 0013| the participant or beneficiary as of the enrollment date." | 0014| Section 4. A new section of the New Mexico Insurance Code | 0015| is enacted to read: | 0016| "[NEW MATERIAL] PROHIBITION OF EXCLUSIONS IN CERTAIN | 0017| CASES.-- | 0018| A. A group health plan or a health insurer offering | 0019| group health insurance shall not impose a preexisting condition | 0020| exclusion: | 0021| (1) in the case of an individual who, as of | 0022| the last day of the thirty-day period beginning with the date | 0023| of birth, is covered under creditable coverage; | 0024| (2) that excludes a child who is adopted or | 0025| placed for adoption before his eighteenth birthday and who, as | 0001| of the last day of the thirty-day period beginning on and | 0002| following the date of the adoption or placement for adoption, | 0003| is covered under creditable coverage; or | 0004| (3) that relates to or includes pregnancy as a | 0005| preexisting condition. | 0006| B. The provisions of Paragraphs (1) and (2) of | 0007| Subsection A of this section do not apply to any individual | 0008| after the end of the first continuous sixty-three-day period | 0009| during which the individual was not covered under any | 0010| creditable coverage." | 0011| Section 5. A new section of the New Mexico Insurance Code | 0012| is enacted to read: | 0013| "[NEW MATERIAL] RULES FOR CREDITING PREVIOUS COVERAGE.- | 0014| - | 0015| A. A period of creditable coverage shall not be | 0016| counted with respect to enrollment of an individual under a | 0017| group health plan if, after the period and before the | 0018| enrollment date, there was a sixty-three-day continuous period | 0019| during which the individual was not covered under any | 0020| creditable coverage. | 0021| B. In determining the continuous period for the | 0022| purpose of Subsection A of this section, any period that an | 0023| individual is in a waiting period for any coverage under a | 0024| group health plan or for group health insurance coverage, or is | 0025| in an affiliation period, shall not be counted." | 0001| Section 6. A new section of the New Mexico Insurance Code | 0002| is enacted to read: | 0003| "[NEW MATERIAL] METHOD OF CREDITING COVERAGE--ELECTION- | 0004| -NOTICE OF ELECTION.-- | 0005| A. Except as provided in Subsection B of this | 0006| section, for purposes of applying Subsection C of Section 3 of | 0007| the Health Insurance Portability Act a group health plan and a | 0008| health insurance issuer offering group health insurance | 0009| coverage shall count a period of creditable coverage without | 0010| regard to the specific benefits covered during the period. | 0011| B. A group health plan or a health insurance issuer | 0012| offering group health insurance coverage may elect to apply | 0013| Subsection C of Section 3 of the Health Insurance Portability | 0014| Act based on coverage of benefits within each of several | 0015| classes or categories of benefits specified in regulations | 0016| rather than as provided in Subsection A of this section. The | 0017| election shall be made uniformly for all participants and | 0018| beneficiaries. If the election is made, a group health plan or | 0019| an issuer shall count a period of creditable coverage with | 0020| respect to any class or category of benefits if any level of | 0021| benefits is covered within the class or category. | 0022| C. A group health plan making an election pursuant | 0023| to Subsection B of this section, whether or not health | 0024| insurance coverage is provided in connection with the plan, | 0025| shall: | 0001| (1) prominently state in disclosure statements | 0002| concerning the plan, and state to each enrollee at the time of | 0003| enrollment under the plan, that the plan has made the election; | 0004| and | 0005| (2) include in the statements made a | 0006| description of the effect of this election. | 0007| D. A health insurance issuer offering group health | 0008| insurance coverage in the small or large group market making an | 0009| election pursuant to Subsection B of this section shall: | 0010| (1) prominently state in disclosure statements | 0011| concerning the coverage, and state to each employer at the time | 0012| of the offer or sale of the coverage, that the issuer has made | 0013| the election; and | 0014| (2) include in the statements made a | 0015| description of the effect of this election." | 0016| Section 7. A new section of the New Mexico Insurance Code | 0017| is enacted to read: | 0018| "[NEW MATERIAL] CERTIFICATION AND DISCLOSURE OF | 0019| COVERAGE.-- | 0020| A. Periods of creditable coverage with respect to | 0021| an individual shall be established through the certification | 0022| required by this section. A group health plan and a health | 0023| insurance issuer offering group health insurance coverage shall | 0024| provide the certification described in Subsection B of this | 0025| section: | 0001| (1) at the time an individual ceases to be | 0002| covered under the plan or otherwise becomes covered under a | 0003| COBRA continuation provision, to the extent practicable, at a | 0004| time consistent with notices required pursuant to any COBRA | 0005| continuation provision; | 0006| (2) in the case of an individual becoming | 0007| covered under a COBRA continuation provision, at the time the | 0008| individual ceases to be covered under that provision; and | 0009| (3) on the request on behalf of an individual | 0010| made not later than twenty-four months after the date of | 0011| cessation of the coverage described in Paragraph (1) or (2) of | 0012| this subsection, whichever is later. | 0013| B. The required certification is a written | 0014| certification of: | 0015| (1) the period of creditable coverage of the | 0016| individual under the plan and the coverage, if any, under the | 0017| COBRA continuation provision; and | 0018| (2) the waiting period, if any, and | 0019| affiliation period, if applicable, imposed with respect to the | 0020| individual for any coverage under the plan. | 0021| C. To the extent that medical care pursuant to a | 0022| group health plan consists of group health insurance coverage, | 0023| the plan satisfies the certification requirement of this | 0024| section if the health insurance issuer offering the coverage | 0025| provides for the certification pursuant to this section. | 0001| D. If a group health plan or health insurance | 0002| issuer that has made an election pursuant to Subsection B of | 0003| Section 6 of the Health Insurance Portability Act enrolls an | 0004| individual for coverage under the plan or insurance and the | 0005| individual provides a certification pursuant to this section, | 0006| the entity providing the individual that certification: | 0007| (1) shall upon request of the plan or issuer | 0008| promptly disclose to the requester information on coverage of | 0009| classes and categories of health benefits available under the | 0010| entity's plan or coverage; and | 0011| (2) may charge the requesting plan or issuer | 0012| the reasonable cost of disclosing the required information." | 0013| Section 8. A new section of the New Mexico Insurance Code | 0014| is enacted to read: | 0015| "[NEW MATERIAL] SPECIAL ENROLLMENT PERIODS FOR | 0016| INDIVIDUALS LOSING OTHER COVERAGE.--A group health plan and a | 0017| health insurance issuer offering group health insurance | 0018| coverage in connection with a group health plan shall permit an | 0019| employee who is eligible, but not enrolled, for coverage under | 0020| the terms of the plan, or a dependent of the employee if the | 0021| dependent is eligible but not enrolled for coverage, to enroll | 0022| for coverage under the terms of the plan if: | 0023| A. the employee or dependent was covered under a | 0024| group health plan or had health insurance coverage at the time | 0025| coverage was previously offered to the employee or dependent; | 0001| B. the employee stated in writing at the time | 0002| coverage was offered that coverage under a group health plan or | 0003| health insurance coverage was the reason for declining | 0004| enrollment, but only if the plan sponsor or issuer required | 0005| such a statement at the time and provided the employee with | 0006| notice of that requirement and the consequences of the | 0007| requirement at the time; | 0008| C. the employee's or dependent's coverage described | 0009| in Subsection A of this section: | 0010| (1) was under a COBRA continuation provision | 0011| and the coverage under that provision was exhausted; or | 0012| (2) was not under a COBRA continuation | 0013| provision and either the coverage was terminated as a result of | 0014| loss of eligibility for the coverage, including as a result of | 0015| legal separation, divorce, death, termination of employment or | 0016| reduction in the number of hours of employment, or employer | 0017| contributions toward the coverage were terminated; and | 0018| D. under the terms of the plan the employee | 0019| requested enrollment not later than thirty days after the date | 0020| of exhaustion of coverage described in Paragraph (1) of | 0021| Subsection C of this section or termination of coverage or | 0022| employer contribution described in Paragraph (2) of Subsection | 0023| C of this section." | 0024| Section 9. A new section of the New Mexico Insurance Code | 0025| is enacted to read: | 0001| "[NEW MATERIAL] SPECIAL ENROLLMENT PERIODS FOR | 0002| DEPENDENT BENEFICIARIES.-- | 0003| A. A group health plan shall provide for a | 0004| dependent special enrollment period described in Subsection B | 0005| of this section during which a person or, if not otherwise | 0006| enrolled, the individual, may be enrolled under the plan as a | 0007| dependent of the individual, and in the case of the birth or | 0008| adoption of a child, the spouse of the individual may be | 0009| enrolled as a dependent of the individual if the spouse is | 0010| otherwise eligible for coverage, if: | 0011| (1) the plan makes coverage available to a | 0012| dependent of an individual; | 0013| (2) the individual is a participant under the | 0014| plan or has met any waiting period applicable to becoming a | 0015| participant and is eligible to be enrolled under the plan but | 0016| for a failure to enroll during a previous enrollment period; | 0017| and | 0018| (3) a person has become the dependent of the | 0019| individual through marriage, birth, adoption or placement for | 0020| adoption. | 0021| B. A dependent special enrollment period pursuant | 0022| to this subsection shall be for a period of not less than | 0023| thirty days and shall begin on the later of: | 0024| (1) the date dependent coverage is made | 0025| available; or | 0001| (2) the date of the marriage, birth, adoption | 0002| or placement for adoption described in Subsection A of this | 0003| section. | 0004| C. If an individual seeks to enroll a dependent | 0005| during the first thirty days of a dependent special enrollment | 0006| period, the coverage of the dependent becomes effective: | 0007| (1) in the case of marriage, not later than | 0008| the first day of the first month beginning after the date the | 0009| completed request for enrollment is received; | 0010| (2) in the case of a dependent's birth, as of | 0011| the date of the birth; or | 0012| (3) in the case of a dependent's adoption or | 0013| placement for adoption, the date of the adoption or placement." | 0014| Section 10. A new section of the New Mexico Insurance | 0015| Code is enacted to read: | 0016| "[NEW MATERIAL] USE OF AFFILIATION PERIOD BY HEALTH | 0017| MAINTENANCE ORGANIZATIONS AS ALTERNATIVE TO PREEXISTING | 0018| CONDITION EXCLUSION.-- | 0019| A. A health maintenance organization that offers | 0020| health insurance coverage in connection with a group health | 0021| plan and does not impose any preexisting condition exclusion | 0022| allowed pursuant to Section 3 of the Health Insurance | 0023| Portability Act with respect to any particular coverage option | 0024| may impose an affiliation period for the coverage option if | 0025| that period: | 0001| (1) is applied uniformly without regard to any | 0002| health status related factors; and | 0003| (2) does not exceed two months, or three | 0004| months in the case of a late enrollee. | 0005| B. During an affiliation period, a health | 0006| maintenance organization is not required to provide health care | 0007| services or benefits to a participant or beneficiary, and it | 0008| shall not charge a premium to a participant or beneficiary for | 0009| any coverage. | 0010| C. An affiliation period begins to run on the | 0011| enrollment date and shall run concurrently with any waiting | 0012| period under the plan. | 0013| D. A health maintenance organization described in | 0014| Subsection A of this section may use alternative methods | 0015| different from those described in that subsection to address | 0016| adverse selection as approved by the superintendent." | 0017| Section 11. A new section of the New Mexico Insurance | 0018| Code is enacted to read: | 0019| "[NEW MATERIAL] PROHIBITING DISCRIMINATION BASED ON | 0020| HEALTH STATUS AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES | 0021| IN ELIGIBILITY TO ENROLL.-- | 0022| A. Except as provided in Subsection B of this | 0023| section, a group health plan and a health insurance issuer | 0024| offering group health insurance coverage in connection with a | 0025| group health plan shall not establish rules for eligibility or | 0001| continued eligibility of any individual to enroll or continue | 0002| to participate in a health plan based on any of the following | 0003| health status related factors in relation to the individual or | 0004| a dependent of the individual: | 0005| (1) health status; | 0006| (2) medical condition, including both physical | 0007| and mental illnesses; | 0008| (3) claims experience; | 0009| (4) receipt of health care; | 0010| (5) medical history; | 0011| (6) genetic information; | 0012| (7) evidence of insurability, including | 0013| conditions arising out of acts of domestic violence; or | 0014| (8) disability. | 0015| B. To the extent consistent with the provisions of | 0016| Section 3 of the Health Insurance Portability Act, the | 0017| provisions of Subsection A of this section do not require a | 0018| group health plan or group health insurance coverage to provide | 0019| particular benefits other than those provided under the terms | 0020| of the plan or coverage or to prevent the plan or coverage from | 0021| establishing limitations or restrictions on the amount, level, | 0022| extent or nature of the benefits or coverage for similarly | 0023| situated individuals enrolled in the plan or coverage." | 0024| Section 12. A new section of the New Mexico Insurance | 0025| Code is enacted to read: | 0001| "[NEW MATERIAL] PROHIBITING DISCRIMINATION BASED ON | 0002| HEALTH STATUS AGAINST INDIVIDUAL PARTICIPANTS AND BENEFICIARIES | 0003| IN PREMIUM CONTRIBUTIONS.-- | 0004| A. Except as provided in Subsection B of this | 0005| section, a group health plan and a health insurance issuer | 0006| offering group health insurance coverage in connection with a | 0007| group health plan shall not require an individual as a | 0008| condition to enroll or continue to participate in a health plan | 0009| to pay a premium or contribution that is greater than the | 0010| premium or contribution for a similarly situated individual | 0011| enrolled in the plan on the basis of the health status related | 0012| factors specified in Subsection A of Section 11 of the Health | 0013| Insurance Portability Act in relation to the individual or an | 0014| individual enrolled under the plan as a dependent of the | 0015| individual. | 0016| B. The provisions of Subsection A of this section | 0017| do not restrict the amount that an employer may be charged for | 0018| coverage under a group health plan and do not prevent a group | 0019| health plan or a health insurance issuer offering group health | 0020| insurance coverage from establishing premium discounts or | 0021| rebates or modifying otherwise applicable copayments or | 0022| deductibles in return for adherence to programs of health | 0023| promotion and disease prevention." | 0024| Section 13. A new section of the New Mexico Insurance | 0025| Code is enacted to read: | 0001| "[NEW MATERIAL] HEALTH INSURANCE ISSUERS--COVERAGE IN | 0002| SMALL GROUP MARKET--EXCEPTIONS FOR NETWORK PLANS, INSUFFICIENT | 0003| FINANCIAL CAPACITY AND BONA FIDE ASSOCIATIONS--EMPLOYER | 0004| CONTRIBUTION RULES.-- | 0005| A. Except as provided in Subsections B through G of | 0006| this section, a health insurance issuer that offers health | 0007| insurance coverage in the small group market shall: | 0008| (1) accept a small employer that applies for | 0009| coverage; | 0010| (2) accept for enrollment under the offered | 0011| coverage an eligible individual who applies for enrollment | 0012| during the period in which the individual first becomes | 0013| eligible to enroll under the terms of the group health plan; | 0014| and | 0015| (3) not place a restriction on an eligible | 0016| individual being a participant or a beneficiary that is | 0017| inconsistent with Sections 11 and 12 of the of the Health | 0018| Insurance Portability Act. | 0019| B. A health insurance issuer that offers health | 0020| insurance coverage in the small group market through a network | 0021| plan may: | 0022| (1) limit the employers that may apply for the | 0023| coverage to those with eligible individuals who live, work or | 0024| reside in the service area for the network plan; and | 0025| (2) deny coverage to employers within the | 0001| service area for the network plan if the issuer has | 0002| demonstrated to the superintendent that it: | 0003| (a) will not have the capacity to | 0004| deliver services adequately to enrollees of any additional | 0005| groups because of its obligations to existing group contract | 0006| holders and enrollees; and | 0007| (b) is applying this exception uniformly | 0008| to all employers without regard to the claims experience of | 0009| those employers, their employees and their dependents or any | 0010| health status related factor relating to those employees and | 0011| dependents. | 0012| C. A health insurance issuer, upon denying | 0013| insurance coverage in any service area pursuant to the | 0014| provisions of Subsection B of this section, shall not offer | 0015| coverage in the small group market within the service area for | 0016| a period of one hundred eighty days after the date coverage is | 0017| denied. | 0018| D. A health insurance issuer may deny health | 0019| insurance coverage in the small group market if the issuer has | 0020| demonstrated to the superintendent that it: | 0021| (1) does not have the financial reserves | 0022| necessary to underwrite additional coverage; and | 0023| (2) is applying this exception uniformly to | 0024| all employers in the small group market in the state consistent | 0025| with state law and without regard to the claims experience of | 0001| those employers, their employees and their dependents or any | 0002| health status related factor relating to those employees and | 0003| dependents. | 0004| E. A health insurance issuer upon denying health | 0005| insurance coverage in connection with group health plans | 0006| pursuant to Subsection D of this section shall not offer | 0007| coverage in connection with group health plans in the small | 0008| group market in the state for a period of one hundred eighty | 0009| days after the date coverage is denied or until the issuer has | 0010| demonstrated to the superintendent that the issuer has | 0011| sufficient financial reserves to underwrite the additional | 0012| coverage, whichever is later. The superintendent may provide | 0013| for the application of this subsection on a service-area- | 0014| specific basis. | 0015| F. The requirement of Subsection A of this section | 0016| does not apply to health insurance coverage offered by a health | 0017| insurance issuer if the coverage is made available in the small | 0018| group market only through one or more bona fide associations. | 0019| G. Subsection A of this section does not preclude a | 0020| health insurance issuer from establishing employer contribution | 0021| rules or group participation rules for the offering of health | 0022| insurance coverage in connection with a group health plan in | 0023| the small group market." | 0024| Section 14. A new section of the New Mexico Insurance | 0025| Code is enacted to read: | 0001| "[NEW MATERIAL] GUARANTEED RENEWABILITY OF COVERAGE FOR | 0002| EMPLOYERS IN THE GROUP MARKET--REQUIREMENT AND EXCEPTIONS TO | 0003| REQUIREMENT.