0001| SENATE BILL 199 | 0002| 42ND LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION, | 0003| 1996 | 0004| INTRODUCED BY | 0005| JANICE D. PASTER | 0006| | 0007| | 0008| | 0009| FOR THE HEALTH CARE TASK FORCE | 0010| | 0011| AN ACT | 0012| RELATING TO INSURANCE; AMENDING AND ENACTING CERTAIN PROVISIONS | 0013| OF THE HEALTH INSURANCE ALLIANCE ACT; AMENDING AND ENACTING | 0014| SECTIONS OF THE NMSA 1978; REPEALING A SECTION OF LAWS 1994; | 0015| DECLARING AN EMERGENCY. | 0016| | 0017| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0018| Section 1. Section 59A-54-12 NMSA 1978 (being Laws 1987, | 0019| Chapter 154, Section 12, as amended) is amended to read: | 0020| "59A-54-12. ELIGIBILITY--POLICY PROVISIONS.-- | 0021| A. A person is eligible for a pool policy only if on | 0022| the effective date of coverage or renewal of coverage the person | 0023| is a New Mexico resident and: | 0024| (1) is not eligible as an insured or covered | 0025| dependent for any health plan that provides coverage for | 0001| comprehensive major medical or comprehensive physician and | 0002| hospital services; | 0003| (2) is only eligible for a health plan that is | 0004| offered at a rate higher than that available from the pool; | 0005| (3) has been rejected for coverage for | 0006| comprehensive major medical or comprehensive physician and | 0007| hospital services; or | 0008| (4) is only eligible for a health plan with a | 0009| rider, waiver or restrictive provision for that particular | 0010| individual based on a specific condition. | 0011| B. Coverage under a pool policy is in excess of and | 0012| shall not duplicate coverage under any other form of health | 0013| insurance. | 0014| C. A pool policy shall provide that coverage of a | 0015| dependent unmarried person terminates when the person becomes | 0016| nineteen years of age or, if the person is enrolled full time in | 0017| an accredited educational institution, when he becomes twenty-five years of age. The policy shall also provide in substance | 0018| that attainment of the limiting age does not operate to | 0019| terminate coverage when the person is and continues to be: | 0020| (1) incapable of self-sustaining employment by | 0021| reason of mental retardation or physical handicap; and | 0022| (2) primarily dependent for support and | 0023| maintenance upon the person in whose name the contract is | 0024| issued. | 0025| Proof of incapacity and dependency shall be furnished to | 0001| the insurer within one hundred twenty days of attainment of the | 0002| limiting age and subsequently as required by the insurer but not | 0003| more frequently than annually after the two-year period | 0004| following attainment of the limiting age. | 0005| D. A pool policy that provides coverage for a family | 0006| member of the person in whose name the contract is issued shall, | 0007| as to the coverage of the family member or the individual in | 0008| whose name the contract was issued, provide that the health | 0009| insurance benefits applicable for children are payable with | 0010| respect to a newly born child of the family member or the person | 0011| in whose name the contract is issued from the moment of coverage | 0012| of injury or illness, including the necessary care and treatment | 0013| of medically diagnosed congenital defects and birth | 0014| abnormalities. If payment of a specific premium is required to | 0015| provide coverage for the child, the contract may require that | 0016| notification of the birth of a child and payment of the required | 0017| premium shall be furnished to the carrier within thirty-one days | 0018| after the date of birth in order to have the coverage continued | 0019| beyond the thirty-one day period. | 0020| E. A pool policy may contain provisions under which | 0021| coverage is excluded during a six-month period following the | 0022| effective date of coverage as to a given individual for pre-existing conditions, as long as either of the following exists: | 0023| (1) the condition has manifested itself within | 0024| a period of six months before the effective date of coverage in | 0025| such a manner as would cause an ordinarily prudent person to | 0001| seek diagnoses or treatment; or | 0002| (2) medical advice or treatment was recommended | 0003| or received within a period of six months before the effective | 0004| date of coverage. | 0005| F. The pre-existing condition exclusions described | 0006| in Subsection E of this section shall be waived to the extent to | 0007| which similar exclusions have been satisfied under any prior | 0008| health insurance coverage [which] that was involuntarily | 0009| terminated, if the application for pool coverage is made not | 0010| later than thirty-one days following the involuntary | 0011| termination. In that case, coverage in the pool shall be | 0012| effective from the date on which the prior coverage was | 0013| terminated. This subsection does not prohibit pre-existing | 0014| conditions coverage in a pool policy that is more favorable to | 0015| the insured than that specified in this subsection. | 0016| G. An individual is not eligible for coverage by the | 0017| pool if: | 0018| (1) he is, at the time of application, eligible | 0019| for medicare or medicaid, which would provide coverage for | 0020| amounts in excess of limited policies such as dread disease, | 0021| cancer policies or hospital indemnity policies; | 0022| (2) he has terminated coverage by the pool | 0023| within the past twelve months; or | 0024| (3) he is an inmate of a public institution or | 0025| is eligible for public programs for which medical care is | 0001| provided. | 0002| H. Any person whose health insurance coverage from a | 0003| qualified state health policy with similar coverage is | 0004| terminated because of nonresidency in another state may apply | 0005| for coverage under the pool. If the coverage is applied for | 0006| within thirty-one days after that termination and if premiums | 0007| are paid for the entire coverage period, the effective date of | 0008| the coverage shall be the date of termination of the previous | 0009| coverage. | 0010| I. A person otherwise eligible and having coverage | 0011| pursuant to the provisions of the Comprehensive Health Insurance | 0012| Pool Act shall not become ineligible because that person becomes | 0013| eligible for coverage pursuant to the provisions of the Health | 0014| Insurance Alliance Act." | 0015| Section 2. Section 59A-56-2 NMSA 1978 (being Laws 1994, | 0016| Chapter 75, Section 2) is amended to read: | 0017| "59A-56-2. PURPOSE.--The purpose of the Health Insurance | 0018| Alliance Act is to provide increased access to voluntary health | 0019| insurance coverage in New Mexico [The initial purpose is to | 0020| improve access to health insurance coverage for small employers | 0021| on a voluntary basis]. An additional purpose of the Health | 0022| Insurance Alliance Act is to provide for the development of [a | 0023| plan] plans for [expanded] health insurance coverage [to | 0024| include uninsured children, other employer groups] for | 0025| children, small employers and individuals." | 0001| Section 3. Section 59A-56-3 NMSA 1978 (being Laws 1994, | 0002| Chapter 75, Section 3) is amended to read: | 0003| "59A-56-3. DEFINITIONS.