-- | 0004| A. Except as provided in Subsections B through G of | 0005| this section, a health insurance issuer that offers health | 0006| insurance coverage in the small or large group market in | 0007| connection with a group health plan shall renew or continue | 0008| that coverage in force at the option of the plan sponsor of the | 0009| plan. | 0010| B. A health insurance issuer may nonrenew or | 0011| discontinue health insurance coverage offered pursuant to | 0012| Subsection A of this section if: | 0013| (1) the plan sponsor has failed to pay | 0014| premiums or contributions in accordance with the terms of the | 0015| health insurance coverage or the issuer has not received timely | 0016| premium payments; | 0017| (2) the plan sponsor has performed an act or | 0018| practice that constitutes fraud or made an intentional | 0019| misrepresentation of a material fact under the terms of the | 0020| coverage; | 0021| (3) the plan sponsor has failed to comply with | 0022| a material plan provision relating to employer contribution or | 0023| group participation rules permitted pursuant to Subsection G of | 0024| Section 13 of the Health Insurance Portability Act; | 0025| (4) the issuer is ceasing to offer coverage in | 0001| the market in accordance with Subsection C of this section; | 0002| (5) in the case of a health insurance issuer | 0003| that offers health insurance coverage in the market through a | 0004| network plan, there is no longer any enrollee in connection | 0005| with that plan who lives, resides or works in the service area | 0006| of the issuer or the area for which the issuer is authorized to | 0007| do business and, in the case of the small group market, the | 0008| issuer would deny enrollment with respect to the network plan | 0009| pursuant to Paragraph (1) of Subsection B of Section 13 of the | 0010| Health Insurance Portability Act; or | 0011| (6) in the case of health insurance coverage | 0012| that is made available only through one or more bona fide | 0013| associations, the membership of any employer in the association | 0014| ceases, but only if the coverage is terminated pursuant to this | 0015| paragraph uniformly without regard to any health status related | 0016| factor relating to a covered individual. | 0017| C. A health insurance issuer may discontinue | 0018| offering a particular type of group health insurance coverage | 0019| offered in the small or large group market only if: | 0020| (1) the issuer provides notice to each plan | 0021| sponsor provided coverage of this type in the market and to the | 0022| participants and beneficiaries covered under the coverage of | 0023| the discontinuation at least ninety days prior to the date of | 0024| the discontinuation; | 0025| (2) the issuer offers to a plan sponsor | 0001| provided coverage of this type in the market the option to | 0002| purchase all, or in the case of the large group market, any, | 0003| other health insurance coverage currently being offered by the | 0004| issuer to a group health plan in that market; and | 0005| (3) in exercising the option to discontinue | 0006| coverage of this type and in offering the option of coverage | 0007| pursuant to Paragraph (2) of this subsection, the issuer acts | 0008| uniformly without regard to the claims experience of those | 0009| sponsors or any health status related factors relating to any | 0010| participants or beneficiaries who may become eligible for that | 0011| coverage. | 0012| D. If a health insurance issuer elects to | 0013| discontinue offering all health insurance coverage in the small | 0014| group market or the large group market, coverage may be | 0015| discontinued only if: | 0016| (1) the issuer provides notice to the | 0017| superintendent and to each plan sponsor and to participants and | 0018| beneficiaries covered under the plan of the discontinuation at | 0019| least one hundred eighty days prior to the date of | 0020| discontinuation; and | 0021| (2) all health insurance issued or delivered | 0022| for issuance in the state in the market is discontinued and | 0023| coverage is not renewed. | 0024| E. After discontinuation pursuant to Subsection D | 0025| of this section, the health insurance issuer shall not provide | 0001| for the issuance of any health insurance coverage in the market | 0002| involved during the five-year period beginning on the date of | 0003| the discontinuation of the last health insurance coverage not | 0004| renewed. | 0005| F. At the time of coverage renewal pursuant to | 0006| Subsection A of this section, a health insurance issuer may | 0007| modify the coverage for a product offered to a group health | 0008| plan: | 0009| (1) in the large group market; or | 0010| (2) in the small group market if, for coverage | 0011| available in that market other than through a bona fide | 0012| association, the modification is effective on a uniform basis | 0013| among group health plans with that product. | 0014| G. If health insurance coverage is made available | 0015| by a health insurance issuer in the small or large group market | 0016| to employers only through one or more associations, a reference | 0017| to "plan sponsor" is deemed, with respect to coverage provided | 0018| to an employer member of the association, to include a | 0019| reference to that employer." | 0020| Section 15. A new section of the New Mexico Insurance | 0021| Code is enacted to read: | 0022| "[NEW MATERIAL] DISCLOSURE OF INFORMATION BY HEALTH | 0023| INSURANCE ISSUERS.-- | 0024| A. A health insurance issuer when offering health | 0025| insurance coverage to a small employer shall: | 0001| (1) make a reasonable disclosure to the small | 0002| employer, as part of its solicitation and sales materials, of | 0003| the availability of information described in Subsection B of | 0004| this section; and | 0005| (2) upon request of the small employer provide | 0006| the information described. | 0007| B. Except as provided in Subsection D of this | 0008| section, a health insurance issuer shall provide information | 0009| pursuant to Subsection A of this section concerning: | 0010| (1) the provisions of coverage concerning the | 0011| issuer's right to change premium rates and the factors that may | 0012| affect changes in premium rates; | 0013| (2) the provisions of coverage relating to | 0014| renewability of coverage; | 0015| (3) the provisions of the coverage relating to | 0016| preexisting condition exclusions; and | 0017| (4) the benefits and premiums available under | 0018| all health insurance coverage for which the small employer is | 0019| qualified. | 0020| C. Information furnished pursuant to this section | 0021| shall be provided to small employers in a manner determined to | 0022| be understandable by the average small employer and shall be | 0023| sufficient to reasonably inform small employers of their rights | 0024| and obligations under the health insurance coverage. | 0025| D. A health insurance issuer is not required by | 0001| this section to disclose information that is proprietary and | 0002| trade secret information." | 0003| Section 16. A new section of the New Mexico Insurance | 0004| Code is enacted to read: | 0005| "[NEW MATERIAL] EXCLUSIONS, LIMITATIONS AND EXCEPTIONS | 0006| FOR CERTAIN PLANS.-- | 0007| A. The requirements of Sections 3 through 15 of the | 0008| Health Insurance Portability Act do not apply to any group | 0009| health plan and health insurance coverage offered in connection | 0010| with a group health plan if, on the first day of the plan year, | 0011| the plan has less than two employees who are current employees. | 0012| B. The requirements of Sections 3 through 15 of the | 0013| Health Insurance Portability Act shall not apply with respect | 0014| to a group health plan that is a nonfederal governmental plan | 0015| if the plan sponsor makes an election under the provisions of | 0016| this subsection in conformity with regulations of the federal | 0017| secretary of health and human services. The period of an | 0018| election for exclusion made pursuant to this subsection is for | 0019| a single specified plan year or, in the case of a plan provided | 0020| pursuant to a collective bargaining agreement, for the term of | 0021| the agreement. The plan for which an election is made shall | 0022| provide under the terms of the election for: | 0023| (1) notice to enrollees on an annual basis and | 0024| at the time of enrollment of the facts and consequences of the | 0025| election; and | 0001| (2) certification and disclosure of creditable | 0002| coverage under the plan with respect to enrollees in accordance | 0003| with Section 7 of the Health Insurance Portability Act. | 0004| C. The requirements of Sections 3 through 15 of the | 0005| Health Insurance Portability Act do not apply to a group health | 0006| plan and group health insurance coverage offered in connection | 0007| with a group health plan in relation to its provision of | 0008| excepted benefits described in Paragraph (9) of Subsection M of | 0009| Section 2 of the Health Insurance Portability Act if the | 0010| benefits are: | 0011| (1) provided under a separate policy, | 0012| certificate or contract of insurance; or | 0013| (2) otherwise not an integral part of the | 0014| plan. | 0015| D. The requirements of Sections 3 through 15 of the | 0016| Health Insurance Portability Act do not apply to any group | 0017| health plan and group health insurance coverage offered in | 0018| connection with a group health plan in relation to its | 0019| provision of excepted benefits described in Paragraph (10) of | 0020| Subsection M of Section 2 of the Health Insurance Portability | 0021| Act if: | 0022| (1) the benefits are provided under a separate | 0023| policy, certificate or contract of insurance; | 0024| (2) there is no coordination between the | 0025| provision of the benefits and any exclusion of benefits under | 0001| any group health plan maintained by the same sponsor; and | 0002| (3) the benefits are paid with respect to an | 0003| event without regard to whether benefits are provided with | 0004| respect to that event under any group health plan maintained by | 0005| the same sponsor. | 0006| E. The requirements of Sections 3 through 15 of the | 0007| Health Insurance Portability Act do not apply to any group | 0008| health plan and group health insurance coverage offered in | 0009| connection with a group health plan in relation to its | 0010| provision of excepted benefits described in Paragraph (11) of | 0011| Subsection M of Section 2 of the Health Insurance Portability | 0012| Act if the benefits are provided under a separate policy, | 0013| certificate or contract of insurance." | 0014| Section 17. A new section of the New Mexico Insurance | 0015| Code is enacted to read: | 0016| "[NEW MATERIAL] TREATMENT OF PARTNERSHIPS AND SELF- | 0017| EMPLOYED INDIVIDUALS.-- | 0018| A. Any plan, fund or program that would not be an | 0019| employee welfare benefit plan, except for the provisions of | 0020| this section, that is established or maintained by a | 0021| partnership, to the extent that the plan, fund or program | 0022| provides medical care to current or former partners in the | 0023| partnership or to their dependents directly or through | 0024| insurance, reimbursement or otherwise, shall be treated as an | 0025| employee welfare benefit plan that is a group health plan. | 0001| B. As used in this section: | 0002| (1) "employer" includes a partnership in | 0003| relation to a partner; and | 0004| (2) "participant" includes: | 0005| (a) in connection with a group health | 0006| plan maintained by a partnership, an individual who is a | 0007| partner in relationship to the partnership; and | 0008| (b) in connection with a group health | 0009| plan maintained by a self-employed individual under which one | 0010| or more employees are participants, the self-employed | 0011| individual, if he or his beneficiaries are or may become | 0012| eligible to receive a benefit under the plan." | 0013| Section 18. Section 59A-18-13.1 NMSA 1978 (being Laws | 0014| 1994, Chapter 75, Section 26) is amended to read: | 0015| "59A-18-13.1. ADJUSTED COMMUNITY RATING.-- | 0016| A. [Until July 1, 1998] Every insurer, fraternal | 0017| benefit society, health maintenance organization or nonprofit | 0018| health care plan that provides primary health insurance or | 0019| health care coverage insuring or covering major medical | 0020| expenses shall, in determining the initial year's premium | 0021| charged for an individual, use only the rating factors of age, | 0022| gender, geographic area of the place of employment and smoking | 0023| practices, except that for individual policies the rating | 0024| factor of the individual's place of residence may be used | 0025| instead of the geographic area of the individual's place of | 0001| employment. In determining the initial and any subsequent | 0002| year's rate, the difference in rates in any one age group that | 0003| may be charged on the basis of a person's gender shall not | 0004| exceed another person's rates in the age group by more than | 0005| twenty percent of the lower rate, and no person's rate shall | 0006| exceed the rate of any other person with similar family | 0007| composition by more than two hundred fifty percent of the lower | 0008| rate, except that the rates for children under the age of | 0009| nineteen or children aged nineteen to twenty-five who are | 0010| full-time students may be lower than the bottom rates in the | 0011| two hundred fifty percent band. The rating factor restrictions | 0012| shall not prohibit an insurer, society, organization or plan | 0013| from offering rates that differ depending upon family | 0014| composition. | 0015| [B. Effective July 1, 1998, every insurer, | 0016| fraternal benefit society, health maintenance organization or | 0017| nonprofit health care plan that provides primary health | 0018| insurance or health care coverage insuring or covering major | 0019| medical expenses shall charge the same premium for the same | 0020| coverage to each New Mexico resident, regardless of a person's | 0021| individual circumstances for medical risk, job risk or gender. | 0022| The only rating factor that may be used is whether a person is | 0023| under or over the age of nineteen. | 0024| C.] B. The superintendent shall adopt | 0025| regulations to implement the provisions of this section." | 0001| Section 19. Section 59A-18-16 NMSA 1978 (being Laws 1984, | 0002| Chapter 127, Section 345.1, as amended) is amended to read: | 0003| "59A-18-16. CONTINUATION OF COVERAGE AND CONVERSION | 0004| RIGHTS--ACCIDENT AND HEALTH INSURANCE POLICIES-- | 0005| NOTICE. Subject to the provisions of the Health Insurance | 0006| Portability Act: | 0007| A. every accident and health insurance policy that | 0008| provides hospital, surgical and medical expense benefits and | 0009| that is delivered, issued for delivery or renewed in this state | 0010| on or after January 1, 1985 shall provide: | 0011| (1) if an individual policy, covered family | 0012| members the right to continue such policy as the named insured | 0013| or through a conversion policy upon the death of the named | 0014| insured or upon the divorce, annulment or dissolution of | 0015| marriage or legal separation of the spouse from the named | 0016| insured; or | 0017| (2) if a group policy: | 0018| (a) each member or employee of the group | 0019| insured the right to continue such coverage for a period of six | 0020| months and thereafter through a conversion policy upon | 0021| termination of membership or employment with the group insured; | 0022| and | 0023| (b) covered family members of an | 0024| employee or member of the group insured the right to continue | 0025| such coverage through a converted or separate policy upon the | 0001| death of the member or employee of the group insured or upon | 0002| the divorce, annulment or dissolution of marriage or legal | 0003| separation of the spouse from the member or employee of the | 0004| group insured. | 0005| Where a continuation of coverage or conversion is made in | 0006| the name of the spouse of the named insured or the spouse of | 0007| the employee or member of the group insured, such coverage may, | 0008| at the option of the spouse, include coverage for dependent | 0009| children for whom the spouse has responsibility for care and | 0010| support; | 0011| B. the right to a continuation of coverage or | 0012| conversion pursuant to this section shall not exist with | 0013| respect to any member or employee of the group insured or any | 0014| covered family member in the event the coverage terminates for | 0015| nonpayment of premium, nonrenewal of the policy or the | 0016| expiration of the term for which the policy is issued. With | 0017| respect to any member or employee of the group insured or any | 0018| covered family member who is eligible for medicare or any other | 0019| similar federal or state health insurance program, the right to | 0020| a continuation of coverage or conversion shall be limited to | 0021| coverage under a medicare supplement insurance policy as | 0022| defined by the rules and regulations adopted by the | 0023| superintendent; | 0024| C. coverage continued through the issuance of a | 0025| converted or separate policy shall be provided at a reasonable, | 0001| nondiscriminatory rate to the insured and shall consist of a | 0002| form of coverage then being offered by the insurer as a | 0003| conversion policy in the jurisdiction where the person | 0004| exercising the conversion right resides that most nearly | 0005| approximates the coverage of the policy from which conversion | 0006| is exercised. Continued and converted coverages shall contain | 0007| renewal provisions that are not less favorable to the insured | 0008| than those contained in the policy from which the conversion is | 0009| made, except that the person who exercises the right of | 0010| conversion is entitled only to have included a right to | 0011| coverage under a medicare supplement insurance policy, as | 0012| defined by the rules and regulations adopted by the | 0013| superintendent, after the attainment of the age of eligibility | 0014| for medicare or any other similar federal or state health in- | 0015| | 0016| surance program; | 0017| D. at the time of inception of coverage, the insurer | 0018| shall furnish to each covered family member who is eighteen | 0019| years of age or over and to each employee or member of the | 0020| group insured a statement setting forth in summary form the | 0021| continuation of coverage and conversion provisions of the | 0022| policy; | 0023| E. the insurer shall notify in writing each employee | 0024| or member, upon that employee's or member's termination of | 0025| employment or membership with the group insured, of the | 0001| continuation and conversion provisions of the policy. The | 0002| employer may give the written notice specified herein. The | 0003| employer should notify the insurer of the employee's or | 0004| member's change of status and last known address. Under no | 0005| circumstances shall the employer have any civil liability under | 0006| the conversion provisions of the Insurance Code; | 0007| F. the eligible employee or member of the group | 0008| insured or covered family member exercising the continuation or | 0009| conversion right [must] shall notify the employer or | 0010| insurer and make payment of the applicable premium within | 0011| thirty days following the date of the notification given by the | 0012| insurer pursuant to Subsection E of this section. There shall | 0013| be no lapse of coverage during the period in which conversion | 0014| is available; | 0015| G. coverage shall be provided through continuation or | 0016| conversion without additional evidence of insurability and | 0017| shall not impose any preexisting condition, limitations or | 0018| other contractual time limitations other than those remaining | 0019| unexpired under the policy or contract from which continuation | 0020| or conversion is exercised; | 0021| H. benefits otherwise payable under a converted or | 0022| separate policy may be reduced so they are not, during the | 0023| first policy year of the converted or separate policy, in | 0024| excess of those that would have been payable under the policy | 0025| from which conversion is exercised. Benefits, if any, | 0001| otherwise payable under a converted or separate policy are not | 0002| payable for a loss claimed under the policy from which conver- | 0003| | 0004| sion is exercised; and | 0005| I. any probationary or waiting period set forth in | 0006| the converted or separate policy is deemed to commence on the | 0007| effective date of the applicant's coverage under the original | 0008| policy." | 0009| Section 20. A new section of Chapter 59A, Article 23 NMSA | 0010| 1978 is enacted to read: | 0011| "[NEW MATERIAL] OUT-OF-STATE ASSOCIATIONS AND TRUSTS.-- | 0012| Unless the rate applicable to the certificate of coverage of an | 0013| out-of-state association or trust complies with the | 0014| requirements of Section 59A-18-13.1 or 59A-23C-5.1 NMSA 1978, | 0015| the out-of-state association or trust shall not: | 0016| A. advertise in the state as a benefit of membership | 0017| for any group health insurance policy available to its members | 0018| or beneficiaries; | 0019| B. issue a certificate for delivery in New Mexico to | 0020| any resident of the state; or | 0021| C. solicit membership in the state on the basis of | 0022| the existence or availability of such health insurance | 0023| coverage." | 0024| Section 21. Section 59A-23B-6 NMSA 1978 (being Laws 1991, | 0025| Chapter 111, Section 6, as amended) is amended to read: | 0001| "59A-23B-6. FORMS AND RATES--APPROVAL OF THE | 0002| SUPERINTENDENT [OF INSURANCE]--ADJUSTED COMMUNITY RATING.-- | 0003| A. All policy or plan forms, including applications, | 0004| enrollment forms, policies, plans, certificates, evidences of | 0005| coverage, riders, amendments, endorsements and disclosure | 0006| forms, shall be submitted to the department of insurance for | 0007| approval prior to use. | 0008| B. No policy or plan may be issued in the state | 0009| unless the rates have first been filed with and approved by the | 0010| superintendent [of insurance]. This subsection shall not | 0011| apply to policies or plans subject to the Small Group Rate and | 0012| Renewability Act. | 0013| C. Until July 1, 1998, in determining the initial | 0014| year's premium or rate charged for coverage under a policy or | 0015| plan, the only rating factors that may be used are age, gender, | 0016| geographic area of the place of employment and smoking | 0017| practices. Until July 1, 1998, in determining the initial and | 0018| any subsequent year's rate, the difference in rates in any one | 0019| age group that may be charged on the basis of a person's gender | 0020| shall not exceed another person's [rates] rate in the age | 0021| group by more than twenty percent of the lower rate, and no | 0022| person's rate shall exceed the rate of any other person with | 0023| similar family composition by more than two hundred fifty | 0024| percent of the lower rate, except that the rates for children | 0025| under the age of nineteen or children aged nineteen to twenty- | 0001| five who are full-time students may be lower than the bottom | 0002| rates in the two hundred fifty percent band. The rating factor | 0003| restrictions shall not prohibit an insurer, society, | 0004| organization or plan from offering rates that differ depending | 0005| upon family composition. | 0006| D. Effective July 1, 1998, each policy or plan | 0007| covered by the Minimum Healthcare Protection Act shall charge | 0008| the same premium for the same coverage to each New Mexico | 0009| resident, regardless of a person's individual circumstances for | 0010| medical risk, job risk or gender. The only rating factor that | 0011| may be used is whether a person is under or over the age of | 0012| nineteen. | 0013| E. The superintendent [of insurance] shall adopt | 0014| regulations to implement the provisions of this section." | 0015| Section 22. Section 59A-23C-3 NMSA 1978 (being Laws 1991, | 0016| Chapter 153, Section 3, as amended) is amended to read: | 0017| "59A-23C-3. DEFINITIONS.--As used in the Small Group Rate | 0018| and Renewability Act: | 0019| A. "actuarial certification" means a written | 0020| statement by a member of the American academy of actuaries or | 0021| another individual acceptable to the superintendent that a | 0022| small employer carrier is in compliance with the provisions of | 0023| Section 59A-23C-5 NMSA 1978, based upon the person's | 0024| examination, including a review of the appropriate records and | 0025| of the actuarial assumptions and methods [utilized] used by | 0001| the carrier in establishing premium rates for applicable health | 0002| benefit plans; | 0003| B. "base premium rate" means, for each class of | 0004| business as to a rating period, the lowest premium rate charged | 0005| under a rating system for that class of business by the small | 0006| employer carrier to small employers with similar case | 0007| characteristics for health benefit plans with the same or | 0008| similar coverage; | 0009| C. "carrier" means any person who provides health | 0010| insurance in this state. For the purposes of the Small Group | 0011| Rate and Renewability Act, "carrier" or "insurer" includes a | 0012| licensed insurance company, a licensed fraternal benefit | 0013| society, a prepaid hospital or medical service plan, a health | 0014| maintenance organization, a nonprofit health care organization, | 0015| a multiple employer welfare arrangement or any other person | 0016| providing a plan of health insurance subject to state insurance | 0017| regulation; | 0018| D. "case characteristics" means demographic or other | 0019| relevant characteristics of a small employer, as determined by | 0020| a small employer carrier, that are considered by the carrier in | 0021| the determination of premium rates for the small employer, but | 0022| "case characteristics" does not include claim experience, | 0023| health status and duration of coverage since issue; | 0024| E. "class of business" means all small employers as | 0025| shown on the records of the small employer carrier. A separate | 0001| class of business may be established by the small employer | 0002| carrier on the basis that the applicable health benefit plans | 0003| have been acquired from another small employer carrier as a | 0004| distinct grouping of plans; | 0005| F. "creditable coverage" means, with respect to an | 0006| individual, coverage of the individual pursuant to: | 0007| (1) a group health plan; | 0008| (2) health insurance coverage; | 0009| (3) Part A or Part B of Title 18 of the Social | 0010| Security Act; | 0011| (4) Title 19 of the Social Security Act except | 0012| coverage consisting solely of benefits pursuant to Section 1928 | 0013| of that title; | 0014| (5) 10 USCA Chapter 55; | 0015| (6) a medical care program of the Indian health | 0016| service or of an Indian nation, tribe or pueblo; | 0017| (7) the Comprehensive Health Insurance Pool Act; | 0018| (8) a health plan offered pursuant to 5 USCA | 0019| Chapter 89; | 0020| (9) a public health plan as defined in federal | 0021| regulations; or | 0022| (10) a health benefit plan offered pursuant to | 0023| Section 5(e) of the federal Peace Corps Act; | 0024| [F.] G. "department" means the department of | 0025| insurance; | 0001| H. "group health plan" means an employee welfare | 0002| benefit plan as defined Section 3(1) of the Employee Retirement | 0003| Income Security Act of 1974 to the extent that the plan | 0004| provides medical care and including items and services paid for | 0005| as medical care to employees or their dependents as defined | 0006| under the terms of the plan directly or through insurance, | 0007| reimbursement or otherwise; | 0008| [G.] I. "health benefit plan" or "plan" means any | 0009| hospital or medical expense incurred policy or certificate, | 0010| hospital or medical service plan contract or health maintenance | 0011| organization subscriber contract. "Health benefit plan" does | 0012| not include accident-only, credit, dental or disability income | 0013| insurance, medicare supplement coverage, coverage issued as a | 0014| supplement to liability insurance, workers' compensation or | 0015| similar insurance or automobile medical-payment insurance; | 0016| [H.] J. "index rate" means, for each class of | 0017| business for small employers with similar case characteristics, | 0018| the arithmetic average of the applicable base premium rate and | 0019| the corresponding highest premium rate; | 0020| K. "late enrollee" means, with respect to coverage | 0021| under a group health plan, a participant or beneficiary who | 0022| enrolls under the plan other than during: | 0023| (1) the first period in which the individual is | 0024| eligible to enroll under the plan; or | 0025| (2) a special enrollment period pursuant to | 0001| Sections 8 and 9 of the Health Insurance Portability Act; | 0002| [I.] L. "new business premium rate" means, for | 0003| each class of business as to a rating period, the premium rate | 0004| charged or offered by the small employer carrier to small | 0005| employers with similar case characteristics for newly issued | 0006| health benefit plans with the same or similar coverage; | 0007| [J.] M. "rating period" means the calendar period | 0008| for which premium rates established by a small employer carrier | 0009| are assumed to be in effect, as determined by the small | 0010| employer carrier; | 0011| [K.] N. "small employer" means any person, firm, | 0012| corporation, partnership or association actively engaged in | 0013| business who, on at least fifty percent of its working days | 0014| during either of the two preceding [year] years, | 0015| employed no less than two and no more than fifty eligible | 0016| employees; provided that: | 0017| (1) in determining the number of eligible | 0018| employees, the spouse or dependent of an employee may, at the | 0019| employer's discretion, be counted as a separate employee; | 0020| [and] | 0021| (2) companies that are affiliated companies or that are | 0022| eligible to file a combined tax return for purposes of state | 0023| income taxation shall be considered one employer; and | 0024| (3) in the case of an employer that was not in | 0025| existence throughout a preceding calendar year, the | 0001| determination of whether the employer is a small or large | 0002| employer shall be based on the average number of employees that | 0003| it is reasonably expected to employ on working days in the | 0004| current calendar year; | 0005| [L.] O. "small employer carrier" means any | 0006| insurer that offers health benefit plans covering the employees | 0007| of a small employer; and | 0008| [M.] P. "superintendent" means the superintendent | 0009| of insurance." | 0010| Section 23. Section 59A-23C-5 NMSA 1978 (being Laws 1991, | 0011| Chapter 153, Section 5, as amended) is amended to read: | 0012| "59A-23C-5. RESTRICTIONS RELATING TO PREMIUM RATES.-- | 0013| A. Premium rates for health benefit plans subject to | 0014| the Small Group Rate and Renewability Act shall be subject to | 0015| the following provisions: | 0016| (1) the index rate for a rating period for any | 0017| class of business shall not exceed the index rate for any other | 0018| class of business by more than twenty percent; | 0019| (2) for a class of business, the premium rates | 0020| charged during a rating period to small employers with similar | 0021| case characteristics for the same or similar coverage, or the | 0022| rates that could be charged to those employers under the rating | 0023| system for that class of business, shall not vary from the | 0024| index rate by more than [twenty] fifteen percent of the | 0025| index rate; | 0001| (3) the percentage increase in the premium rate | 0002| charged to a small employer for a new rating period may not | 0003| exceed the sum of the following: | 0004| (a) the percentage change in the new | 0005| business premium rate measured from the first day of the prior | 0006| rating period to the first day of the new rating period. In | 0007| the case of a class of business for which the small employer | 0008| carrier is not issuing new policies, the carrier shall use the | 0009| percentage change in the base premium rate; | 0010| (b) an adjustment, not to exceed ten percent | 0011| annually and adjusted pro rata for rating periods of less than | 0012| one year due to the claim experience, health status or duration | 0013| of coverage of the employees or dependents of the small | 0014| employer as determined from the carrier's rate manual for the | 0015| class of business; and | 0016| (c) any adjustment due to change in coverage | 0017| or change in the case characteristics of the small employer as | 0018| determined from the carrier's rate manual for the class of | 0019| business; and | 0020| (4) in the case of health benefit plans issued | 0021| prior to the effective date of the Small Group Rate and | 0022| Renewability Act, a premium rate for a rating period may exceed | 0023| the ranges described in Paragraph (1) or (2) of this subsection | 0024| for a period of five years following the effective date of the | 0025| Small Group Rate and Renewability Act. In that case, the | 0001| percentage increase in the premium rate charged to a small | 0002| employer in that class of business for a new rating period may | 0003| not exceed the sum of the following: | 0004| (a) the percentage change in the new | 0005| business premium rate measured from the first day of the prior | 0006| rating period to the first day of the new rating period. In | 0007| the case of a class of business for which the small employer | 0008| carrier is not issuing new policies, the carrier shall use the | 0009| percentage change in the base premium rate; and | 0010| (b) any adjustment due to change in coverage | 0011| or change in the case characteristics of the small employer as | 0012| determined from the carrier's rate manual for the class of | 0013| business. | 0014| B. Nothing in this section is intended to affect the | 0015| use by a small employer carrier of legitimate rating factors | 0016| other than claim experience, health status or duration of | 0017| coverage in the determination of premium rates. Small employer | 0018| carriers shall apply rating factors, including case | 0019| characteristics, consistently with respect to all small | 0020| employers in a class of business. | 0021| C. A small employer carrier shall not involuntarily | 0022| transfer a small employer into or out of a class of business. | 0023| A small employer carrier shall not offer to transfer a small | 0024| employer into or out of a class of business unless the offer | 0025| is made to transfer all small employers in the class of | 0001| business without regard to case characteristics, claim | 0002| experience, health status or duration since issue. | 0003| D. Prior to usage and [the effective date of the | 0004| Small Group Rate and Renewability Act] June 14, 1991, each | 0005| carrier shall file with the superintendent the rate manuals and | 0006| any updates thereto for each class of business. A rate filing | 0007| fee is payable under Subsection U of Section 59A-6-1 NMSA 1978 | 0008| for the filing of each update. The superintendent shall | 0009| disapprove within sixty days of receipt of a complete filing or | 0010| the filing is deemed approved. If the superintendent | 0011| disapproves [any such] the form during the sixty-day review | 0012| period, he shall give the carrier written notice of the | 0013| disapproval stating the [ground thereof] reasons for | 0014| disapproval. At any time, the superintendent, after a hearing | 0015| [thereof], may disapprove a form or withdraw a previous | 0016| approval. The superintendent's order [on such] after the | 0017| hearing shall state the grounds for disapproval or withdrawal | 0018| of a previous approval and the date not less than twenty days | 0019| later when disapproval or withdrawal becomes effective." | 0020| Section 24. Section 59A-23C-5.1 NMSA 1978 (being Laws | 0021| 1994, Chapter 75, Section 33) is amended to read: | 0022| "59A-23C-5.1. ADJUSTED COMMUNITY RATING.-- | 0023| A. Until July 1, 1998, a health benefit plan that is | 0024| offered by a carrier to a small employer shall be offered | 0025| without regard to the health status of any individual in the | 0001| group, except as provided in the Small Group Rate and | 0002| Renewability Act. The only rating factors that may be used to | 0003| determine the initial year's premium charged a group, subject | 0004| to the maximum rate variation provided in this section for all | 0005| rating factors, are the group members': | 0006| (1) [age] ages; | 0007| (2) [gender] genders; | 0008| (3) geographic [area] areas of the place of | 0009| employment; or | 0010| (4) smoking practices. | 0011| B. Until July 1, 1998, in determining the initial and | 0012| any subsequent year's rate, the difference in rates in any one | 0013| age group that may be charged on the basis of a person's gender | 0014| shall not exceed another person's [rates] rate in the age | 0015| group by more than twenty percent of the lower rate, and no | 0016| person's rate shall exceed the rate of any other person with | 0017| similar family composition by more than two hundred fifty | 0018| percent of the lower rate, except that the rates for children | 0019| under the age of nineteen or children aged nineteen to twenty- | 0020| five who are full-time students may be lower than the bottom | 0021| rates in the two hundred fifty percent band. The rating factor | 0022| restrictions shall not prohibit a carrier from offering rates | 0023| that differ depending upon family composition. | 0024| C. Effective July 1, 1998, a health benefit plan that | 0025| is offered by a carrier to a small employer shall charge the | 0001| same premium for the same coverage to each New Mexico resident, | 0002| regardless of a person's individual circumstances for medical | 0003| risk, job risk or gender. The only rating factor that may be | 0004| used is whether a person is under or over the age of nineteen. | 0005| D. The superintendent shall adopt regulations to | 0006| implement the provisions of this section." | 0007| Section 25. Section 59A-23C-7.1 NMSA 1978 (being Laws | 0008| 1994, Chapter 75, Section 32) is amended to read: | 0009| "59A-23C-7.1. PREEXISTING CONDITIONS--LIMITATIONS.