--As used in the Health Insurance | 0004| Alliance Act: | 0005| A. "alliance" means the New Mexico health insurance | 0006| alliance; | 0007| B. "approved health plan" means any arrangement for | 0008| the provision of health insurance offered through and approved | 0009| by the alliance [by which insureds have access to health | 0010| insurance]; | 0011| C. "board" means the board of directors of the | 0012| alliance; | 0013| D. "child" means a dependent unmarried individual | 0014| who is less than nineteen years of age or an unmarried | 0015| individual who is enrolled full time in an accredited | 0016| educational institution until the individual becomes twenty-five | 0017| years of age; | 0018| E. "department" means the department of insurance; | 0019| [D.] F. "director" means an individual who | 0020| serves on the board; | 0021| [E.] G. "earned premiums" means premiums paid or | 0022| due during [the] a calendar year for coverage under an | 0023| approved health plan less any unearned premiums at the end of | 0024| that calendar year plus any unearned premiums from the end of | 0025| the [previous] immediately preceding calendar year; | 0001| [F.] H. "eligible expenses" [are] means the | 0002| allowable charges for a health care service [and items for | 0003| which benefits are extended] covered under an approved health | 0004| plan; | 0005| I. "gross earned premiums" means premiums paid or | 0006| due during a calender year for all health insurance written in | 0007| the state less any unearned premiums at the end of that calendar | 0008| year plus any unearned premiums from the end of the immediately | 0009| preceding calendar year; | 0010| [G.] J. "health care service" means a service or | 0011| product furnished an individual [or incidental to the | 0012| furnishing of the service or product] for the purpose of | 0013| preventing, alleviating, curing or healing human illness or | 0014| injury and includes services and products incidental to | 0015| furnishing the described services or products; | 0016| [H.] K. "health insurance" means "health" | 0017| insurance as defined in Section 59A-7-3 NMSA 1978; any hospital | 0018| and medical expense-incurred policy, including medicare | 0019| supplement insurance; nonprofit health care [service] plan | 0020| service contract; health maintenance organization subscriber | 0021| contract; short-term, accident, fixed indemnity, specified | 0022| disease policy, long-term care or disability income | 0023| insurance contracts and limited health benefit or credit | 0024| health insurance; coverage for health care services under | 0025| uninsured arrangements of group or group-type contracts, | 0001| including employer self-insured, cost-plus or other benefits | 0002| methodologies not involving insurance or not subject to New | 0003| Mexico premium taxes; coverage for health care services under | 0004| group-type contracts that are not available to the general | 0005| public and can be obtained only because of connection with a | 0006| particular organization or group; or coverage by medicare or | 0007| other governmental [benefits; or "health insurance" as defined | 0008| by Section 59A-7-3 NMSA 1978] programs providing health care | 0009| services; but "health insurance" does not include insurance | 0010| [arising out of] issued pursuant to provisions of the | 0011| Workers' Compensation Act or similar law, automobile medical | 0012| payment insurance or [insurance under] provisions by which | 0013| benefits are payable with or without regard to fault [and] | 0014| that [is] are required by law to be contained in any | 0015| liability insurance policy; | 0016| [I.] L. "health maintenance organization" means | 0017| a health maintenance organization as defined by Subsection M of | 0018| Section 59A-46-2 NMSA 1978; | 0019| [J.] M. "incurred claims" means claims paid | 0020| during a calendar year plus claims incurred in the calendar year | 0021| and paid prior to April 1 of the succeeding year, less claims | 0022| incurred previous to the current calendar year and paid prior to | 0023| April 1 of the current year; | 0024| [K.] N. "insured" means a small employer or its | 0025| employee and an individual covered by an approved health plan, | 0001| [or an individual] a former employee of a small employer who | 0002| is covered by an approved health plan through conversion or an | 0003| individual covered by an approved health plan that allows | 0004| individual enrollment; | 0005| [L.] O. "medicare" means coverage under both | 0006| Parts A and B of Title 18 of the federal Social Security Act; | 0007| [M.] P. "member" means [an insurance company | 0008| authorized to transact health insurance business in this state, | 0009| a nonprofit health care plan, a health maintenance organization | 0010| or self-insurers not subject to federal preemption, but does not | 0011| include an insurance company that is licensed under the Prepaid | 0012| Dental Plan Law or a company that is solely engaged in the sale | 0013| of dental insurance and is licensed under a provision of the | 0014| Insurance Code] a member of the alliance; | 0015| Q. "nonprofit health care plan" means a "health | 0016| care plan" as defined in Subsection K of Section 59A-47-3 NMSA | 0017| 1978; | 0018| R. "premiums" means the premiums received for | 0019| coverage under an approved health plan during a calendar year; | 0020| [N.] S. "small employer" means a person that is | 0021| a resident of this state, has employees at least fifty percent | 0022| of whom are residents of this state, is actively engaged in | 0023| business and that on at least fifty percent of its working days | 0024| during the preceding calendar year employed no [less] fewer | 0025| than two and no more than fifty eligible employees; provided | 0001| that: (1) in determining the number of eligible | 0002| employees, the spouse or dependent of an employee may, at the | 0003| employer's discretion, be counted as a separate employee; and | 0004| (2) companies that are [affiliated companies | 0005| or that are] eligible to file a combined tax return or a | 0006| consolidated tax return for purposes of state income taxation | 0007| shall be considered one employer; [and | 0008| O.] T. "superintendent" means the superintendent | 0009| of insurance; | 0010| U. "total premiums" means the total premiums for | 0011| business written in the state received during a calendar year; | 0012| and | 0013| V. "unearned premiums" means the portion of a | 0014| premium previously paid for which the coverage period is in the | 0015| future." | 0016| Section 4. Section 59A-56-4 NMSA 1978 (being Laws 1994, | 0017| Chapter 75, Section 4) is amended to read: | 0018| "59A-56-4. ALLIANCE CREATED--BOARD CREATED.-- | 0019| A. The "New Mexico health insurance alliance" is | 0020| created as a nonprofit [independent] public corporation for | 0021| the purpose of providing increased access to health insurance in | 0022| the state. All insurance companies authorized to transact | 0023| health insurance business in this state, nonprofit health care | 0024| plans, health maintenance organizations and self-insurers not | 0025| subject to federal preemption shall organize and be members of | 0001| the alliance as a condition of their authority to offer health | 0002| insurance in this state, except for an insurance company that | 0003| is licensed under the Prepaid Dental Plan Law or a company that | 0004| is solely engaged in the sale of dental insurance and is | 0005| licensed under a provision of the Insurance Code. The alliance | 0006| [shall] is not [be considered] a governmental agency for | 0007| any purpose. | 0008| B. The [board of directors of the New Mexico health | 0009| insurance] alliance [is created] shall be governed by a | 0010| board of directors constituted pursuant to the provisions of | 0011| this section. The board is a governmental entity for purposes | 0012| of the Tort Claims Act, but the board shall not be considered a | 0013| governmental entity for any other purpose. | 0014| C. The superintendent shall, within sixty days after | 0015| [the effective date of the Health Insurance Alliance Act] | 0016| March 4, 1994, give notice to all members of the time and | 0017| place for the initial organizational meeting of the alliance. | 0018| Each member shall be entitled to one vote in person or by proxy | 0019| at the organizational meeting. | 0020| D. The alliance shall operate subject to the | 0021| supervision