-- | 0010| A. A health benefit plan that is offered by a carrier | 0011| to a small employer may include a preexisting condition | 0012| [restriction that excludes coverage for a condition for up to | 0013| six months after the effective date of the plan, provided that | 0014| within six months before the effective date of coverage: | 0015| (1) medical advice or treatment for the | 0016| condition was recommended by or received from a licensed health | 0017| care provider; or | 0018| (2) the condition manifested itself in a manner | 0019| that would cause a reasonable person to seek diagnosis or | 0020| treatment] exclusion only if: | 0021| (1) the exclusion extends for a period of not | 0022| more than twelve months, or eighteen months in the case of a | 0023| late enrollee, after the enrollment date; and | 0024| (2) the period of the exclusion is reduced by | 0025| the aggregate of the periods of creditable coverage applicable | 0001| to the participant or beneficiary as of the enrollment date. | 0002| B. As used in this section, "preexisting condition | 0003| exclusion" means a limitation or exclusion of benefits relating | 0004| to a condition based on the fact that the condition was present | 0005| before the date of enrollment for coverage for the benefits | 0006| whether or not any medical advice, diagnosis, care or treatment | 0007| was recommended or received before that date, but genetic | 0008| information is not included as a preexisting condition for the | 0009| purposes of limiting or excluding benefits in the absence of a | 0010| diagnosis of the condition related to the genetic information. | 0011| C. A carrier shall not impose a preexisting condition | 0012| exclusion: | 0013| (1) in the case of an individual who, as of the | 0014| last day of the thirty-day period beginning with the date of | 0015| birth, is covered under creditable coverage; | 0016| (2) that excludes a child who is adopted or | 0017| placed for adoption before his eighteenth birthday and who, as | 0018| of the last day of the thirty-day period beginning on and | 0019| following the date of the adoption or placement for adoption, | 0020| is covered under creditable coverage; or | 0021| (3) that relates to or includes pregnancy as a | 0022| preexisting condition. | 0023| D. The provisions of Paragraphs (1) and (2) of | 0024| Subsection C of this section do not apply to any individual | 0025| after the end of the first continuous sixty-three-day period | 0001| during which the individual was not covered under any | 0002| creditable coverage. | 0003| [B.] E. The preexisting condition [restriction] | 0004| exclusion authorized in this section shall be waived to the | 0005| extent that similar conditions have been satisfied under a | 0006| prior health benefit plan that was subject to the Small Group | 0007| Rate and Renewability Act, provided the [application for] | 0008| effective date of coverage under the new health benefit plan | 0009| is made not later than [thirty-one] sixty-three days after | 0010| the individual ceases to be a member of the group insured or | 0011| the group ceases to be insured under the prior health benefit | 0012| plan, whichever occurs first. If the conditions authorized in | 0013| this section have been previously satisfied, coverage under the | 0014| new health benefit plan shall be effective from the date on | 0015| which the prior coverage terminated. | 0016| [C.] F. Nothing in this section requires the use | 0017| in a health benefit plan offered by a carrier of a preexisting | 0018| condition [restriction] exclusion. Nothing in this section | 0019| prohibits the use of a preexisting condition [restrictions] | 0020| exclusion that [are] is less restrictive on small | 0021| employers and insured persons than the [conditions] | 0022| exclusion authorized in this section. | 0023| [D.] G. The superintendent shall adopt | 0024| regulations to implement the provisions of this section." | 0025| Section 26. Section 59A-23D-1 NMSA 1978 (being Laws 1995, | 0001| Chapter 93, Section 1) is amended to read: | 0002| "59A-23D-1. SHORT TITLE. [Sections 1 through 7 of this | 0003| act] Chapter 59A, Article 23D NMSA 1978 may be cited as the | 0004| "Medical Care Savings Account Act"." | 0005| Section 27. Section 59A-23D-2 NMSA 1978 (being Laws 1995, | 0006| Chapter 93, Section 2) is amended to read: | 0007| "59A-23D-2. DEFINITIONS.--As used in the Medical Care | 0008| Savings Account Act: | 0009| A. "account administrator" means any of the following | 0010| that administers medical care savings accounts: | 0011| (1) a national or state chartered bank, savings | 0012| and loan association, savings bank or credit union; | 0013| (2) a trust company authorized to act as a | 0014| fiduciary in this state; | 0015| (3) an insurance company or health maintenance | 0016| organization authorized to do business in this state pursuant | 0017| to the [New Mexico] Insurance Code; or | 0018| [(4) an employer that has a self-insured health | 0019| plan under the federal Employee Retirement Income Security Act | 0020| of 1974; | 0021| (5) a broker, agent or investment advisor; | 0022| (6) a person who holds a certificate or | 0023| registration as an insurance administrator or for whom the | 0024| registration has been waived; or | 0025| (7) an employer who participates in the medical | 0001| care savings account program;] | 0002| (4) a person approved by the federal health and | 0003| human services secretary; | 0004| B. "deductible" means the total covered medical | 0005| expense [the] an employee or his dependents must pay prior | 0006| to any payment by [the] a qualified higher deductible | 0007| health plan for a calendar year; | 0008| C. "department" means the department of insurance; | 0009| D. "dependent" means: | 0010| (1) a spouse; | 0011| (2) an unmarried or unemancipated child of the | 0012| employee who is a minor and who is: | 0013| (a) a natural child; | 0014| (b) a legally adopted child; | 0015| (c) a stepchild living in the same household | 0016| who is primarily dependent on the employee for maintenance and | 0017| support; | 0018| (d) a child for whom the employee is the | 0019| legal guardian and who is primarily dependent on the employee | 0020| for maintenance and support, as long as evidence of the | 0021| guardianship is evidenced in a court order or decree; or | 0022| (e) a foster child living in the same | 0023| household, if the child is not otherwise provided with health | 0024| care or health insurance coverage; | 0025| (3) an unmarried child described in | 0001| Subparagraphs (a) through (e) of Paragraph (2) of this | 0002| subsection who is between the ages of eighteen and twenty-five | 0003| and is a full-time student at an accredited educational | 0004| institution; provided, "full-time student" means a student is | 0005| enrolled in and taking twelve or more semester hours or | 0006| equivalent contact hours in secondary, undergraduate or | 0007| vocational school or nine or more semester hours or equivalent | 0008| contact hours in graduate school; or | 0009| (4) a child over the age of eighteen who is | 0010| incapable of self-sustaining employment by reason of mental | 0011| retardation or physical handicap and who is chiefly dependent | 0012| on the employee for support and maintenance; | 0013| E. "eligible individual" means an individual who | 0014| with respect to any month: | 0015| (1) is covered under a qualified higher | 0016| deductible health plan as of the first day of that month; | 0017| (2) is not, while covered under a qualified | 0018| higher deductible health plan, covered under any health plan | 0019| that: | 0020| (a) is not a qualified higher deductible | 0021| health plan; and | 0022| (b) provides coverage for any benefit that | 0023| is covered under the qualified higher deductible health plan; | 0024| and | 0025| (3) is covered by a qualified higher deductible | 0001| health plan that is established and maintained by the employer | 0002| of the individual or of the spouse of the individual when the | 0003| employer is a small employer; | 0004| [E.] F. "eligible medical expense" means an | 0005| expense paid by the employee for medical care described in | 0006| Section 213(d) of the Internal Revenue Code of 1986 that is | 0007| deductible for federal income tax purposes to the extent that | 0008| those amounts are not compensated for by insurance or | 0009| otherwise; | 0010| [F.] G. "employee" includes a self-employed | 0011| individual; | 0012| [G.] H. "employer" includes a self-employed | 0013| individual; | 0014| [H.] I. "medical care savings account" or | 0015| "savings account" means an account established by an employer | 0016| [to pay the eligible medical expenses of an employee and his | 0017| dependents] in the United States exclusively for the purpose | 0018| of paying the eligible medical expenses of the employee, but | 0019| only if the written governing instrument creating the trust | 0020| meets the following requirements: | 0021| (1) except in the case of a rollover | 0022| contribution, no contribution will be accepted: | 0023| (a) unless it is in cash; or | 0024| (b) to the extent the contribution, when | 0025| added to previous contributions to the trust for the calendar | 0001| year, exceeds seventy-five percent of the highest annual limit | 0002| deductible permitted pursuant to the Medical Care Savings | 0003| Account Act; | 0004| (2) no part of the trust assets will be invested | 0005| in life insurance contracts; | 0006| (3) the assets of the trust will not be | 0007| commingled with other property except in a common trust fund or | 0008| common investment fund; and | 0009| (4) the interest of an individual in the balance | 0010| in his account is nonforfeitable; | 0011| [I.] J. "program" means the medical care savings | 0012| account program established by an employer for his employees; | 0013| [and | 0014| J.] K. "qualified higher deductible health plan" | 0015| means a health coverage policy, certificate or contract that | 0016| provides for payments for covered health care benefits that | 0017| exceed the policy, certificate or contract deductible [and], | 0018| that is purchased by an employer for the benefit of an employee | 0019| and that has the following deductible provisions: | 0020| (1) self-only coverage with an annual deductible | 0021| of not less than one thousand five hundred dollars ($1,500) or | 0022| more than two thousand two hundred fifty dollars ($2,250) and a | 0023| maximum annual out-of-pocket expense requirement of three | 0024| thousand dollars ($3,000), not including premiums; | 0025| (2) family coverage with an annual deductible of | 0001| not less than three thousand dollars ($3,000) or more than four | 0002| thousand five hundred dollars ($4,500) and a maximum annual | 0003| out-of-pocket expense requirement of five thousand five hundred | 0004| dollars ($5,500), not including premiums; and | 0005| (3) preventive care coverage may be provided | 0006| within the policies without the preventive care being subjected | 0007| to the qualified higher deductibles; and | 0008| L. "small employer" means: | 0009| (1) with respect to any calendar year, an | 0010| employer that employed an average of fifty or fewer employees | 0011| on business days during either of the two preceding calendar | 0012| years, but a preceding calendar year may be taken into account | 0013| only if the employer was in existence throughout that year and | 0014| if not in existence throughout a preceding calendar year, the | 0015| determination shall be based on the average number of employees | 0016| reasonably expected to be employed on business days in the | 0017| current calendar year; or | 0018| (2) a growing employer that satisfies the | 0019| conditions of Section 220C(4)(c) of the Internal Revenue Code | 0020| of 1986." | 0021| Section 28. Section 59A-23D-3 NMSA 1978 (being Laws 1995, | 0022| Chapter 93, Section 3) is amended to read: | 0023| "59A-23D-3. ACCOUNT ADMINISTRATOR--REGISTRATION WITH | 0024| DEPARTMENT--DEPARTMENT POWERS AND DUTIES.-- | 0025| A. An account administrator shall register annually | 0001| with the department and pay [a] an annual registration fee | 0002| of twenty-five dollars ($25.00). The registration fee shall be | 0003| deposited in the general fund. Registration as an account | 0004| administrator does not affect the regulation of a bank, savings | 0005| and loan association, credit union, trust company or insurance | 0006| company as otherwise provided by law. | 0007| B. An account administrator shall provide to the | 0008| department annually a list of the employers for whom it | 0009| provides account administration and the number of employees and | 0010| dependents for whom it administers accounts. The information | 0011| shall be provided in the form requested by the department. The | 0012| department may request other information it deems appropriate | 0013| from the account administrator; provided, however, that the | 0014| department shall not request any information about an | 0015| individual employee or dependent unless a complaint has been | 0016| filed with the department by that employee or dependent and the | 0017| information is required to investigate the complaint. | 0018| C. The department may receive, investigate and settle | 0019| complaints about medical care savings accounts and account | 0020| administrators or it may refer complaints to other appropriate | 0021| agencies. | 0022| D. The department, beginning January 1, 1998, shall | 0023| adjust annually the [maximum] deductible for qualified higher | 0024| deductible health plans to reflect the [last known increase in | 0025| the medical care component of the consumer price index | 0001| published by the United States department of labor. For 1995, | 0002| the maximum deductible shall not be less than one thousand | 0003| dollars ($1,000) and not more than three thousand dollars | 0004| ($3,000) | 0005| E. The department may adjust annually the maximum | 0006| employer contribution to reflect the last known increase in the | 0007| medical care component of the consumer price index. For 1995, | 0008| the employer's contribution shall not exceed three thousand | 0009| dollars ($3,000)] adjustment allowed by the Internal Revenue | 0010| Code of 1986 for medical savings accounts." | 0011| Section 29. Section 59A-23D-5 NMSA 1978 (being Laws 1995, | 0012| Chapter 93, Section 5) is amended to read: | 0013| "59A-23D-5. ACCOUNT ADMINISTRATOR--EMPLOYER AND EMPLOYEE | 0014| RESPONSIBILITIES.-- | 0015| A. [The] An employer, in conjunction with [the] | 0016| an account administrator, shall provide a current written | 0017| statement to employees that details how money in their medical | 0018| care savings accounts is or will be invested and the rate of | 0019| return employees may reasonably anticipate on the investment of | 0020| the savings accounts. The account administrator shall file the | 0021| statement with the department. | 0022| B. Except as provided in Section [6 of this act] | 0023| 59A-23D-6 NMSA 1978, money in [the] a savings account | 0024| shall be used solely for the purpose of paying the eligible | 0025| medical expenses of [the] an employee and his dependents. | 0001| C. The account administrator shall reimburse the | 0002| employee from the employee's medical care savings account for | 0003| eligible medical expenses. When seeking reimbursement, the | 0004| employee shall submit documentation of eligible medical | 0005| expenses paid by the employee. | 0006| D. If an employer makes contributions to a program on | 0007| a periodic installment basis, the employer may advance to an | 0008| employee, interest free, an amount necessary to cover eligible | 0009| medical expenses incurred that exceed the amount in the | 0010| employee's savings account if the employee agrees to repay the | 0011| advance from future installments or when he ceases to be an | 0012| employee of the employer or a participant in the program. Such | 0013| advances shall be exempt from taxation under the Income Tax | 0014| Act." | 0015| Section 30. Section 59A-23D-6 NMSA 1978 (being Laws 1995, | 0016| Chapter 93, Section 6) is amended to read: | 0017| "59A-23D-6. WITHDRAWALS.-- | 0018| A. An employee may withdraw money without penalty | 0019| from his medical care savings account for a purpose other than | 0020| reimbursement of eligible medical expenses [when he reaches | 0021| the age of fifty-nine and one-half] when the employee attains | 0022| the age specified in Section 1811 of the Social Security Act. | 0023| An employee may also withdraw money without penalty for payment | 0024| of coverage for: | 0025| (1) a health plan during any period of | 0001| continuation coverage required under any federal law; | 0002| (2) a qualified long-term care insurance | 0003| contract as defined by Section 7702B(6) of the Internal Revenue | 0004| Code of 1986; or | 0005| (3) a health plan during a period in which the | 0006| individual is receiving unemployment compensation under any | 0007| federal or state law. | 0008| B. Except as provided in Subsection A of this | 0009| section, if an employee withdraws money from the employee's | 0010| medical care savings account [on the last business day of the | 0011| account administrator's business year for a purpose not set | 0012| forth in Section 4 of the Medical Care Savings Account Act the | 0013| money withdrawn shall be considered income to the individual, | 0014| subject to taxation. The withdrawal does not subject the | 0015| employee to a penalty or make interest earned on the account | 0016| during the tax year taxable as income to the employee] that | 0017| is not used exclusively to pay eligible medical expenses of the | 0018| employee or a dependent, it shall be included in the gross | 0019| income of the employee for taxation purposes. | 0020| C. Except as provided in Subsection A of this | 0021| section, if an employee withdraws money from the employee's | 0022| medical care savings account for a purpose [not set forth in | 0023| Section 4 of the Medical Care Savings Account Act at any time | 0024| other than the last business day of the account administrator's | 0025| business year] other than a rollover to a new account | 0001| administrator: | 0002| (1) the amount of the withdrawal shall be | 0003| considered gross income to the [individual] employee and | 0004| subject to taxation; and | 0005| (2) the administrator shall [withdraw and] | 0006| also consider as a withdrawal on behalf of the employee | 0007| [pay] a penalty equal to [ten] fifteen percent of the | 0008| amount of the withdrawal and | 0009| [(3) all interest earned on the balance in the | 0010| savings account during the tax year in which the withdrawal is | 0011| made shall be considered income to the individual and subject | 0012| to taxation] shall consider this as gross income to the | 0013| employee for taxation purposes. | 0014| D. If an individual is no longer employed by an | 0015| employer that participates in a program or if an employee | 0016| chooses to cease participating in the program, the individual | 0017| or employee shall, within sixty days of his final day of | 0018| employment or participation: | 0019| (1) request, in writing, the [transfer] | 0020| rollover of his savings account to a new account | 0021| administrator; | 0022| (2) request, in writing, that the former | 0023| employer's account administrator continue to administer the | 0024| savings account, including in the request an agreement to pay | 0025| the cost, if any, of account administration on that savings | 0001| account; or | 0002| (3) withdraw the money from the savings account | 0003| subject to the provisions of Subsection C of this section, if | 0004| the withdrawal is not for the purpose of a rollover when within | 0005| sixty days of the receipt of the funds they are placed with a | 0006| new account administrator. | 0007| E. No more than [thirty days after the expiration of | 0008| the sixty-day period] sixty days after the date of | 0009| notification by the employee pursuant to Subsection D of this | 0010| section, the account administrator shall: | 0011| (1) transfer the savings account to a new | 0012| account administrator as requested; | 0013| (2) agree, in writing, to continue to act as the | 0014| account administrator for the savings account; or | 0015| (3) mail a check to the individual or employee | 0016| at his last known address for the amount in the account as of | 0017| the day the check was issued [excluding the applicable | 0018| withdrawal penalty. The penalty shall be paid to the human | 0019| services department at the same time as the individual's or | 0020| employee's check is issued]. | 0021| F. Upon the death of an employee, the account | 0022| administrator shall distribute the principal and accumulated | 0023| interest of the savings account to the estate of the employee." | 0024| Section 31. Section 59A-23D-7 NMSA 1978 (being Laws 1995, | 0025| Chapter 93, Section 7) is amended to read: | 0001| "59A-23D-7. REPORT.-- | 0002| A. The superintendent [of insurance] shall report | 0003| to the legislature on or before December 1, 1999 on the | 0004| availability of health care coverage pursuant to the Medical | 0005| Care Savings Account Act and the market share of programs in | 0006| comparison with traditional employer-provided health insurance | 0007| programs; the results of a survey of employer and employee | 0008| satisfaction with programs; and the results of a loss ratio | 0009| study relative to programs. | 0010| B. The superintendent shall adopt and promulgate | 0011| regulations for enforcing and administering the provisions of | 0012| the Medical Care Savings Account Act." | 0013| Section 32. Section 59A-54-3 NMSA 1978 (being Laws 1987, | 0014| Chapter 154, Section 3, as amended) is amended to read: | 0015| "59A-54-3. DEFINITIONS.--As used in the Comprehensive | 0016| Health Insurance Pool Act: | 0017| A. "board" means the board of directors of the pool; | 0018| B. "health care facility" means any entity providing | 0019| health care services that is licensed by the department of | 0020| health; | 0021| C. "health care services" means any services or | 0022| products included in the furnishing to any individual of | 0023| medical care or hospitalization or incidental to the furnishing | 0024| of such care or hospitalization, as well as the furnishing to | 0025| any person of any other services or products for the purpose of | 0001| preventing, alleviating, curing or healing human illness or | 0002| injury; | 0003| D. "health insurance" means any hospital and medical | 0004| expense-incurred policy, nonprofit health care service plan | 0005| contract, health maintenance organization subscriber contract, | 0006| short-term, accident, fixed indemnity, specified disease policy | 0007| or disability income contracts and limited benefit or credit | 0008| insurance, or as defined by Section 59A-7-3 NMSA 1978. [The | 0009| term] "Health insurance" does not include insurance arising | 0010| out of the Workers' Compensation Act or similar law, automobile | 0011| medical payment insurance or insurance under which benefits are | 0012| payable with or without regard to fault and which is required | 0013| by law to be contained in any liability insurance policy; | 0014| E. "health maintenance organization" means any person | 0015| who provides, at a minimum, either directly or through | 0016| contractual or other arrangements with others, basic health | 0017| care services to enrollees on a fixed prepayment basis and who | 0018| is responsible for the availability, accessibility and quality | 0019| of the health care services provided or arranged, or as defined | 0020| by Subsection [F] M of Section 59A-46-2 NMSA 1978; | 0021| F. "health plan" means any arrangement by which | 0022| persons, including dependents or spouses, covered or making | 0023| application to be covered under the pool have access to | 0024| hospital and medical benefits or reimbursement, including group | 0025| or individual insurance or subscriber contract; coverage | 0001| through health maintenance organizations, preferred provider | 0002| organizations or other alternate delivery systems; coverage | 0003| under prepayment, group practice or individual practice plans; | 0004| coverage under uninsured arrangements of group or group-type | 0005| contracts, including employer self-insured, cost-plus or other | 0006| benefits methodologies not involving insurance or not subject | 0007| to New Mexico premium taxes; coverage under group-type | 0008| contracts [which] that are not available to the general | 0009| public and can be obtained only because of connection with a | 0010| particular organization or group; and coverage by medicare or | 0011| other governmental benefits. [The term] "Health plan" | 0012| includes coverage through health insurance; | 0013| G. "insured" means an individual resident of this | 0014| state who is eligible to receive benefits from any insurer or | 0015| other health plan; | 0016| H. "insurer" means an insurance company authorized to | 0017| transact health insurance business in this state, a nonprofit | 0018| health care plan, a health maintenance organization and self- | 0019| insurers not subject to federal preemption. "Insurer" does not | 0020| include an insurance company that is licensed under the Prepaid | 0021| Dental Plan Law or a company that is solely engaged in the sale | 0022| of dental insurance and is licensed not under that act, but | 0023| under another provision of the Insurance Code; | 0024| I. "medicare" means coverage under both Part A and B | 0025| of Title XVIII of the Social Security Act, [42 USC 1395 et | 0001| seq.] as amended; | 0002| J. "pool" means the New Mexico comprehensive health | 0003| insurance pool; | 0004| K. "superintendent" means the superintendent of | 0005| insurance; and | 0006| L. "therapist" means a licensed physical, | 0007| occupational, speech or respiratory therapist." | 0008| Section 33. Section 59A-54-12 NMSA 1978 (being Laws 1987, | 0009| Chapter 154, Section 12, as amended) is amended to read: | 0010| "59A-54-12. ELIGIBILITY--POLICY PROVISIONS.-- | 0011| A. Except as provided in Subsection B of this | 0012| section, a person is eligible for a pool policy only if on the | 0013| effective date of coverage or renewal of coverage the person is | 0014| a New Mexico resident, and: | 0015| (1) is not eligible as an insured or covered | 0016| dependent for any health plan that provides coverage for | 0017| comprehensive major medical or comprehensive physician and | 0018| hospital services; | 0019| (2) is only eligible for a health plan that is | 0020| offered at a rate higher than that available from the pool; | 0021| (3) has been rejected for coverage for | 0022| comprehensive major medical or comprehensive physician and | 0023| hospital services; [or] | 0024| (4) is only eligible for a health plan with a | 0025| rider, waiver or restrictive provision for that particular | 0001| individual based on a specific condition; or | 0002| (5) has as of the date the individual seeks | 0003| coverage from the pool an aggregate of eighteen or more months | 0004| of creditable coverage, the most recent of which was under a | 0005| group health plan, governmental plan or church plan as defined | 0006| in Subsections Q, O and D, respectively, of Section 2 of the | 0007| Health Insurance Portability Act, except for the purposes of | 0008| aggregating creditable coverage a period of creditable coverage | 0009| shall not be counted with respect to enrollment of an | 0010| individual for coverage under the pool, if, after that period | 0011| and before the enrollment date there was a sixty-three-day or | 0012| longer period during all of which the individual was not | 0013| covered under any creditable coverage. | 0014| B. A person's eligibility for a policy issued under | 0015| the Health Insurance Alliance Act shall not preclude a person | 0016| from remaining on a pool policy; provided, a self-employed | 0017| person who qualifies for an approved health plan under the | 0018| Health Insurance Alliance Act by using a dependent as the | 0019| second employee may choose a pool policy in lieu of the health | 0020| plan under that act. | 0021| [B.] C. Coverage under a pool policy is in excess | 0022| of and shall not duplicate coverage under any other form of | 0023| health insurance. | 0024| [C.] D. A pool policy shall provide that coverage | 0025| of a dependent unmarried person terminates when the person | 0001| becomes nineteen years of age or, if the person is enrolled | 0002| full time in an accredited educational institution, when he | 0003| becomes twenty-five years of age. The policy shall also | 0004| provide in substance that attainment of the limiting age does | 0005| not operate to terminate coverage when the person is and | 0006| continues to be: | 0007| (1) incapable of self-sustaining employment by | 0008| reason of [mental retardation] developmental disability or | 0009| physical handicap; and | 0010| (2) primarily dependent for support and | 0011| maintenance upon the person in whose name the contract is | 0012| issued. | 0013| Proof of incapacity and dependency shall be furnished to | 0014| the insurer within one hundred twenty days of attainment of the | 0015| limiting age and subsequently as required by the insurer but | 0016| not more frequently than annually after the two-year period | 0017| following attainment of the limiting age. | 0018| [D.] E. A pool policy that provides coverage for | 0019| a family member of the person in whose name the contract is | 0020| issued shall, as to the coverage of the family member or the | 0021| individual in whose name the contract was issued, provide that | 0022| the health insurance benefits applicable for children are | 0023| payable with respect to a newly born child of the family member | 0024| or the person in whose name the contract is issued from the | 0025| moment of coverage of injury or illness, including the | 0001| necessary care and treatment of medically diagnosed congenital | 0002| defects and birth abnormalities. If payment of a specific | 0003| premium is required to provide coverage for the child, the | 0004| contract may require that notification of the birth of a child | 0005| and payment of the required premium shall be furnished to the | 0006| carrier within thirty-one days after the date of birth in order | 0007| to have the coverage continued beyond the thirty-one day | 0008| period. | 0009| [E.] F. Except for a person eligible as provided | 0010| in Paragraphs (5) of Subsection A of this section, a pool | 0011| policy may contain provisions under which coverage is excluded | 0012| during a six-month period following the effective date of | 0013| coverage as to a given individual for pre-existing conditions, | 0014| as long as either of the following exists: | 0015| (1) the condition has manifested itself within a | 0016| period of six months before the effective date of coverage in | 0017| such a manner as would cause an ordinarily prudent person to | 0018| seek diagnoses or treatment; or | 0019| (2) medical advice or treatment was recommended | 0020| or received within a period of six months before the effective | 0021| date of coverage. | 0022| [F.] G. The preexisting condition exclusions | 0023| described in Subsection [E] F of this section shall be | 0024| waived to the extent to which similar exclusions have been | 0025| satisfied under any prior health insurance coverage [which] | 0001| that was involuntarily terminated, if the application for | 0002| pool coverage is made not later than thirty-one days following | 0003| the involuntary termination. In that case, coverage in the | 0004| pool shall be effective from the date on which the prior | 0005| coverage was terminated. This subsection does not prohibit | 0006| preexisting conditions coverage in a pool policy that is more | 0007| favorable to the insured than that specified in this | 0008| subsection. | 0009| [G.] H. An individual is not eligible for | 0010| coverage by the pool if: | 0011| (1) he is, at the time of application, eligible | 0012| for medicare or medicaid which would provide coverage for | 0013| amounts in excess of limited policies such as dread disease, | 0014| cancer policies or hospital indemnity policies; | 0015| (2) he has terminated coverage by the pool | 0016| within the past twelve months; [or] | 0017| (3) he is an inmate of a public institution or | 0018| is eligible for public programs for which medical care is | 0019| provided; | 0020| (4) he is eligible for coverage under a group | 0021| health plan; | 0022| (5) he has other health insurance coverage; | 0023| (6) the most recent coverages within the | 0024| coverage period described in Paragraph (5) of Subsection A of | 0025| this section was terminated as a result of nonpayment of | 0001| premium or fraud; or | 0002| (7) he has been offered the option of | 0003| continuation coverage under a federal COBRA continuation | 0004| provision as defined in Subsection F of Section 2 of the Health | 0005| Insurance Portability Act or under a similar state program, and | 0006| he has elected the coverage and did not exhaust the | 0007| continuation coverage under the provision or program. | 0008| [H.] I. Any person whose health insurance | 0009| coverage from a qualified state health policy with similar | 0010| coverage is terminated because of nonresidency in another state | 0011| may apply for coverage under the pool. If the coverage is | 0012| applied for within thirty-one days after that termination and | 0013| if premiums are paid for the entire coverage period, the | 0014| effective date of the coverage shall be the date of termination | 0015| of the previous coverage." | 0016| Section 34. Section 59A-56-1 NMSA 1978 (being Laws 1994, | 0017| Chapter 75, Section 1) is amended to read: | 0018| "59A-56-1. SHORT TITLE. [Sections 1 through 25 of this | 0019| act] Chapter 59A, Article 56 NMSA 1978 may be cited as the | 0020| "Health Insurance Alliance Act"." | 0021| Section 35. Section 59A-56-2 NMSA 1978 (being Laws 1994, | 0022| Chapter 75, Section 2) is amended to read: | 0023| "59A-56-2. PURPOSE.--The purpose of the Health Insurance | 0024| Alliance Act is to provide increased access to voluntary health | 0025| insurance coverage for small employer groups in New Mexico. | 0001| [The initial purpose is to improve access to health insurance | 0002| coverage for small employers on a voluntary basis.] An | 0003| additional purpose of the Health Insurance Alliance Act is to | 0004| provide for [the development of a plan for expanded health | 0005| insurance coverage to include uninsured children, other | 0006| employer groups and individuals] access to voluntary health | 0007| insurance coverage for individuals in the individual market who | 0008| have met eligibility criteria established by that act." | 0009| Section 36. Section 59A-56-3 NMSA 1978 (being Laws 1994, | 0010| Chapter 75, Section 3) is amended to read: | 0011| "59A-56-3. DEFINITIONS.--As used in the Health Insurance | 0012| Alliance Act: | 0013| A. "alliance" means the New Mexico health insurance | 0014| alliance; | 0015| B. "approved health plan" means any arrangement for | 0016| the provisions of health insurance offered through and | 0017| approved by the alliance [by which insureds have access to | 0018| health insurance]; | 0019| C. "board" means the board of directors of the | 0020| alliance; | 0021| D. "child" means a dependent unmarried individual | 0022| who is less than nineteen years of age or an unmarried | 0023| individual who is enrolled full time in an accredited | 0024| educational institution until the individual becomes twenty- | 0025| five years of age; | 0001| E. "creditable coverage" means, with respect to an | 0002| individual, coverage of the individual pursuant to: | 0003| (1) a group health plan; | 0004| (2) health insurance coverage; | 0005| (3) Part A or Part B of Title 18 of the Social | 0006| Security Act; | 0007| (4) Title 19 of the Social Security Act except | 0008| coverage consisting solely of benefits pursuant to Section 1928 | 0009| of that title; | 0010| (5) 10 USCA Chapter 55; | 0011| (6) a medical care program of the Indian health | 0012| service or of an Indian nation, tribe or pueblo; | 0013| (7) the Comprehensive Health Insurance Pool Act; | 0014| (8) a health plan offered pursuant to 5 USCA | 0015| Chapter 89; | 0016| (9) a public health plan as defined in federal | 0017| regulations; or | 0018| (10) a health benefit plan offered pursuant to | 0019| Section 5(e) of the federal Peace Corps Act; | 0020| F. "department" means the department of insurance; | 0021| [D.] G. "director" means an individual who serves | 0022| on the board; | 0023| [E.] H. "earned premiums" means premiums paid or | 0024| due during [the] a calendar year for coverage under an | 0025| approved health plan less any unearned premiums at the end of | 0001| that calendar year plus any unearned premiums from the end of | 0002| the [previous] immediately preceding calendar year; | 0003| [F.] I. "eligible expenses" [are] means the | 0004| allowable charges for a health care service [and items for | 0005| which benefits are extended] covered under an approved | 0006| health plan; | 0007| J. "eligible individual": | 0008| (1) means an individual: | 0009| (a) who, as of the date of the individual's | 0010| application for coverage under an approved health plan, has an | 0011| aggregate of eighteen or more months of creditable coverage, | 0012| the most recent of which was under a group health plan, | 0013| governmental plan or church plan as those plans are defined in | 0014| Subsections Q, O and D of Section 2 of the Health Insurance | 0015| Portability Act, respectively, or health insurance offered in | 0016| connection with any of those plans, but for the purposes of | 0017| aggregating creditable coverage, a period of creditable | 0018| coverage shall not be counted with respect to enrollment of an | 0019| individual for coverage under an approved health plan, if, | 0020| after that period and before the enrollment date there was a | 0021| sixty-three-day or longer period during all of which the | 0022| individual was not covered under any creditable coverage; or | 0023| (b) entitled to continuation coverage | 0024| pursuant to Section 59A-56-20 NMSA 1978; and | 0025| (2) does not include an individual who: | 0001| (a) has or is eligible for coverage under a | 0002| group health plan; | 0003| (b) is eligible for coverage under medicare | 0004| or a state plan under Title 19 of the federal Social Security | 0005| Act or any successor program; | 0006| (c) has other health insurance coverage; | 0007| (d) during the most recent coverage within | 0008| the coverage period described in Subsection E of Section | 0009| 59A-36-3 NMSA 1978 was terminated from coverage as a result of | 0010| nonpayment of premium or fraud; or | 0011| (e) has been offered the option of coverage | 0012| under a COBRA continuation provision as that term is defined in | 0013| Subsection F of Section 2 of the Health Insurance Portability | 0014| Act, or under a similar state program, except for continuation | 0015| coverage under Section 59A-56-20 NMSA 1978, and did not exhaust | 0016| the coverage available under the offered program; | 0017| K. "enrollment date" means, with respect to an | 0018| individual covered under a group health plan or health | 0019| insurance coverage, the date of enrollment of the individual in | 0020| the plan or coverage or, if earlier, the first day of the | 0021| waiting period for that enrollment; | 0022| L. "gross earned premiums" means premiums paid or due | 0023| during a calendar year for all health insurance written in the | 0024| state less any unearned premiums at the end of that calendar | 0025| year plus any unearned premiums from the end of the immediately | 0001| preceding calendar year; | 0002| M. "group health plan" means an employee welfare | 0003| benefit plan to the extent the plan provides hospital, surgical | 0004| or medical expenses benefits to employees or their dependents, | 0005| as defined by the terms of the plan, directly through | 0006| insurance, reimbursement or otherwise; | 0007| [G.] N. "health care service" means a service or | 0008| product furnished an individual [or incidental to the | 0009| furnishing of the service or product] for the purpose of | 0010| preventing, alleviating, curing or healing human illness or | 0011| injury and includes services and products incidental to | 0012| furnishing the described services or products; | 0013| [H.] O. "health insurance" means "health" | 0014| insurance as defined in Section 59A-7-3 NMSA 1978; any | 0015| hospital and medical expense-incurred policy, including | 0016| medicare supplement insurance; nonprofit health care | 0017| [service] plan service contract; health maintenance | 0018| organization subscriber contract; short-term, accident, fixed | 0019| indemnity, specified disease policy, long-term care or | 0020| disability income insurance contracts and limited health | 0021| benefit or credit health insurance; coverage for health care | 0022| services under uninsured arrangements of group or group-type | 0023| contracts, including employer self-insured, cost-plus or other | 0024| benefits methodologies not involving insurance or not subject | 0025| to New Mexico premium taxes; coverage for health care | 0001| services under group-type contracts that are not available to | 0002| the general public and can be obtained only because of | 0003| connection with a particular organization or group; coverage by | 0004| medicare or other governmental [benefits; or "health | 0005| insurance" as defined by Section 59A-7-3 NMSA 1978] programs | 0006| providing health care services; but "health insurance" does | 0007| not include insurance [arising out of] issued pursuant to | 0008| provisions of the Workers' Compensation Act or similar law, | 0009| automobile medical payment insurance or [insurance under] | 0010| provisions by which benefits are payable with or without | 0011| regard to fault [and] that [is] are required by law to be | 0012| contained in any liability insurance policy; | 0013| [I.] P. "health maintenance organization" means a | 0014| health maintenance organization as defined by Subsection M of | 0015| Section 59A-46-2 NMSA 1978; | 0016| [J.] Q. "incurred claims" means claims paid | 0017| during a calendar year plus claims incurred in the calendar | 0018| year and paid prior to April 1 of the succeeding year, less | 0019| claims incurred previous to the current calendar year and paid | 0020| prior to April 1 of the current year; | 0021| [K.] R. "insured" means a small employer or its | 0022| employee and an individual covered by an approved health plan | 0023| [or an individual], a former employee of a small employer | 0024| who is covered by an approved health plan through conversion | 0025| or an individual covered by an approved health plan that | 0001| allows individual enrollment; | 0002| [L.] S. "medicare" means coverage under both | 0003| Parts A and B of Title 18 of the federal Social Security Act; | 0004| [M.] T. "member" means [an insurance company | 0005| authorized to transact health insurance business in this state, | 0006| a nonprofit health care plan, a health maintenance organization | 0007| or self-insurers not subject to federal preemption, but does | 0008| not include an insurance company that is licensed under the | 0009| Prepaid Dental Plan Law or a company that is solely engaged in | 0010| the sale of dental insurance and is licensed under a provision | 0011| of the Insurance Code] a member of the alliance; | 0012| U. "nonprofit health care plan" means a "health care | 0013| plan" as defined in Subsection K of Section 59A-47-3 NMSA 1978; | 0014| V. "premiums" means the premiums received for | 0015| coverage under an approved health plan during a calendar year; | 0016| [N.] W. "small employer" means a person that is a | 0017| resident of this state, has employees at least fifty percent of | 0018| whom are residents of this state, is actively engaged in | 0019| business and that on at least fifty percent of its working days | 0020| during either of the two preceding calendar [year] | 0021| years, employed no less than two and no more than fifty | 0022| eligible employees; provided that: | 0023| (1) in determining the number of eligible | 0024| employees, the spouse or dependent of an employee may, at the | 0025| employer's discretion, be counted as a separate employee; | 0001| [and] | 0002| (2) companies that are affiliated companies or | 0003| that are eligible to file a combined tax return for purposes of | 0004| state income taxation shall be considered one employer; and | 0005| (3) in the case of an employer that was not in | 0006| existence throughout a preceding calender year, the | 0007| determination of whether the employer is a small or large | 0008| employer shall be based on the average number of employees that | 0009| it is reasonably expected to employ on working days in the | 0010| current calender year; | 0011| [O.] X. "superintendent" means the superintendent | 0012| of insurance; | 0013| Y. "total premiums" means the total premiums for | 0014| business written in the state received during a calendar year; | 0015| and | 0016| Z. "unearned premiums" means the portion of a premium | 0017| previously paid for which the coverage period is in the | 0018| future." | 0019| Section 37. Section 59A-56-4 NMSA 1978 (being Laws 1994, | 0020| Chapter 75, Section 4) is amended to read: | 0021| "59A-56-4. ALLIANCE CREATED--BOARD CREATED.-- | 0022| A. The "New Mexico health insurance alliance" is | 0023| created as a nonprofit [independent] public corporation for | 0024| the purpose of providing increased access to health insurance | 0025| in the state. All insurance companies authorized to transact | 0001| health insurance business in this state, nonprofit health care | 0002| plans, health maintenance organizations and self-insurers not | 0003| subject to federal preemption shall organize and be members of | 0004| the alliance as a condition of their authority to offer health | 0005| insurance in this state [The alliance shall not be considered | 0006| a governmental agency for any purpose], except for an | 0007| insurance company that is licensed under the Prepaid Dental | 0008| Plan Law or a company that is solely engaged in the sale of | 0009| dental insurance and is licensed under a provision of the | 0010| Insurance Code. | 0011| B. The [board of directors of the New Mexico health | 0012| insurance] alliance [is created] shall be governed by a | 0013| board of directors constituted pursuant to the provisions of | 0014| this section. The board is a governmental entity for purposes | 0015| of the Tort Claims Act, but neither the board nor the | 0016| alliance shall [not] be considered a governmental entity for | 0017| any other purpose. | 0018| C. The superintendent shall, within sixty days after | 0019| [the effective date of the Health Insurance Alliance Act] | 0020| March 4, 1994, give notice to all members of the time and | 0021| place for the initial organizational meeting of the alliance. | 0022| Each member shall be entitled to one vote in person or by proxy | 0023| at the organizational meeting. | 0024| D. The alliance shall operate subject to the | 0025| supervision and approval of the board. The board shall consist | 0001| of: | 0002| (1) five directors, [appointed] elected by | 0003| the members, who shall be officers or employees of members and | 0004| shall consist of one representative of a nonprofit health care | 0005| plan, two representatives of health maintenance organizations | 0006| and two representatives of other types of members; | 0007| (2) five directors, appointed by the governor, | 0008| who shall be officers, general partners or proprietors of | 0009| small employers [and] who, after the term of the initial | 0010| appointments, are covered by approved health plans; | 0011| (3) four directors appointed by the governor, | 0012| who shall be employees of small employers, and who, after the | 0013| term of the initial appointments, are employees of small | 0014| employers covered by approved health plans; and | 0015| (4) the superintendent or his designee, [The | 0016| superintendent] who shall be a nonvoting member, except when | 0017| his vote is necessary to break a tie. | 0018| E. The superintendent shall serve as [chair] | 0019| chairman of the board unless he declines, in which event he | 0020| shall appoint the [chair] chairman. | 0021| F. The directors [appointed] elected by the | 0022| members shall be [appointed] elected for initial terms of | 0023| three years or less, staggered so that the term of at least one | 0024| director [shall expire] expires on June 30 of each year. | 0025| The directors appointed by the governor shall be appointed for | 0001| initial terms of three years or less, staggered so that the | 0002| term of at least one director [shall expire] expires on | 0003| June 30 of each year. Following the initial terms, directors | 0004| shall be elected or appointed for terms of three years. [If | 0005| the members fail to make the initial appointments within sixty | 0006| days following the first organizational meeting, the | 0007| superintendent shall make those appointments.] A director | 0008| whose term has expired shall continue to serve until his | 0009| successor is elected or appointed and qualified. | 0010| G. Whenever a vacancy on the board occurs, the | 0011| electing or appointing authority of [that director] the | 0012| position that is vacant shall fill the vacancy by electing | 0013| or appointing an individual to serve the balance of the | 0014| unexpired term; provided, when a vacancy occurs in one of the | 0015| director's positions elected by the members, the superintendent | 0016| is authorized to appoint a temporary replacement director until | 0017| the next scheduled election of directors elected by the members | 0018| is held. The individual elected or appointed to fill a | 0019| vacancy shall meet the requirements for initial election or | 0020| appointment to that position. | 0021| H. Directors may be reimbursed by the alliance as | 0022| provided in the Per Diem and Mileage Act for nonsalaried | 0023| public officers, but shall receive no other compensation, | 0024| perquisite or allowance from the alliance." | 0025| Section 38. Section 59A-56-5 NMSA 1978 (being Laws 1994, | 0001| Chapter 75, Section 5) is amended to read: | 0002| "59A-56-5. PLAN OF OPERATION.-- | 0003| A. The board shall submit a plan of operation to the | 0004| superintendent and any amendments to the plan necessary or | 0005| suitable to assure the fair, reasonable and equitable | 0006| administration of the alliance. | 0007| B. The superintendent shall, after notice and | 0008| hearing, approve the plan of operation if it is determined to | 0009| assure the fair, reasonable and equitable administration of the | 0010| alliance. The plan of operation shall become effective upon | 0011| written approval of the superintendent consistent with the date | 0012| on which health insurance coverage through the alliance | 0013| pursuant to the provisions of the Health Insurance Alliance Act | 0014| is made available. [If the board fails to submit a plan of | 0015| operation within one hundred eighty days after the appointment | 0016| of the board, the superintendent shall, after notice and | 0017| hearing, adopt and promulgate a plan of operation.] A plan of | 0018| operation adopted by the superintendent shall continue in force | 0019| until modified by him or superseded by a subsequent plan of | 0020| operation submitted by the board and approved by the | 0021| superintendent. | 0022| C. The plan of operation shall: | 0023| (1) establish procedures for the handling and | 0024| accounting of assets of the alliance; | 0025| (2) establish regular times and places for | 0001| meetings of the board; | 0002| (3) establish procedures for records to be kept | 0003| of all financial transactions and for annual fiscal reporting | 0004| to the superintendent; | 0005| (4) establish the amount of and the method for | 0006| collecting assessments pursuant to Section [11 of the Health | 0007| Insurance Alliance Act] 59A-56-11 NMSA 1978; | 0008| (5) establish a program to publicize the | 0009| existence of the alliance, the approved health plans, the | 0010| eligibility requirements and procedures for enrollment in an | 0011| approved health plan and to maintain public awareness of the | 0012| alliance; | 0013| (6) establish penalties for [noncollection] | 0014| nonpayment of assessments [from] by members; | 0015| (7) establish procedures for alternative dispute | 0016| resolution of disputes between members and insureds; and | 0017| (8) contain additional provisions necessary and | 0018| proper for the execution of the powers and duties of the | 0019| alliance." | 0020| Section 39. Section 59A-56-6 NMSA 1978 (being Laws 1994, | 0021| Chapter 75, Section 6) is amended to read: | 0022| "59A-56-6. BOARD--POWERS AND DUTIES.-- | 0023| A. The board shall have the general powers and | 0024| authority granted to insurance companies licensed to transact | 0025| health insurance business under the laws of this state. | 0001| B. The board: | 0002| (1) may enter into contracts to carry out the | 0003| provisions of the Health Insurance Alliance Act, including, | 0004| with the approval of the superintendent, contracting with | 0005| similar alliances of other states for the joint performance of | 0006| common administrative functions or with persons or other | 0007| organizations for the performance of administrative functions; | 0008| (2) may sue and be sued; | 0009| (3) may conduct periodic audits of the members | 0010| to assure the general accuracy of the financial data submitted | 0011| to the alliance; | 0012| (4) shall establish maximum rate schedules, | 0013| allowable rate adjustments, administrative allowances, | 0014| reinsurance premiums and agent referral, [and] servicing | 0015| fees [and any other actuarial functions appropriate to the | 0016| operation of the alliance, but within the limits established] | 0017| or commissions subject to applicable provisions in the | 0018| Insurance Code. In determining the initial year's rate for | 0019| health insurance, the only rating factors that may be used are | 0020| age, gender, geographic area of the place of employment and | 0021| smoking practices. In any year's rate, the difference in rates | 0022| in any one age group that may be charged on the basis of a | 0023| person's gender shall not exceed another person's rates in the | 0024| age group by more than twenty percent of the lower rate, and no | 0025| person's rate shall exceed the rate of any other person with | 0001| similar family composition by more than two hundred fifty | 0002| percent of the lower rate, except that the rates for children | 0003| under the age of nineteen may be lower than the bottom rates in | 0004| the two hundred fifty percent band. The rating factor | 0005| restrictions shall not prohibit a member from offering rates | 0006| that differ depending upon family composition; | 0007| (5) may direct a member to issue policies or | 0008| certificates of coverage of health insurance in accordance with | 0009| the requirements of the Health Insurance Alliance Act; | 0010| (6) shall establish procedures for alternative | 0011| dispute resolution of disputes between members and insureds; | 0012| (7) shall cause the alliance to have an annual | 0013| audit of its operations by an independent certified public | 0014| accountant; | 0015| (8) shall conduct all board meetings as if it | 0016| were [an agency] subject to the provisions of the Open | 0017| Meetings Act; | 0018| (9) shall draft one or more sample health | 0019| insurance policies that are the prototype documents for the | 0020| members; | 0021| (10) shall determine the design criteria to be | 0022| met for an approved health plan; | 0023| (11) shall review each proposed approved health | 0024| plan to determine if it meets the alliance designed criteria | 0025| and, if it does meet the criteria, approve the plan; provided | 0001| that the board shall not permit more than one approved health | 0002| plan per member for each set of plan design criteria; | 0003| (12) shall review annually each approved health | 0004| plan to determine if it still qualifies as an approved health | 0005| plan based on the alliance designed criteria and, if the plan | 0006| is no longer approved, arrange for the transfer of the insureds | 0007| covered under the formerly approved plan to an approved | 0008| health plan; | 0009| (13) may terminate an approved health plan not | 0010| operating as required by the board; | 0011| (14) shall terminate an approved health plan if | 0012| timely claim payments are not made pursuant to the plan; and | 0013| (15) shall engage in significant marketing | 0014| activities, including a program of media advertising, to inform | 0015| small employers and eligible individuals of the existence of | 0016| the alliance, its purpose and the health insurance available or | 0017| potentially available through the alliance. | 0018| C. The alliance is subject to and responsible for | 0019| examination by the superintendent. No later than March 1 of | 0020| each year, the board shall submit to the superintendent an | 0021| audited financial report for the preceding calendar year in a | 0022| form approved by the superintendent." | 0023| Section 40. Section 59A-56-8 NMSA 1978 (being Laws 1994, | 0024| Chapter 75, Section 8) is amended to read: | 0025| "59A-56-8. APPROVED HEALTH PLAN [OR SERVICE].-- | 0001| A. An approved health plan shall conform to the | 0002| alliance's approved health plan design criteria. The board may | 0003| allow more than one plan design for approved health plans. A | 0004| member may provide one approved health plan for each plan | 0005| design approved by the board. | 0006| B. The board shall designate plan designs for | 0007| approved health plans. The board may designate plan designs | 0008| for an approved health plan that provides catastrophic coverage | 0009| or other benefit plan designs. | 0010| [B. The] C. Each approved health plan shall | 0011| offer a premium that is no greater than [fifteen] ten | 0012| percent over and no less than [fifteen] ten percent under | 0013| the average of the standard rate index for plans with the same | 0014| characteristics. | 0015| D. Each approved health plan offered to an eligible | 0016| individual shall offer a premium that is no more than twenty- | 0017| five percent over and no less than twenty-five percent under | 0018| the average of the standard risk rate index determined pursuant | 0019| to Section 59A-56-23 NMSA 1978. | 0020| [C.] E. Any member that [submits a bid for] | 0021| provides or offers to [provide or renews] renew a group | 0022| health insurance contract providing health insurance benefits | 0023| to employees of the state, a county, a municipality or a school | 0024| district for which public funds are contributed shall offer | 0025| at least one approved health plan to small employers and | 0001| eligible individuals; provided, however, if a member does not | 0002| offer anywhere in the United States a plan that meets | 0003| substantially the design criteria of an approved health plan, | 0004| the member shall not be required to offer an approved health | 0005| plan. | 0006| F. If a plan design approved by the board is not | 0007| offered by any member already offering an approved health plan, | 0008| but a member offers a substantially similar plan design outside | 0009| the alliance, the board may require the member to offer that | 0010| plan design as an approved health plan through the alliance. | 0011| G. A member required to offer, and offering, an | 0012| approved health plan pursuant to the requirement of Subsection | 0013| E of this section shall continue to offer that plan for five | 0014| consecutive years after the date the member was last required | 0015| to offer the plan. A member offering an approved health plan | 0016| but not required to offer it pursuant to the cited subsection | 0017| may withdraw the plan but shall continue to offer it for five | 0018| consecutive years after the date notice of future withdrawal is | 0019| given to the board unless: | 0020| (1) the member substitutes another approved | 0021| health plan for the plan withdrawn; or | 0022| (2) the board allows the plan to be withdrawn | 0023| because it imposes a serious hardship upon the member. | 0024| H. No member shall be required to offer an approved | 0025| health plan if the member notifies the superintendent in | 0001| writing that it will no longer offer health insurance, life | 0002| insurance or annuities in the state, except for renewal of | 0003| existing contracts, provided that: | 0004| (1) the member does not offer or provide health | 0005| insurance, life insurance or annuities for a period of five | 0006| years from the date of notification to the superintendent to | 0007| any person in the state who is not covered by the member | 0008| through a health insurance policy in effect on the date of the | 0009| notification; and | 0010| (2) with respect to health or life insurance | 0011| policies or annuities in effect on the date of notification to | 0012| the superintendent, the member continues to comply with all | 0013| applicable laws and regulations governing the provision of | 0014| insurance in this state, including the payment of applicable | 0015| taxes, fees and assessments." | 0016| Section 41. Section 59A-56-9 NMSA 1978 (being Laws 1994, | 0017| Chapter 75, Section 9) is amended to read: | 0018| "59A-56-9. REINSURANCE.