and approval of the board. The board shall consist | 0022| of: | 0023| (1) five directors, [appointed] elected by | 0024| the members, who shall be officers or employees of members and | 0025| shall consist of one representative of a nonprofit health care | 0001| plan, two representatives of health maintenance organizations | 0002| and two representatives of other types of members; | 0003| (2) five directors, appointed by the governor, | 0004| who shall be officers, general partners or proprietors of | 0005| small employers [and] who, after the term of the initial | 0006| appointments, are covered by approved health plans; | 0007| (3) four directors appointed by the governor, | 0008| who shall be employees of small employers, and who, after the | 0009| term of the initial appointments, are employees of small | 0010| employers covered by approved health plans; and | 0011| (4) the superintendent or his designee, [The | 0012| superintendent] who shall be a nonvoting member except when | 0013| his vote is necessary to break a tie. | 0014| E. The superintendent shall serve as chair of the | 0015| board unless he declines, in which event he shall appoint the | 0016| chair. | 0017| F. The directors [appointed] elected by the | 0018| members shall be [appointed] elected for initial terms of | 0019| three years or less, staggered so that the term of at least one | 0020| director [shall expire] expires on June 30 of each year. | 0021| The directors appointed by the governor shall be appointed for | 0022| initial terms of three years or less, staggered so that the term | 0023| of at least one director [shall expire] expires on June 30 | 0024| of each year. Following the initial terms, directors shall be | 0025| elected or appointed for terms of three years. [If the | 0001| members fail to make the initial appointments within sixty days | 0002| following the first organizational meeting, the superintendent | 0003| shall make those appointments.] A director whose term has | 0004| expired shall continue to serve until his successor is elected | 0005| or appointed. | 0006| G. Whenever a vacancy on the board occurs, the | 0007| electing or appointing authority of [that director] the | 0008| director's position that is vacant shall fill the vacancy by | 0009| electing or appointing an individual to serve the balance of | 0010| the unexpired term; provided, when a vacancy occurs in one of | 0011| the director's positions elected by the members, the | 0012| superintendent is authorized to appoint a temporary replacement | 0013| director until the next scheduled election of directors elected | 0014| by the members is held. The individual elected or appointed | 0015| to fill a vacancy shall meet the requirements for initial | 0016| election or appointment to that position. | 0017| H. Directors may be reimbursed by the alliance as | 0018| provided in the Per Diem and Mileage Act in the same manner and | 0019| amounts as nonsalaried public officers, but shall receive no | 0020| other compensation, perquisite or allowance from the | 0021| alliance." | 0022| Section 5. Section 59A-56-5 NMSA 1978 (being Laws 1994, | 0023| Chapter 75, Section 5) is amended to read: | 0024| "59A-56-5. PLAN OF OPERATION.-- | 0025| A. The board shall submit a plan of operation to the | 0001| superintendent and any amendments to the plan necessary or | 0002| suitable to assure the fair, reasonable and equitable | 0003| administration of the alliance. | 0004| B. The superintendent shall, after notice and | 0005| hearing, approve the plan of operation if it is determined to | 0006| assure the fair, reasonable and equitable administration of the | 0007| alliance. The plan of operation shall become effective upon | 0008| written approval of the superintendent consistent with the date | 0009| on which health insurance coverage through the alliance pursuant | 0010| to the provisions of the Health Insurance Alliance Act is made | 0011| available. [If the board fails to submit a plan of operation | 0012| within one hundred eighty days after the appointment of the | 0013| board, the superintendent shall, after notice and hearing, adopt | 0014| and promulgate a plan of operation.] A plan of operation | 0015| adopted by the superintendent shall continue in force until | 0016| modified by him or superseded by a subsequent plan of operation | 0017| submitted by the board and approved by the superintendent. | 0018| C. The plan of operation shall: | 0019| (1) establish procedures for the handling and | 0020| accounting of assets of the alliance; | 0021| (2) establish regular times and places for | 0022| meetings of the board; | 0023| (3) establish procedures for records to be kept | 0024| of all financial transactions and for annual fiscal reporting to | 0025| the superintendent; | 0001| (4) establish the amount of and the method for | 0002| collecting assessments pursuant to Section [11 of the Health | 0003| Insurance Alliance Act] 59A-56-11 NMSA 1978; | 0004| (5) establish a program to publicize the | 0005| existence of the alliance, the approved health plans, the | 0006| eligibility requirements and procedures for enrollment in an | 0007| approved health plan and to maintain public awareness of the | 0008| alliance; | 0009| (6) establish penalties for [noncollection] | 0010| nonpayment of assessments [from] by members; | 0011| (7) establish procedures for alternative | 0012| dispute resolution of disputes between members and insureds; and | 0013| (8) contain additional provisions necessary and | 0014| proper for the execution of the powers and duties of the | 0015| alliance." | 0016| Section 6. Section 59A-56-6 NMSA 1978 (being Laws 1994, | 0017| Chapter 75, Section 6) is amended to read: | 0018| "59A-56-6. BOARD--POWERS AND DUTIES.-- | 0019| A. The board shall have the general powers and | 0020| authority granted to insurance companies licensed to transact | 0021| health insurance business under the laws of this state. | 0022| B. The board: | 0023| (1) may enter into contracts to carry out the | 0024| provisions of the Health Insurance Alliance Act, including, with | 0025| the approval of the superintendent, contracting with similar | 0001| alliances of other states for the joint performance of common | 0002| administrative functions or with persons or other organizations | 0003| for the performance of administrative functions; | 0004| (2) may sue and be sued; | 0005| (3) may conduct periodic audits of the members | 0006| to assure the general accuracy of the financial data submitted | 0007| to the alliance; | 0008| (4) shall establish maximum rate schedules, | 0009| allowable rate adjustments, administrative allowances, | 0010| reinsurance premiums and agent referral, [and] servicing | 0011| fees [and any other actuarial functions appropriate to the | 0012| operation of the alliance, but within the limits established] | 0013| or commissions subject to applicable provisions in the | 0014| Insurance Code. In determining the initial year's rate for | 0015| health insurance, the only rating factors that may be used are | 0016| age, gender, geographic area of the place of employment and | 0017| smoking practices. In any year's rate, the difference in rates | 0018| in any one age group that may be charged on the basis of a | 0019| person's gender shall not exceed another person's rates in the | 0020| age group by more than twenty percent of the lower rate, and no | 0021| person's rate shall exceed the rate of any other person with | 0022| similar family composition by more than two hundred fifty | 0023| percent of the lower rate, except that the rates for children | 0024| under the age of nineteen may be lower than the bottom rates in | 0025| the two hundred fifty percent band. The rating factor | 0001| restrictions shall not prohibit a member from offering rates | 0002| that differ depending upon family composition; | 0003| (5) may direct a member to