-- | 0019| A. [Any] A member offering an approved health plan | 0020| [to small employers] shall be reinsured for certain losses by | 0021| the alliance. Within six months following the end of each | 0022| calendar year in which the member offering the approved health | 0023| plan paid more in incurred claims [than], plus the member's | 0024| reinsurance premium pursuant to Subsection B of this section, | 0025| than eighty-five percent of earned premiums received by the | 0001| member [received in gross earned premiums] on all approved | 0002| health plans issued by the member [combined], the member | 0003| shall receive from the alliance the excess amount for the | 0004| calendar year by which the incurred claims and reinsurance | 0005| premium exceeded eighty-five percent of the [gross] earned | 0006| premiums received by the alliance or its administrator. | 0007| B. The alliance shall withhold from all premiums that | 0008| it receives a reinsurance premium as established by the board: | 0009| (1) for insured small employer groups, the | 0010| reinsurance premium shall not exceed five percent of premiums | 0011| paid by insured groups in [their] the first year of | 0012| coverage and shall not exceed ten percent of [such] premiums | 0013| for renewal years; and | 0014| (2) for eligible individuals, the reinsurance | 0015| premium shall not exceed ten percent of premiums paid by | 0016| individuals in the first year of coverage or continuation | 0017| coverage and shall not exceed fifteen percent of premiums paid | 0018| by individuals for renewal years; in determining the | 0019| reinsurance premium for a particular calendar year, the board | 0020| shall set the reinsurance premium at a rate that will recover | 0021| the total reinsurance loss for the preceding year over a | 0022| reasonable number of years in accordance with sound actuarial | 0023| principles." | 0024| Section 42. Section 59A-56-10 NMSA 1978 (being Laws 1994, | 0025| Chapter 75, Section 10) is amended to read: | 0001| "59A-56-10. ADMINISTRATION.--The alliance shall deduct | 0002| from premiums collected for approved health plans an | 0003| administrative charge as set by the board. The administrative | 0004| charge shall be determined before the beginning of each | 0005| calendar year: | 0006| A. for insured small employer groups, the maximum | 0007| administrative charge the alliance may charge is ten percent of | 0008| [gross] premiums [from a small employer] in the first year | 0009| and five percent of [gross] premiums in renewal years; and | 0010| B. for eligible individuals, the maximum | 0011| administrative charge the alliance may charge in any year is | 0012| ten percent of premiums." | 0013| Section 43. Section 59A-56-11 NMSA 1978 (being Laws 1994, | 0014| Chapter 75, Section 11) is amended to read: | 0015| "59A-56-11. ASSESSMENTS.-- | 0016| A. After the completion of each calendar year, the | 0017| alliance shall assess all its members for the [total] net | 0018| reinsurance loss in the previous calendar year and for the net | 0019| administrative loss that occurred in the previous calendar | 0020| year, taking into account investment income for the period and | 0021| other appropriate gains and losses using the following | 0022| definitions: | 0023| (1) net reinsurance losses shall be the | 0024| [reinsurance incurred claims against the alliance for the | 0025| previous calendar year reduced by the reinsurance earned] | 0001| amount determined for the previous calendar year in accordance | 0002| with Subsection A of Section 59A-56-9 NMSA 1978 for all members | 0003| offering an approved health plan reduced by reinsurance | 0004| premiums charged by the alliance in the previous calendar | 0005| year. Net reinsurance losses shall be calculated separately | 0006| for group and individual coverage. If the reinsurance premiums | 0007| for either category of coverage exceed the amount calculated in | 0008| accordance with Subsection A of Section 59A-56-9 NMSA 1978, the | 0009| premiums shall be applied first to offset the net reinsurance | 0010| losses incurred in the other category of coverage and second to | 0011| offset administrative losses; and | 0012| (2) net administrative losses shall be the | 0013| administrative expenses incurred by the alliance in the | 0014| previous calendar year and projected for the current calendar | 0015| year less the sum of administrative allowances [earned] | 0016| received by the alliance [and any legislative appropriation | 0017| for the period], but, in the event of an administrative gain, | 0018| net administrative losses for the purpose of assessments shall | 0019| be considered zero, and the gain shall be carried forward to | 0020| the administrative fund for the next calendar year as an | 0021| additional allowance. | 0022| B. The assessment for each member shall be determined | 0023| by multiplying the total losses of the alliance's operation, as | 0024| defined in Subsection A of this section, by a fraction, the | 0025| numerator of which [equals] is an amount equal to that | 0001| member's total [premium] premiums, or [its] the | 0002| equivalent, exclusive of premiums received by the member for | 0003| an approved health plan for health insurance written in the | 0004| state during the preceding calendar year and the denominator of | 0005| which equals the total premiums of all health insurance | 0006| [premiums] written in the state during the preceding calendar | 0007| year exclusive of premiums for approved health plans; | 0008| provided that [premium income] total premiums shall not | 0009| include payments by the secretary of human services pursuant to | 0010| a contract issued under Section 1876 of the federal Social | 0011| Security Act, [and shall not include premium income] total | 0012| premiums exempted by the federal Employee Retirement Income | 0013| Security Act of 1974 or [other] federal government | 0014| programs. | 0015| C. If assessments exceed actual reinsurance losses | 0016| and administrative losses of the alliance, the excess shall be | 0017| held at interest by the board to offset future losses. | 0018| D. To enable the board to properly determine the net | 0019| reinsurance amount and its responsibility for reinsurance to | 0020| each member: | 0021| (1) by April 15 of each year, each member | 0022| offering an approved health plan shall submit a listing of all | 0023| incurred claims [or health charges of each approved health | 0024| plan for the previous year, including all claims or health | 0025| charges incurred in the previous year and paid prior to April 1 | 0001| of the current year. From this amount shall be subtracted and | 0002| identified by list all incurred claims or health charges of | 0003| each approved health plan paid in the previous year's months of | 0004| January, February and March incurred prior to] for the | 0005| previous year; and | 0006| (2) by April 15 of each year, each member shall | 0007| submit a report that includes the total [amount of all] | 0008| earned premiums received during the prior year less [any | 0009| earned premium] the total earned premiums exempted by | 0010| federal government programs. | 0011| E. The alliance shall notify [members] each | 0012| member of the amount of [the] its assessment due by May 15 | 0013| of each year. The assessment shall be paid by the member by | 0014| June 15 of each year. | 0015| F. The proportion of participation of each member in | 0016| the alliance shall be determined annually by the board, based | 0017| on annual statements filed by each member and other reports | 0018| deemed necessary by the board. Any deficit incurred by the | 0019| alliance shall be recouped by assessments apportioned among the | 0020| members pursuant to the formula provided in Subsection B of | 0021| this section; provided that the assessment paid for any member | 0022| shall be allowed as a credit on the future premium tax return | 0023| for that member, with the credit limited to fifty percent of | 0024| the premium tax due the first year the assessment is imposed; | 0025| forty percent the second year; and thirty percent the third and | 0001| all subsequent years. | 0002| G. The board may [abate or] defer, in whole or in | 0003| part, the payment of an assessment of a member if, in the | 0004| opinion of the board, after approval of the superintendent, | 0005| payment of the assessment would endanger the ability of the | 0006| member to fulfill its contractual obligations. In the event | 0007| payment of an assessment against a member is [abated or] | 0008| deferred, the amount [by which such assessment is abated or] | 0009| deferred may be assessed against the other members in a manner | 0010| consistent with the basis for assessments set forth in | 0011| Subsection A of this section. [The member receiving the | 0012| abatement or deferment shall remain liable to the alliance for | 0013| the deficiency for four years, including interest at the | 0014| prevailing rate as determined by regulation of the | 0015| superintendent. The board may sue to recover the abatement or | 0016| deferment, plus interest and costs.] The member receiving the | 0017| deferment shall pay the assessment in full plus interest at the | 0018| prevailing rate as determined by regulation of the | 0019| superintendent within four years from the date payment is | 0020| deferred. After four years but within five years of the date | 0021| of the deferment, the board may sue to recover the amount of | 0022| the deferred payment plus interest and costs. Board actions to | 0023| recover deferred payments brought after five years of the date | 0024| of deferment are barred. Any amount received shall be deducted | 0025| from future assessments or reimbursed pro rata to the members | 0001| paying the deferred assessment." | 0002| Section 44. Section 59A-56-13 NMSA 1978 (being Laws 1994, | 0003| Chapter 75, Section 13) is amended to read: | 0004| "59A-56-13. ALLIANCE ADMINISTRATOR.-- | 0005| A. The board may select an alliance administrator | 0006| through a competitive request for proposal process. The | 0007| board shall evaluate proposals based on criteria established by | 0008| the board that shall include: | 0009| (1) proven ability to [handle accident and] | 0010| administer health insurance programs; | 0011| (2) an estimate of total charges for | 0012| administering the alliance for the proposed contract period; | 0013| and | 0014| (3) ability to administer the alliance in a | 0015| cost-efficient manner. | 0016| B. The alliance administrator contract shall be for a | 0017| period up to four years, subject to annual renegotiation of the | 0018| fees and services, and shall provide for cancellation of the | 0019| contract for cause, termination of the alliance by the | 0020| legislature or the combining of the alliance with a | 0021| governmental body. | 0022| C. At least one year prior to the expiration of | 0023| [each four-year period of service by the] an alliance | 0024| administrator contract, the board [shall] may invite all | 0025| interested parties, including the current administrator, to | 0001| submit [bids] proposals to serve as alliance administrator | 0002| for [up to] a succeeding [four-year] contract period. | 0003| Selection of the administrator for a succeeding contract | 0004| period shall be made at least six months prior to the | 0005| expiration of the current contract. | 0006| D. The alliance administrator shall: | 0007| (1) take applications for an approved health | 0008| plan from small employers or a referring agent; | 0009| (2) establish a premium billing procedure for | 0010| collection of premiums from insureds. Billings shall be made | 0011| on a periodic basis, not less than monthly, as determined by | 0012| the board; | 0013| (3) pay the member that offers an approved | 0014| health plan the net premium due after deduction of reinsurance | 0015| and administrative allowances; | 0016| (4) provide the member with any changes in the | 0017| status of insureds; | 0018| (5) perform all necessary functions to assure | 0019| that each member is providing timely payment of benefits to | 0020| individuals covered under an approved health plan, including: | 0021| (a) making information available to insureds | 0022| relating to the proper manner of submitting a claim for | 0023| benefits to the member offering the approved health plan and | 0024| distributing forms on which submissions shall be made; and | 0025| (b) making information available on approved | 0001| health plan benefits and rates to insureds; | 0002| (6) submit regular reports to the board | 0003| regarding the operation of the alliance, the frequency, content | 0004| and form of which shall be determined by the board; | 0005| (7) following the close of each fiscal year, | 0006| determine [net written] premiums of members, the expense of | 0007| administration and the paid and incurred [losses] health | 0008| care service charges for the year and report this information | 0009| to the board and the superintendent on a form prescribed by the | 0010| superintendent; and | 0011| (8) establish the premiums for reinsurance and | 0012| the administrative charges, subject to approval of the board." | 0013| Section 45. Section 59A-56-14 NMSA 1978 (being Laws 1994, | 0014| Chapter 75, Section 14) is amended to read: | 0015| "59A-56-14. ELIGIBILITY--GUARANTEED ISSUE--PLAN | 0016| PROVISIONS.-- | 0017| A. A small employer is eligible for an approved | 0018| health plan if on the effective date of coverage or renewal: | 0019| (1) at least fifty percent of its employees not | 0020| otherwise insured elect to be covered under the approved health | 0021| plan; [and] | 0022| (2) the small employer has not terminated | 0023| coverage with an approved health plan within three years of the | 0024| date of application for coverage except to change to another | 0025| approved health plan; and | 0001| (3) the small employer does not offer other | 0002| general group health insurance coverage to its employees. For | 0003| the purposes of this paragraph, general group health insurance | 0004| coverage excludes coverage providing only a specific limited | 0005| form of health insurance such as accident or disability income | 0006| insurance coverage or a specific health care service such as | 0007| dental care. | 0008| B. An individual is eligible for an approved health | 0009| plan if on the effective date of coverage or renewal he meets | 0010| the definition of an eligible individual under Section 59A-56-3 | 0011| NMSA 1978. | 0012| [B.] C. An approved health plan shall provide | 0013| [that coverage of a dependent unmarried individual terminates | 0014| when the individual becomes nineteen years of age or, if the | 0015| individual is enrolled full time in an accredited educational | 0016| institution, when the individual becomes twenty-five years of | 0017| age] coverage for a child. The policy shall also provide in | 0018| substance that attainment of the limiting age by an unmarried | 0019| dependent individual does not operate to terminate coverage | 0020| when the individual continues to be incapable of self- | 0021| sustaining employment by reason of [mental retardation] | 0022| developmental disability or physical handicap and the | 0023| individual is primarily dependent for support and maintenance | 0024| upon the employee. Proof of incapacity and dependency shall be | 0025| furnished to the alliance and the member that offered the | 0001| approved health plan within one hundred twenty days of | 0002| attainment of the limiting age. The board may require | 0003| subsequent proof annually after a two-year period following | 0004| attainment of the limiting age. | 0005| [C.] D. An approved health plan shall provide | 0006| that the health insurance benefits applicable for eligible | 0007| dependents are payable with respect to a newly born child of | 0008| the family member or the individual in whose name the contract | 0009| is issued from the moment of birth, including the necessary | 0010| care and treatment of medically diagnosed congenital defects | 0011| and birth abnormalities. If payment of a specific premium is | 0012| required to provide coverage for the child, the contract may | 0013| require that notification of the birth of a child and payment | 0014| of the required premium shall be furnished to the member within | 0015| thirty-one days after the date of birth in order to have the | 0016| coverage from birth. An approved health plan shall provide | 0017| that the health insurance benefits applicable for eligible | 0018| dependents are payable for an adopted child in accordance with | 0019| the provisions of Section 59A-22-34.1 NMSA 1978. | 0020| [D.] E. Except as provided in Subsections [E and | 0021| G] G, H and I of this section, an approved health plan | 0022| offered to a small employer may contain [provisions under | 0023| which coverage is excluded during a six-month period following | 0024| the effective date of coverage of an individual for preexisting | 0025| conditions, as long as either of the following exists: | 0001| (1) the condition has manifested itself within a | 0002| period of six months before the effective date of coverage in | 0003| such a manner as would cause an ordinarily prudent person to | 0004| seek diagnosis or treatment; or | 0005| (2) medical advice or treatment was recommended | 0006| or received within a period of six months before the effective | 0007| date of coverage] a preexisting condition exclusion only if: | 0008| (1) the exclusion extends for a period of not | 0009| more than six months, after the enrollment date; and | 0010| (2) the period of the exclusion is reduced by | 0011| the aggregate of the periods of creditable coverage applicable | 0012| to the participant or beneficiary as of the enrollment date. | 0013| F. As used in this section, "preexisting condition | 0014| exclusion" means a limitation or exclusion of benefits relating | 0015| to a condition based on the fact that the condition was present | 0016| before the date of enrollment for coverage for the benefits | 0017| whether or not any medical advice, diagnosis, care or treatment | 0018| was recommended or received before that date, but genetic | 0019| information is not included as a preexisting condition for the | 0020| purposes of limiting or excluding benefits in the absence of a | 0021| diagnosis of the condition related to the genetic information. | 0022| G. An insurer shall not impose a preexisting | 0023| condition exclusion: | 0024| (1) in the case of an individual who, as of the | 0025| last day of the thirty-day period beginning with the date of | 0001| birth, is covered under creditable coverage; | 0002| (2) that excludes a child who is adopted or | 0003| placed for adoption before his eighteenth birthday and who, as | 0004| of the last day of the thirty-day period beginning on and | 0005| following the date of the adoption or placement for adoption, | 0006| is covered under creditable coverage; or | 0007| (3) that relates to or includes pregnancy as a | 0008| preexisting condition. | 0009| H. The provisions of Paragraphs (1) and (2) of | 0010| Subsection G of this section do not apply to any individual | 0011| after the end of the first continuous sixty-three-day period | 0012| during which the individual was not covered under any | 0013| creditable coverage. | 0014| [E.] I. The preexisting condition exclusions | 0015| described in Subsection [D] E of this section shall be | 0016| waived to the extent to which similar exclusions have been | 0017| satisfied under any prior health insurance coverage if the | 0018| [application] effective date of coverage for health | 0019| insurance through the alliance is made not later than [thirty- | 0020| one] sixty-three days following the termination of the prior | 0021| coverage. In that case, coverage through the alliance shall be | 0022| effective from the date on which the prior coverage was | 0023| terminated. This subsection does not prohibit preexisting | 0024| conditions coverage in an approved health plan that is more | 0025| favorable to the [insured] covered individual than that | 0001| specified in this subsection. | 0002| J. An approved health plan issued to an eligible | 0003| individual shall not contain any preexisting condition | 0004| exclusion. | 0005| [F.] K. An individual is not eligible for | 0006| coverage by the alliance under an approved health plan issued | 0007| to a small employer if he: | 0008| (1) [he] is [at the time of application] | 0009| eligible for medicare; provided, however, if an individual has | 0010| health insurance coverage from an employer whose group includes | 0011| twenty or more individuals, an individual eligible for medicare | 0012| who continues to be employed may choose to be covered through | 0013| an approved health plan; | 0014| (2) [he] has voluntarily terminated health | 0015| insurance issued through the alliance within the past twelve | 0016| months unless it was due to a change in employment; or | 0017| (3) [he] is an inmate of a public institution | 0018| [or is eligible for public programs, other than state-funded | 0019| programs, for which medical care is provided]. | 0020| [G.] L. The alliance shall provide for an open | 0021| enrollment period of sixty days from the initial offering of an | 0022| approved health plan. Individuals enrolled during the open | 0023| enrollment period shall not be subject to the preexisting | 0024| conditions limitation. | 0025| M. If an insured covered by an approved health plan | 0001| switches to another approved health plan that provides | 0002| increased or additional benefits such as lower deductible or | 0003| co-payment requirements, the member offering the approved | 0004| health plan with increased or additional benefits may require | 0005| the six-month period for preexisting conditions provided in | 0006| Subsection E of this section to be satisfied prior to receipt | 0007| of the additional benefits." | 0008| Section 46. Section 59A-56-17 NMSA 1978 (being Laws 1994, | 0009| Chapter 75, Section 17) is amended to read: | 0010| "59A-56-17. BENEFITS.