issue policies or | 0004| certificates of coverage of health insurance in accordance with | 0005| the requirements of the Health Insurance Alliance Act; | 0006| (6) shall establish procedures for alternative | 0007| dispute resolution of disputes between members and insureds; | 0008| (7) shall cause the alliance to have an annual | 0009| audit of its operations by an independent certified public | 0010| accountant; | 0011| (8) shall conduct all board meetings as if it | 0012| were [an agency] subject to the provisions of the Open | 0013| Meetings Act; | 0014| (9) shall draft one or more sample health | 0015| insurance policies that are the prototype documents for the | 0016| members; | 0017| (10) shall determine the design criteria to be | 0018| met for an approved health plan; | 0019| (11) shall review each proposed approved health | 0020| plan to determine if it meets the alliance designed criteria | 0021| and, if it does meet the criteria, approve the plan [provided | 0022| that], but the board shall not permit more than one approved | 0023| health plan per member for each set of plan design criteria; | 0024| (12) shall review annually each approved health | 0025| plan to determine if it still qualifies as an approved health | 0001| plan based on the alliance designed criteria and, if the plan is | 0002| no longer approved, arrange for the transfer of the insureds | 0003| covered under the formerly approved plan to an approved health | 0004| plan; | 0005| (13) may terminate an approved health plan not | 0006| operating as required by the board; | 0007| (14) shall terminate an approved health plan if | 0008| timely claim payments are not made pursuant to the plan; and | 0009| (15) shall engage in significant marketing | 0010| activities, including a program of media advertising, to inform | 0011| small employers and eligible individuals of the existence of | 0012| the alliance, its purpose and the health insurance available or | 0013| potentially available through the alliance. | 0014| C. The alliance is subject to and responsible for | 0015| examination by the superintendent. No later than March 1 of | 0016| each year, the board shall submit to the superintendent an | 0017| audited financial report for the preceding calendar year in a | 0018| form approved by the superintendent." | 0019| Section 7. Section 59A-56-8 NMSA 1978 (being Laws 1994, | 0020| Chapter 75, Section 8) is amended to read: | 0021| "59A-56-8. APPROVED HEALTH PLAN [OR SERVICE].-- | 0022| A. An approved health plan shall conform to the | 0023| alliance's approved health plan design criteria. The board may | 0024| allow more than one plan design for approved health plans. A | 0025| member may provide one approved health plan for each plan design | 0001| approved by the board. | 0002| B. The board shall designate plan designs for | 0003| standard approved health plans. The board may designate plan | 0004| designs for an approved health plan that provides catastrophic | 0005| coverage or other benefit plan designs. | 0006| [B. The] C. Each approved health plan shall | 0007| offer a premium that is no greater than [fifteen] ten | 0008| percent over and no less than [fifteen] ten percent under | 0009| the average of the standard rate index for plans with the same | 0010| characteristics. | 0011| [C.] D. Any member that [submits a bid for] | 0012| provides or offers to [provide or renews] renew a group | 0013| health insurance contract providing health insurance benefits to | 0014| employees of the state, a county, a municipality or a school | 0015| district for which public funds are contributed shall offer at | 0016| least one approved health plan to small employers; provided, | 0017| however, if a member does not offer anywhere in the United | 0018| States a plan that meets substantially the design criteria of an | 0019| approved health plan, the member shall not be required to offer | 0020| an approved health plan. | 0021| E. If a plan design approved by the board is not | 0022| offered by any member already offering an approved health plan, | 0023| but a member offers a substantially similar plan design outside | 0024| the alliance, the board may require the member to offer that | 0025| plan design as an approved health plan through the alliance. | 0001| F. An approved health plan shall be offered for at | 0002| least five consecutive years following the date last required in | 0003| accordance with Subsection D of this section or after notifying | 0004| the board of its future withdrawal if not required in accordance | 0005| with Subsection D of this section unless: | 0006| (1) the member substitutes another approved | 0007| health plan for the plan withdrawn; or | 0008| (2) the board allows the plan to be withdrawn | 0009| because it imposes a serious hardship upon the member. | 0010| G. No member shall be required to offer an approved | 0011| health plan if the member notifies the superintendent in writing | 0012| that it will no longer offer health insurance, life insurance or | 0013| annuities in the state, except for renewal of existing | 0014| contracts, provided that: | 0015| (1) the member does not offer or provide health | 0016| insurance, life insurance or annuities for a period of five | 0017| years from the date of notification to the superintendent to any | 0018| person in the state who is not covered by the member through a | 0019| health insurance policy in effect on the date of the | 0020| notification; and | 0021| (2) with respect to health or life insurance | 0022| policies or annuities in effect on the date of notification to | 0023| the superintendent, the member continues to comply with all | 0024| applicable laws and regulations governing the provision of | 0025| insurance in this state, including the payment of applicable | 0001| taxes, fees and assessments." | 0002| Section 8. Section 59A-56-9 NMSA 1978 (being Laws 1994, | 0003| Chapter 75, Section 9) is amended to read: | 0004| "59A-56-9. REINSURANCE.-- | 0005| A. [Any] A member offering an approved health | 0006| plan [to small employers] shall be reinsured for certain | 0007| losses by the alliance. Within six months following the end of | 0008| each calendar year in which the member offering the approved | 0009| health plan paid more in incurred claims [than], plus the | 0010| member's reinsurance premium pursuant to Subsection B of this | 0011| section, than eighty-five percent of earned premiums received | 0012| by the member [received in gross earned premiums] on all | 0013| approved health plans issued by the member, [combined] the | 0014| member shall receive from the alliance the excess amount for | 0015| the calendar year by which the incurred claims and reinsurance | 0016| premium exceeded eighty-five percent of the [gross] earned | 0017| premiums received by the alliance or its administrator. | 0018| B. The alliance shall withhold from all premiums | 0019| that it receives a reinsurance premium as established by the | 0020| board. The reinsurance premium shall not exceed five percent of | 0021| premiums paid [by insured groups] in [their] the first | 0022| year of coverage and shall not exceed ten percent of [such] | 0023| premiums for renewal years. In determining the reinsurance | 0024| premium for a particular calendar year, the board shall set the | 0025| reinsurance premium at a rate that will recover the total | 0001| reinsurance loss for the preceding year over a reasonable number | 0002| of years in accordance with sound actuarial principles." | 0003| Section 9. Section 59A-56-10 NMSA 1978 (being Laws 1994, | 0004| Chapter 75, Section 10) is amended to read: | 0005| "59A-56-10. ADMINISTRATION.--The alliance shall deduct | 0006| from premiums collected for approved health plans an | 0007| administrative charge as set by the board. The administrative | 0008| charge shall be determined before the beginning of each calendar | 0009| year. The maximum administrative charge the alliance may charge | 0010| is ten percent of [gross] premiums [from a small employer] | 0011| in the first year and five percent of [gross] premiums in | 0012| renewal years." | 0013| Section 10. 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 year, | 0020| taking into account investment income for the period and other | 0021| appropriate gains and losses using the following definitions: | 0022| (1) net reinsurance losses shall be the | 0023| [reinsurance incurred claims against the alliance for the | 0024| previous calendar year reduced by the reinsurance earned] | 0025| amount determined for the previous calendar year in accordance | 0001| with Subsection A of Section 59A-56-9 NMSA 1978 for all members | 0002| offering an approved health plan reduced by reinsurance | 0003| premiums charged by the alliance in the previous calendar | 0004| year; and | 0005| (2) net administrative losses shall be the | 0006| administrative expenses incurred by the alliance in the previous | 0007| calendar year and projected for the current calendar year less | 0008| the sum of administrative allowances [earned] received by | 0009| the alliance and any legislative appropriation for the period, | 0010| but, in the event of an administrative gain, net administrative | 0011| losses for the purpose of assessments shall be considered zero, | 0012| and the gain shall be carried forward to the administrative fund | 0013| for the next calendar year as an additional allowance. | 0014| B. The assessment for each member shall be | 0015| determined by multiplying the total losses of the alliance's | 0016| operation, as defined in Subsection A of this section, by a | 0017| fraction, the numerator of which [equals] is an amount equal | 0018| to that member's total [premium] premiums, or [its] the | 0019| equivalent, exclusive of premiums received by the member for an | 0020| approved health plan for health insurance written in the state | 0021| during the preceding calendar year and the denominator of which | 0022| equals the total premiums of all health insurance [premiums] | 0023| written in the state during the preceding calendar year | 0024| exclusive of premiums for approved health plans; provided that | 0025| [premium income] total premiums shall not include payments | 0001| by the secretary of human services pursuant to a contract issued | 0002| under Section 1876 of the federal Social Security Act, [and | 0003| shall not include premium income] total premiums exempted by | 0004| the federal Employee Retirement Income Security Act of 1974 or | 0005| [other] federal government programs. | 0006| C. If assessments exceed actual reinsurance losses | 0007| and administrative losses of the alliance, the excess shall be | 0008| held at interest by the board to offset future losses. | 0009| D. To enable the board to properly determine the net | 0010| reinsurance amount and its responsibility for reinsurance to | 0011| each member: | 0012| (1) by April 15 of each year, each member | 0013| offering an approved health plan shall submit a listing of all | 0014| incurred claims [or health charges of each approved health plan | 0015| for the previous year, including all claims or health charges | 0016| incurred in the previous year and paid prior to April 1 of the | 0017| current year. From this amount shall be subtracted and | 0018| identified by list all incurred claims or health charges of each | 0019| approved health plan paid in the previous year's months of | 0020| January, February and March incurred prior to] for the | 0021| previous year; and | 0022| (2) by April 15 of each year, each member shall | 0023| submit a report that includes the total [amount of all] earned | 0024| premiums received during the prior year less [any earned | 0025| premium] the total earned premiums exempted by federal | 0001| government programs. | 0002| E. The alliance shall notify [members] each | 0003| member of the amount of [the] its assessment due by May 15 | 0004| of each year. The assessment shall be paid by the member by | 0005| June 15 of each year. | 0006| F. The proportion of participation of each member in | 0007| the alliance shall be determined annually by the board, based on | 0008| annual statements filed by each member and other reports deemed | 0009| necessary by the board. Any deficit incurred by the alliance | 0010| shall be recouped by assessments apportioned among the members | 0011| pursuant to the formula provided in Subsection B of this | 0012| section; provided that the assessment paid for any member shall | 0013| be allowed as a credit on the future premium tax return for | 0014| that member, with the credit limited to fifty percent of the | 0015| premium tax due the first year the assessment is imposed; forty | 0016| percent the second year; and thirty percent the third and all | 0017| subsequent years. | 0018| G. The board may [abate or] defer, in whole or in | 0019| part, the payment of an assessment of a member if, in the | 0020| opinion of the board, after approval of the superintendent, | 0021| payment of the assessment would endanger the ability of the | 0022| member to fulfill its contractual obligations. In the event | 0023| payment of an assessment against a member is [abated or] | 0024| deferred, the amount [by which such assessment is abated or] | 0025| deferred may be assessed against the other members in a manner | 0001| consistent with the basis for assessments set forth in | 0002| Subsection A of this section. [The member receiving the | 0003| abatement or deferment shall remain liable to the alliance for | 0004| the deficiency for four years including interest at the | 0005| prevailing rate as determined by regulation of the | 0006| superintendent. The board may sue to recover the abatement or | 0007| deferment plus interest and costs.] The member receiving the | 0008| deferment shall pay the assessment in full plus interest at the | 0009| prevailing rate as determined by regulation of the | 0010| superintendent within four years from the date payment is | 0011| deferred. After four years but within five years of the date of | 0012| the deferment, the board may sue to recover the amount of the | 0013| deferred payment plus interest and costs. Board actions to | 0014| recover deferred payments brought after five years of the date | 0015| of deferment are barred. Any amount received shall be deducted | 0016| from future assessments or reimbursed pro rata to the members | 0017| paying the deferred assessment. | 0018| H. In addition to the assessments provided in this | 0019| section for reinsurance and administrative losses, the board may | 0020| impose on all members annually an assessment not to exceed two | 0021| hundred dollars ($200) for the board to hire consultants and | 0022| plan and develop alliance programs. This additional | 0023| assessment shall be allowed as a credit on the next premium tax | 0024| due for the member." | 0025| Section 11. Section 59A-56-13 NMSA 1978 (being Laws 1994, | 0001| Chapter 75, Section 13) is amended to read: | 0002| "59A-56-13. ALLIANCE ADMINISTRATOR.