-- | 0011| A. An approved health plan [issued through the | 0012| alliance] shall pay for [or provide] medically necessary | 0013| eligible expenses that exceed the deductible, co-payment and | 0014| co-insurance amounts applicable under the provisions of Section | 0015| [18 of the Health Insurance Alliance Act] 59A-56-18 NMSA | 0016| 1978 and are not otherwise limited or excluded. The Health | 0017| Insurance Alliance Act does not prohibit the board from | 0018| approving additional types of health plan designs with similar | 0019| cost-benefit structures or other types of health plan | 0020| designs. An approved health plan for small employers shall, | 0021| at a minimum, reflect the levels of health insurance coverage | 0022| generally available in New Mexico for small employer group | 0023| policies, but an approved health plan for small employers may | 0024| also offer health plan designs that are not generally available | 0025| in New Mexico for small employer group policies. | 0001| B. The board may design and require an approved | 0002| health plan to contain cost-containment measures and | 0003| requirements, including managed care, pre-admission | 0004| certification and concurrent inpatient review and the use of | 0005| fee schedules for health care providers, including the | 0006| diagnosis-related grouping system and the resource-based | 0007| relative value system." | 0008| Section 47. Section 59A-56-18 NMSA 1978 (being Laws 1994, | 0009| Chapter 75, Section 18) is amended to read: | 0010| "59A-56-18. DEDUCTIBLES--CO-INSURANCE--MAXIMUM OUT-OF- | 0011| POCKET PAYMENTS.-- | 0012| A. Subject to the limitations provided in Subsection | 0013| C of this section, an approved health plan offered through the | 0014| alliance may impose a deductible on a per-person calendar year | 0015| basis. [A deductible plan of five hundred dollars ($500) shall | 0016| initially be offered.] An approved health plan offered by a | 0017| health maintenance organization [plans] shall provide | 0018| equivalent cost-benefit structures. The board may authorize | 0019| deductibles in other amounts and equivalent cost-benefit | 0020| structures. [The deductible shall be applied to the first five | 0021| hundred dollars ($500) or any other amount determined as | 0022| deductible by the board of eligible expenses incurred by the | 0023| covered individual.] | 0024| B. Subject to the limitations provided in Subsection | 0025| C of this section, a mandatory co-insurance requirement | 0001| [shall] for an approved health plan may be imposed [at an | 0002| average not to exceed thirty percent] as a percentage of | 0003| eligible expenses in excess of [the mandatory] a | 0004| deductible. Health maintenance organizations shall impose | 0005| equivalent cost-benefit structures. | 0006| C. The maximum aggregate out-of-pocket payments for | 0007| eligible expenses [or health care services] by the covered | 0008| individual shall be determined by the board." | 0009| Section 48. Section 59A-56-19 NMSA 1978 (being Laws 1994, | 0010| Chapter 75, Section 19) is amended to read: | 0011| "59A-56-19. DEPENDENT FAMILY MEMBER REQUIRED COVERAGE-- | 0012| SMALL EMPLOYER RESPONSIBILITY.-- | 0013| A. A small employer [may] shall collect or make a | 0014| payroll deduction from the compensation of an employee for the | 0015| portion of the approved health plan cost the employee is | 0016| responsible for paying. The small employer may contribute to | 0017| the cost of that plan on behalf of the employee. | 0018| B. A small employer shall make available to dependent | 0019| family members of an employee covered by an approved health | 0020| plan the same approved health plan. The small employer may | 0021| contribute to the cost of group [family] coverage. | 0022| C. All premiums collected, deducted from the | 0023| compensation of employees or paid on their behalf by the small | 0024| employer shall be promptly remitted to the alliance." | 0025| Section 49. Section 59A-56-20 NMSA 1978 (being Laws 1994, | 0001| Chapter 75, Section 20) is amended to read: | 0002| "59A-56-20. RENEWABILITY.-- | 0003| A. An approved health plan shall contain provisions | 0004| under which the member offering the plan is obligated to renew | 0005| the health insurance if premiums are paid until the day the | 0006| plan is replaced by another plan or the small employer | 0007| terminates coverage. An individual covered by health insurance | 0008| under an approved health plan may retain coverage until he | 0009| [first] becomes eligible for medicare as the primary | 0010| coverage, except that in a family policy [the age of the | 0011| younger family member shall be used to continue the coverage | 0012| and as the basis for eligibility] coverage under an approved | 0013| health plan shall continue for any person in the family who is | 0014| not eligible for medicare. | 0015| B. An approved health plan issued to an eligible | 0016| individual shall contain provisions under which the member | 0017| offering the plan is obligated to renew the health insurance | 0018| except for: | 0019| (1) nonpayment of premium; | 0020| (2) fraud; or | 0021| (3) termination of the approved health plan, | 0022| except that the individual has the right to transfer to another | 0023| approved health plan. | 0024| [B.] C. If an approved health plan ceases to | 0025| exist, the alliance shall provide an alternate approved health | 0001| plan. | 0002| [C.] D. An approved health plan shall provide | 0003| covered individuals the right to continue health insurance | 0004| coverage through an approved health plan as individual health | 0005| insurance provided by the same member upon the death of the | 0006| employee or upon the divorce, annulment or dissolution of | 0007| marriage or legal separation of the spouse from the employee or | 0008| by termination of employment by electing to do so within a | 0009| period of time specified in the health insurance, if the | 0010| employee was covered under an approved health plan while | 0011| employed for at least six consecutive months. The individual | 0012| may be charged an additional administrative charge for the | 0013| individual health insurance. | 0014| E. The right to continue health insurance coverage | 0015| provided in this section terminates if the covered individual | 0016| resides outside the United States for more than six consecutive | 0017| months." | 0018| Section 50. Section 59A-56-21 NMSA 1978 (being Laws 1994, | 0019| Chapter 75, Section 21) is amended to read: | 0020| "59A-56-21. [RULES] REGULATIONS.--The superintendent | 0021| shall: | 0022| A. adopt [rules] regulations that provide for | 0023| disclosure by members of the availability of health insurance | 0024| from the alliance; and | 0025| B. adopt [rules] regulations to carry out the | 0001| provisions of the Health Insurance Alliance Act." | 0002| Section 51. Section 59A-56-23 NMSA 1978 (being Laws 1994, | 0003| Chapter 75, Section 23) is amended to read: | 0004| "59A-56-23. RATES--STANDARD RISK RATE--EXPERIENCE RATING | 0005| PROHIBITED.-- | 0006| A. The alliance shall determine a standard risk rate | 0007| index by actuarially calculating the average index rates that | 0008| the insurer has filed under the requirements of the Small Group | 0009| Rate and Renewability Act with the benefits similar to the | 0010| alliance's standard approved health plan. A standard risk rate | 0011| based on age and other appropriate demographic characteristics | 0012| may be used. No standard risk rate shall be more than | 0013| [fifteen] ten percent higher or [fifteen] ten percent | 0014| lower than the average index rate. In determining the standard | 0015| risk rate, the alliance shall consider the benefits provided by | 0016| the approved health plan. | 0017| B. Experience rating is not allowed other than for | 0018| reinsurance purposes. | 0019| C. All rates and rate schedules shall be submitted to | 0020| the superintendent for approval prior to use." | 0021| Section 52. Section 59A-56-24 NMSA 1978 (being Laws 1994, | 0022| Chapter 75, Section 24) is amended to read: | 0023| "59A-56-24. BENEFIT PAYMENTS REDUCTION.-- | 0024| A. An approved health plan shall be the last payer of | 0025| benefits whenever any other benefit is available. Benefits | 0001| otherwise payable under the approved health plan shall be | 0002| reduced by all amounts paid or payable through any other health | 0003| insurance and by all hospital and medical expense benefits paid | 0004| or payable under any workers' compensation coverage, automobile | 0005| medical payment or liability insurance, whether provided on the | 0006| basis of fault or no-fault, and by any hospital or medical | 0007| benefits paid or payable under or provided pursuant to any | 0008| state or federal [law] program, excluding medicaid. | 0009| B. The administrator or the alliance shall have a | 0010| cause of action against any person covered by an approved | 0011| health plan for the recovery of the amount of benefits paid | 0012| that are not for [covered] eligible expenses. Benefits due | 0013| from the approved health plan may be reduced or refused as a | 0014| set-off against any amount recoverable under this section." | 0015| Section 53. A new section of the Health Insurance | 0016| Alliance Act is enacted to read: | 0017| "[NEW MATERIAL] HEALTH INSURANCE COVERAGE FOR | 0018| CHILDREN.-- | 0019| A. The board may adopt a children's health insurance | 0020| program that conforms to one or more prototypes established by | 0021| the board. | 0022| B. Members providing approved health plans in the | 0023| alliance are eligible to bid to provide a children's health | 0024| insurance program. A children's health insurance program is | 0025| not considered a separate approved health plan within the | 0001| meaning of the Health Insurance Alliance Act. | 0002| C. If an employer offers a group health insurance | 0003| plan for employees that includes coverage for children and if | 0004| the employee chooses to provide coverage for eligible children | 0005| through the children's health insurance program of the alliance | 0006| instead of the employer's group health insurance plan, the | 0007| employer shall pay as part of the premium for the children's | 0008| health insurance program the contribution that the employer | 0009| would have paid to provide coverage to the child through the | 0010| employer's group health insurance plan. | 0011| D. The board shall provide an addendum to the plan of | 0012| operation for the superintendent's approval to assure the fair, | 0013| reasonable and equitable administration of the children's | 0014| health insurance program. | 0015| E. All policy forms written to conform to the | 0016| prototype of the children's health insurance programs shall be | 0017| filed and approved by the superintendent before they are | 0018| issued." | 0019| Section 54. A new section of the Health Insurance | 0020| Alliance Act is enacted to read: | 0021| "[NEW MATERIAL] EXEMPTION.--The alliance is exempt from | 0022| payment of all fees and taxes levied by this state or any of | 0023| its political subdivisions." | 0024| Section 55. TEMPORARY PROVISION--REPORT.--The department | 0025| of insurance and the New Mexico health insurance alliance shall | 0001| prepare and publish a report to the legislature by October 1, | 0002| 1997 on the alliance program and recommendations to facilitate | 0003| participation in the alliance programs. | 0004| Section 56. REPEAL.--Laws 1994, Chapter 75, Section 35 is | 0005| repealed. | 0006| Section 57. EMERGENCY.--It is necessary for the public | 0007| peace, health and safety that this act take effect immediately. | 0008| - 115 - | 0009| State of New Mexico | 0010| House of Representatives | 0011| | 0012| FORTY-THIRD LEGISLATURE | 0013| FIRST SESSION, 1997 | 0014| | 0015| | 0016| February 27, 1997 | 0017| | 0018| | 0019| Mr. Speaker: | 0020| | 0021| Your BUSINESS AND INDUSTRY COMMITTEE, to whom has | 0022| been referred | 0023| | 0024| HOUSE BILL 832 | 0025| | 0001| has had it under consideration and reports same with | 0002| recommendation that it DO PASS, amended as follows: | 0003| | 0004| 1. On page 12, line 6, strike "twelve" and insert "six". | 0005| | 0006| 2. On page 41, line 16, strike "Until July 1, 1998, in" and | 0007| insert "In". | 0008| | 0009| 3. On page 41, line 20, after "practices" insert "except | 0010| that for individual policies the rating factor of the | 0011| individual's place of residence may be used instead of the | 0012| geographic area of the individual's place of employment" and | 0013| strike "Until July 1, 1998, in" and insert "In". | 0014| | 0015| 4. On page 42, strike all of lines 9 through 14. | 0016| | 0017| 5. Reletter the following subsection accordingly. | 0018| | 0019| 6. On page 47, line 25, remove the brackets and line- | 0020| through and strike "fifteen". | 0021| | 0022| 7. On page 51, line 11, strike "Until July 1, 1998, in" and | 0023| insert "In". | 0024| | 0025| 8. On page 51, strike all of lines 24 and 25 and on page | 0001| 52, strike all of lines 1 through 4. | 0002| | 0003| 9. Reletter the following subsection accordingly. | 0004| | 0005| 10. On page 52, between lines 20 and 21, insert the | 0006| following paragraph: | 0007| | 0008| "(1) the exclusion relates to a condition, | 0009| physical or mental, regardless of the cause of the condition, for | 0010| which medical advice, diagnosis, care or treatment was | 0011| recommended or received within the six-month period ending on the | 0012| enrollment date;". | 0013| | 0014| 11. Renumber the succeeding paragraphs accordingly. | 0015| | 0016| 12. On page 52, line 22, strike "twelve" and insert "six". | 0017| | 0018| 13. On page 58, lines 1 and 2, strike "when the employer is | 0019| a small employer". | 0020| | 0021| 14. On page 58, line 16, after "employee" insert "or a | 0022| dependent". | 0023| | 0024| 15. On page 59, line 11, remove bracket and line through | 0025| "and" and on line 12 insert an opening bracket before "J.". | 0001| | 0002| 16. On page 60, line 5, strike "; and" and insert a period | 0003| and closing quotation marks. | 0004| | 0005| 17. On page 60, strike all of lines 6 through 18. | 0006| | 0007| 18. On page 80, lines 4 and 5, strike ", including medicare | 0008| supplement insurance". | 0009| | 0010| 19. On page 80, lines 7 and 8, strike ", long-term care". | 0011| | 0012| 20. On page 84, strike all of line 18 following "employers" | 0013| and strike line 19 through "plans". | 0014| | 0015| 21. On page 84, strike all of line 21 following | 0016| "employers", strike all of line 22 and strike line 23 through | 0017| "plans". | 0018| | 0019| 22. On page 91, lines 19 and 20, remove the brackets and | 0020| line-through and strike "ten". | 0021| | 0022| 23. On page 103, on lines 15 and 16, strike "coverage for a | 0023| child. The policy shall also provide". | 0024| | 0025| 24. On page 105, between lines 5 and 6, insert the | 0001| following paragraph: | 0002| | 0003| "(1) the exclusion relates to a condition, | 0004| physical or mental, regardless of the cause of the condition, for | 0005| which medical advice, diagnosis, care or treatment was | 0006| recommended or received within the six-month period ending on the | 0007| enrollment date;". | 0008| | 0009| 25. Renumber the succeeding paragraphs accordingly. | 0010| | 0011| 26. On page 113, lines 3 and 4, remove the brackets and | 0012| line-through and strike "ten". | 0013| | 0014| 27. On page 114, strike all of lines 6 through 25. | 0015| | 0016| 28. On page 115, strike all of lines 1 through 13. | 0017| | 0018| 29. Renumber the succeeding sections accordingly. | 0019| | 0020| 30. On page 115, strike lines 19 and 20. | 0021| | 0022| 31. Renumber the succeeding section accordingly., | 0023| | 0024| and thence referred to the JUDICIARY COMMITTEE. | 0025| | 0001| | 0002| Respectfully submitted, | 0003| | 0004| | 0005| | 0006| | 0007| | 0008| | 0009| Fred Luna, Chairman | 0010| | 0011| | 0012| Adopted Not Adopted | 0013| (Chief Clerk) | 0014| (Chief Clerk) | 0015| | 0016| Date | 0017| | 0018| The roll call vote was 7 For 0 Against | 0019| Yes: 7 | 0020| Excused: Alwin, Chavez, Lutz, J.G. Taylor, Varela | 0021| Absent: Getty | 0022| | 0023| | 0024| .117464.5 | 0025| G:\BILLTEXT\BILLW_97\H0832 | 0001| | 0002| FORTY-THIRD LEGISLATURE | 0003| FIRST SESSION, 1997 | 0004| | 0005| | 0006| March 12, 1997 | 0007| | 0008| Mr. President: | 0009| | 0010| Your CORPORATIONS & TRANSPORTATION COMMITTEE, to | 0011| whom has been referred | 0012| | 0013| HOUSE BILL 832, as amended | 0014| | 0015| has had it under consideration and reports same with | 0016| recommendation that it DO PASS, and thence referred to the | 0017| PUBLIC AFFAIRS COMMITTEE. | 0018| | 0019| Respectfully submitted, | 0020| | 0021| | 0022| | 0023| | 0024| __________________________________ | 0025| Roman M. Maes, III, Chairman | 0001| | 0002| | 0003| | 0004| Adopted_______________________ Not | 0005| Adopted_______________________ | 0006| (Chief Clerk) (Chief Clerk) | 0007| | 0008| | 0009| Date ________________________ | 0010| | 0011| | 0012| The roll call vote was 7 For 0 Against | 0013| Yes: 7 | 0014| No: 0 | 0015| Excused: Fidel, Griego, Howes | 0016| Absent: None | 0017| | 0018| | 0019| H0832CT1 | 0020| | 0021| | 0022| | 0023| FORTY-THIRD LEGISLATURE | 0024| FIRST SESSION, 1997 | 0025| | 0001| | 0002| March 16, 1997 | 0003| | 0004| Mr. President: | 0005| | 0006| Your PUBLIC AFFAIRS COMMITTEE, to whom has been | 0007| referred | 0008| | 0009| HOUSE BILL 832, as amended | 0010| | 0011| has had it under consideration and reports same with | 0012| recommendation that it DO PASS. | 0013| | 0014| Respectfully submitted, | 0015| | 0016| | 0017| | 0018| | 0019| __________________________________ | 0020| Shannon Robinson, Chairman | 0021| | 0022| | 0023| | 0024| Adopted_______________________ Not | 0025| Adopted_______________________ | 0001| (Chief Clerk) (Chief Clerk) | 0002| | 0003| | 0004| Date ________________________ | 0005| | 0006| | 0007| The roll call vote was 5 For 0 Against | 0008| Yes: 5 | 0009| No: 0 | 0010| Excused: Boitano, Garcia, Ingle, Rodarte | 0011| Absent: None | 0012| | 0013| | 0014| | 0015| | 0016| H0832PA1 |