-- | 0003| A. The board may select an alliance administrator | 0004| through a competitive request for proposal process. The board | 0005| shall evaluate proposals based on criteria established by the | 0006| board that shall include: | 0007| (1) proven ability to [handle accident and] | 0008| administer health insurance programs; | 0009| (2) an estimate of total charges for | 0010| administering the alliance for the proposed contract period; | 0011| and | 0012| (3) ability to administer the alliance in a | 0013| cost-efficient manner. | 0014| B. The alliance administrator contract shall be for | 0015| a period up to four years, subject to annual renegotiation of | 0016| the fees and services, and shall provide for cancellation of the | 0017| contract for cause, termination of the alliance by the | 0018| legislature or the combining of the alliance with a governmental | 0019| body. | 0020| C. At least one year prior to the expiration of | 0021| [each four-year period of service by the] an alliance | 0022| administrator contract, the board [shall] may invite all | 0023| interested parties, including the current administrator, to | 0024| submit [bids] proposals to serve as alliance administrator | 0025| for [up to] a succeeding [four-year] contract period. | 0001| Selection of the administrator for a succeeding contract | 0002| period shall be made at least six months prior to the expiration | 0003| of the current contract. | 0004| D. The alliance administrator shall: | 0005| (1) take applications for an approved health | 0006| plan from small employers or a referring agent; | 0007| (2) establish a premium billing procedure for | 0008| collection of premiums from insureds. Billings shall be made on | 0009| a periodic basis, not less than monthly, as determined by the | 0010| board; | 0011| (3) pay the member that offers an approved | 0012| health plan the net premium due after deduction of reinsurance | 0013| and administrative allowances; | 0014| (4) provide the member with any changes in the | 0015| status of insureds; | 0016| (5) perform all necessary functions to assure | 0017| that each member is providing timely payment of benefits to | 0018| individuals covered under an approved health plan, including: | 0019| (a) making information available to | 0020| insureds relating to the proper manner of submitting a claim for | 0021| benefits to the member offering the approved health plan and | 0022| distributing forms on which submissions shall be made; and | 0023| (b) making information available on | 0024| approved health plan benefits and rates to insureds; | 0025| (6) submit regular reports to the board | 0001| regarding the operation of the alliance, the frequency, content | 0002| and form of which shall be determined by the board; | 0003| (7) following the close of each fiscal year, | 0004| determine [net written] premiums of members, the expense of | 0005| administration and the paid and incurred [losses] health care | 0006| service charges for the year and report this information to the | 0007| board and the superintendent on a form prescribed by the | 0008| superintendent; and | 0009| (8) establish the premiums for reinsurance and | 0010| the administrative charges, subject to approval of the board." | 0011| Section 12. Section 59A-56-14 NMSA 1978 (being Laws 1994, | 0012| Chapter 75, Section 14) is amended to read: | 0013| "59A-56-14. ELIGIBILITY--GUARANTEED ISSUE--PLAN | 0014| PROVISIONS.-- | 0015| A. A small employer is eligible for an approved | 0016| health plan if on the effective date of coverage or renewal: | 0017| (1) at least fifty percent of its eligible | 0018| employees not otherwise insured elect to be covered under the | 0019| approved health plan; [and] | 0020| (2) the small employer has not terminated | 0021| coverage with an approved health plan within three years of the | 0022| date of application for coverage except to change to another | 0023| approved health plan; and | 0024| (3) the small employer does not offer other | 0025| general group health insurance coverage to its employees. For | 0001| the purposes of this paragraph, general group health insurance | 0002| coverage excludes coverage providing only a specific limited | 0003| form of health insurance such as accident or disability income | 0004| insurance coverage or a specific health care service such as | 0005| dental care. | 0006| B. An approved health plan shall provide [that | 0007| coverage of a dependent unmarried individual terminates when the | 0008| individual becomes nineteen years of age or, if the individual | 0009| is enrolled full time in an accredited educational institution, | 0010| when the individual becomes twenty-five years of age] coverage | 0011| for a child. The policy shall also provide in substance that | 0012| attainment of the limiting age by an unmarried dependent | 0013| individual does not operate to terminate coverage when the | 0014| individual continues to be incapable of self-sustaining | 0015| employment by reason of [mental retardation] developmental | 0016| disability or physical handicap and the individual is primarily | 0017| dependent for support and maintenance upon the employee. Proof | 0018| of incapacity and dependency shall be furnished to the alliance | 0019| and the member that offered the approved health plan within one | 0020| hundred twenty days of attainment of the limiting age. The | 0021| board may require subsequent proof annually after a two-year | 0022| period following attainment of the limiting age. | 0023| C. An approved health plan shall provide that the | 0024| health insurance benefits applicable for eligible dependents are | 0025| payable with respect to a newly born child of the family member | 0001| or the individual in whose name the contract is issued from the | 0002| moment of birth, including the necessary care and treatment of | 0003| medically diagnosed congenital defects and birth abnormalities. | 0004| If payment of a specific premium is required to provide coverage | 0005| for the child, the contract may require that notification of the | 0006| birth of a child and payment of the required premium shall be | 0007| furnished to the member within thirty-one days after the date of | 0008| birth in order to have the coverage from birth. An approved | 0009| health plan shall provide that the health insurance benefits | 0010| applicable for eligible dependents are payable for an adopted | 0011| child in accordance with the provisions of Section 59A-22-34.1 | 0012| NMSA 1978. | 0013| D. Except as provided in Subsections E, [and] G | 0014| and H of this section, an approved health plan may contain | 0015| provisions under which coverage is excluded during a six-month | 0016| period following the effective date of coverage of an individual | 0017| for preexisting conditions, as long as either of the following | 0018| exists: | 0019| (1) the condition has manifested itself within | 0020| a period of six months before the effective date of coverage in | 0021| such a manner as would cause an ordinarily prudent person to | 0022| seek diagnosis or treatment; or | 0023| (2) medical advice or treatment was recommended | 0024| or received within a period of six months before the effective | 0025| date of coverage. | 0001| E. The preexisting condition exclusions described in | 0002| Subsection D of this section shall be waived to the extent to | 0003| which similar exclusions have been satisfied under any prior | 0004| health insurance coverage if the application for health | 0005| insurance through the alliance is made not later than thirty-one | 0006| days following the termination of the prior coverage. In that | 0007| case, coverage through the alliance shall be effective from the | 0008| date on which the prior coverage was terminated. This | 0009| subsection does not prohibit preexisting conditions coverage in | 0010| an approved health plan that is more favorable to the | 0011| [insured] covered individual than that specified in this | 0012| subsection. | 0013| F. An individual is not eligible for coverage by the | 0014| alliance if he: | 0015| (1) [he] is [at the time of application] | 0016| eligible for medicare; provided, however, if an individual has | 0017| health insurance coverage from an employer whose group includes | 0018| twenty or more individuals, an individual eligible for medicare | 0019| who continues to be employed may choose to be covered through an | 0020| approved health plan; | 0021| (2) [he] has voluntarily terminated health | 0022| insurance issued through the alliance within the past twelve | 0023| months unless it was due to a change in employment; or | 0024| (3) [he] is an inmate of a public institution | 0025| [or is eligible for public programs, other than state-funded | 0001| programs, for which medical care is provided]. | 0002| G. The alliance shall provide for an open enrollment | 0003| period of sixty days from the initial offering of an approved | 0004| health plan. Individuals enrolled during the open enrollment | 0005| period shall not be subject to the preexisting conditions | 0006| limitation. | 0007| H. If an insured covered by an approved health plan | 0008| switches to another approved health plan that provides increased | 0009| or additional benefits such as lower deductible or co-payment | 0010| requirements, the member offering the approved health plan with | 0011| increased or additional benefits may require the six-month | 0012| period for preexisting conditions provided in Subsection D of | 0013| this section to be satisfied prior to receipt of the additional | 0014| benefits. | 0015| I. An approved health plan shall provide for a | 0016| thirty-day reinstatement period from the end of a grace period | 0017| provided by the approved health plan, requiring payments of all | 0018| back premiums plus a penalty of five percent of the annualized | 0019| premium. Any claims incurred between the date through which | 0020| premiums have been paid and the date of reinstatement are not | 0021| covered unless covered by the conditions of the approved health | 0022| plan." | 0023| Section 13. Section 59A-56-17 NMSA 1978 (being Laws 1994, | 0024| Chapter 75, Section 17) is amended to read: | 0025| "59A-56-17. BENEFITS.-- | 0001| A. An approved health plan [issued through the | 0002| alliance] shall pay for [or provide] medically necessary | 0003| eligible expenses that exceed the deductible, co-payment and co-insurance amounts applicable under the provisions of Section | 0004| [18 of the Health Insurance Alliance Act] 59A-56-18 NMSA | 0005| 1978 and are not otherwise limited or excluded. The Health | 0006| Insurance Alliance Act does not prohibit the board from | 0007| approving additional types of health plan designs with similar | 0008| cost-benefit structures or other types of health plan designs. | 0009| An approved health plan for small employers shall, at a | 0010| minimum, reflect the levels of health insurance coverage | 0011| generally available in New Mexico for small employer group | 0012| policies, but an approved health plan for small employers may | 0013| also offer health plan designs that are not generally available | 0014| in New Mexico for small employer group policies. | 0015| B. The board may design and require an approved | 0016| health plan to contain cost-containment measures and | 0017| requirements, including managed care, pre-admission | 0018| certification, [and] concurrent inpatient review and the use | 0019| of fee schedules for health care providers, including the | 0020| diagnosis-related grouping system and the resource-based | 0021| relative value system." | 0022| Section 14. Section 59A-56-18 NMSA 1978 (being Laws 1994, | 0023| Chapter 75, Section 18) is amended to read: | 0024| "59A-56-18. DEDUCTIBLES--CO-INSURANCE--MAXIMUM OUT-OF-POCKET PAYMENTS.-- | 0025| A. Subject to the limitations provided in Subsection | 0001| C of this section, an approved health plan offered through the | 0002| alliance may impose a deductible on a per-person calendar year | 0003| basis. [A deductible plan of five hundred dollars ($500) shall | 0004| initially be offered.] Approved health plans offered by | 0005| health maintenance [organization plans] organizations shall | 0006| provide equivalent cost-benefit structures. The board may | 0007| authorize deductibles in other amounts and equivalent cost-benefit structures. [The deductible shall be applied to the | 0008| first five hundred dollars ($500) or any other amount determined | 0009| as deductible by the board of eligible expenses incurred by the | 0010| covered individual.] | 0011| B. Subject to the limitations provided in Subsection | 0012| C of this section, a mandatory co-insurance requirement | 0013| [shall] for an approved health plan may be imposed [at an | 0014| average not to exceed thirty percent] as a percentage of | 0015| eligible expenses in excess of [the mandatory] a deductible. | 0016| Health maintenance organizations shall impose equivalent cost-benefit structures. | 0017| C. The maximum aggregate out-of-pocket payments for | 0018| eligible expenses [or health care services] by the covered | 0019| individual shall be determined by the board." | 0020| Section 15. Section 59A-56-19 NMSA 1978 (being Laws 1994, | 0021| Chapter 75, Section 19) is amended to read: | 0022| "59A-56-19. DEPENDENT FAMILY MEMBER REQUIRED COVERAGE--SMALL EMPLOYER RESPONSIBILITY.-- | 0023| A. A small employer [may] shall collect or make | 0024| a payroll deduction from the compensation of an employee for the | 0025| portion of the approved health plan cost the employee is | 0001| responsible for paying. The small employer may contribute to | 0002| the cost of that plan on behalf of the employee. | 0003| B. A small employer shall make available to | 0004| dependent family members of an employee covered by an approved | 0005| health plan the same approved health plan. The small employer | 0006| may contribute to the cost of [group] family coverage. | 0007| C. All premiums collected, deducted from the | 0008| compensation of employees or paid on their behalf by the small | 0009| employer shall be promptly remitted to the alliance." | 0010| Section 16. Section 59A-56-20 NMSA 1978 (being Laws 1994, | 0011| Chapter 75, Section 20) is amended to read: | 0012| "59A-56-20. RENEWABILITY.-- | 0013| A. An approved health plan shall contain provisions | 0014| under which the member offering the plan is obligated to renew | 0015| the health insurance if premiums are paid until the day the plan | 0016| is replaced by another plan or the small employer terminates | 0017| coverage. An individual covered by health insurance under an | 0018| approved health plan may retain coverage until he [first] | 0019| becomes eligible for medicare as the primary coverage, except | 0020| that in a family policy [the age of the younger family member | 0021| shall be used to continue the coverage and as the basis for | 0022| eligibility] coverage under an approved health plan shall | 0023| continue for any person in the family who is not eligible for | 0024| medicare. | 0025| B. If an approved health plan ceases to exist, the | 0001| alliance shall provide an alternate approved health plan. | 0002| C. An approved health plan shall provide covered | 0003| individuals the right to continue health insurance coverage | 0004| through an approved health plan as individual health insurance | 0005| provided by the same member upon the death of the employee or | 0006| upon the divorce, annulment or dissolution of marriage or legal | 0007| separation of the spouse from the employee or by termination of | 0008| employment by electing to do so within a period of time | 0009| specified in the health insurance, provided that the employee | 0010| was covered under an approved health plan while employed for at | 0011| least six consecutive months. The individual may be charged an | 0012| additional administrative charge for the individual health | 0013| insurance. | 0014| D. 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 17. 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 18. 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 | 0020| to the superintendent for approval prior to use." | 0021| Section 19. 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 | 0025| of 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 state | 0008| 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 health | 0011| plan for the recovery of the amount of benefits paid that are | 0012| not for [covered] eligible expenses. Benefits due from the | 0013| approved health plan may be reduced or refused as a set-off | 0014| against any amount recoverable under this section." | 0015| Section 20. A new section of the Health Insurance Alliance | 0016| Act is enacted to read: | 0017| "[NEW MATERIAL] HEALTH INSURANCE COVERAGE FOR CHILDREN.-- | 0018| A. The board may adopt a children's health insurance | 0019| program that conforms to one or more prototypes established by | 0020| the board. | 0021| B. Members providing approved health plans in the | 0022| alliance are eligible to bid to provide a children's health | 0023| insurance plan. A children's health insurance plan is not | 0024| considered a separate approved health plan within the meaning of | 0025| the Health Insurance Alliance Act. | 0001| C. If an employer offers a group health insurance | 0002| plan for employees that includes coverage for children and if | 0003| the employee chooses to provide coverage for eligible children | 0004| through the children's health insurance program of the alliance | 0005| instead of the employer's group health insurance plan, the | 0006| employer shall pay as part of the premium for the children's | 0007| health insurance plan the contribution that the employer would | 0008| have paid to provide coverage to the child through the | 0009| employer's group health insurance plan. | 0010| D. The board shall provide an addendum to the plan | 0011| of operation for the superintendent's approval to assure the | 0012| fair, reasonable and equitable administration of the children's | 0013| health insurance program. | 0014| E. All policy forms written to conform to the | 0015| prototype of the children's health insurance plans shall be | 0016| filed and approved by the superintendent before they are | 0017| issued." | 0018| Section 21. A new section of the Health Insurance Alliance | 0019| Act is enacted to read: | 0020| "[NEW MATERIAL] EXEMPTION.--The alliance is exempt from | 0021| payment of all fees and taxes levied by this state or any of its | 0022| political subdivisions." | 0023| Section 22. TEMPORARY PROVISION--REPORT.--The department | 0024| of insurance and the New Mexico health insurance alliance shall | 0025| prepare and publish a report to the legislature by October 1, | 0001| 1996 on the alliance programs and recommendations to facilitate | 0002| participation in the alliance programs. | 0003| Section 23. REPEAL.--Laws 1994, Chapter 75, Section 35 is | 0004| repealed. | 0005| Section 24. EMERGENCY.--It is necessary for the public | 0006| peace, health and safety that this act take effect immediately. | 0007|  | 0008| | 0009| | 0010| FORTY-SECOND LEGISLATURE | 0011| SECOND SESSION, 1996 | 0012| | 0013| | 0014| JANUARY 24, 1996 | 0015| | 0016| Mr. President: | 0017| | 0018| Your COMMITTEES' COMMITTEE, to whom has been referred | 0019| | 0020| SENATE BILL 199 | 0021| | 0022| has had it under consideration and finds same to be GERMANE, PURSUANT | 0023| TO CONSTITUTIONAL PROVISIONS, and thence referred to the | 0024| CORPORATIONS AND TRANSPORTATION COMMITTEE. | 0025| | 0001| Respectfully submitted, | 0002| | 0003| | 0004| | 0005| | 0006| __________________________________ | 0007| SENATOR MANNY M. ARAGON, Chairman | 0008| | 0009| | 0010| | 0011| Adopted_______________________ Not Adopted_______________________ | 0012| (Chief Clerk) (Chief Clerk) | 0013| | 0014| | 0015| Date ________________________ | 0016| | 0017| | 0018| | 0019| S0199CC1 | 0020| | 0021| FORTY-SECOND LEGISLATURE SB 199/a | 0022| SECOND SESSION, 1996 | 0023| | 0024| | 0025| January 30, 1996 | 0001| | 0002| Mr. President: | 0003| | 0004| Your CORPORATIONS & TRANSPORTATION COMMITTEE, to whom | 0005| has been referred | 0006| | 0007| SENATE BILL 199 | 0008| | 0009| has had it under consideration and reports same with recommendation that | 0010| it DO PASS, amended as follows: | 0011| | 0012| 1. On page 39, strike lines 10 through 25 in their entirety and | 0013| on page 40, strike lines 1 through 17 in their entirety. | 0014| | 0015| 2. Renumber the succeeding sections accordingly. | 0016| | 0017| 3. On page 40, line 20, after "legislature" insert "and the | 0018| governor". | 0019| | 0020| 4. On page 40, lines 20 and 21, strike the comma and "1996" and | 0021| insert in lieu thereof "of each year, beginning on October 1, 1996". | 0022| | 0023| 5. On page 40, line 22, after the period insert the following new | 0024| sentence to read: | 0025| | 0001| "The report shall include a director's report from members and insured | 0002| representatives that reflects comments made by members and insureds | 0003| regarding the alliance for each year the directors are required to | 0004| report to the legislature and the governor.". | 0005| | 0006| 6. On page 40, between lines 24 and 25, insert the following new | 0007| section to read: | 0008| | 0009| "Section 24. DELAYED REPEAL.--The Health Insurance Alliance Act is | 0010| repealed June 30, 2003.". | 0011| | 0012| 7. Renumber the succeeding section accordingly, | 0013| | 0014| | 0015| | 0016| | 0017| | 0018| | 0019| | 0020| | 0021| | 0022| and thence referred to the FINANCE COMMITTEE. | 0023| | 0024| Respectfully submitted, | 0025| | 0001| | 0002| | 0003| __________________________________ | 0004| Roman M. Maes, III, Chairman | 0005| | 0006| | 0007| | 0008| Adopted_______________________ Not Adopted_______________________ | 0009| (Chief Clerk) (Chief Clerk) | 0010| | 0011| | 0012| Date ________________________ | 0013| | 0014| | 0015| The roll call vote was 7 For 0 Against | 0016| Yes: 7 | 0017| No: 0 | 0018| Excused: McKibben, Reagan | 0019| Absent: 0 | 0020| | 0021| | 0022| | 0023| | 0024| | 0025| S0199CT1 .111191.1 | 0001| | 0002| | 0003| FORTY-SECOND LEGISLATURE SB 199/a | 0004| SECOND SESSION, 1996 | 0005| | 0006| | 0007| February 3, 1996 | 0008| | 0009| Mr. President: | 0010| | 0011| Your FINANCE COMMITTEE, to whom has been referred | 0012| | 0013| SENATE BILL 199, as amended | 0014| | 0015| has had it under consideration and reports same with recommendation that | 0016| it DO PASS, amended as follows: | 0017| | 0018| 1. Strike Senate Corporations and Transportation Committee | 0019| Amendment 6. | 0020| | 0021| 2. On page 1, line 20, after the subsection designation "A." | 0022| strike "A" and insert in lieu thereof "Except as provided in Subsection | 0023| I of this section, a". | 0024| | 0025| 3. On page 5, strike lines 11 through 15 and insert in lieu | 0001| thereof: | 0002| | 0003| "I. A person's eligibility for a policy issued under the | 0004| Health Insurance Alliance Act shall not preclude a person from remaining | 0005| on or choosing a pool policy; provided, a self-employed person who | 0006| qualifies for an approved health plan under the Health Insurance | 0007| Alliance Act by using a dependent as the second employee may choose a | 0008| pool policy in lieu of the health plan under that act."". | 0009| | 0010| 4. On page 10, line 1, strike "and" and between lines 1 and 2, | 0011| insert the following new paragraph: | 0012| | 0013| "(2) a self-employed person who qualifies as a small | 0014| employer by using a spouse or dependent as a second employee, and one of | 0015| the two is covered under a policy pursuant to the Comprehensive Health | 0016| Insurance Pool Act, is a small employer for purposes of the Health | 0017| Insurance Alliance Act; and". | 0018| | 0019| 5. Renumber the succeeding paragraph accordingly. | 0020| | 0021| 6. On page 40, strike lines 23 and 24 in their entirety. | 0022| | 0023| 7. On page 40, between lines 24 and 25, insert the following new | 0024| section to read: | 0025| | 0001| "Section 23. Laws 1994, Chapter 75, Section 35 is amended to read: | 0002| | 0003| "Section 35. DELAYED REPEAL.--The Health Insurance Alliance Act is | 0004| repealed June 30, [1998] 2003."". | 0005| | 0006| | 0007| | 0008| Respectfully submitted, | 0009| | 0010| | 0011| | 0012| __________________________________ | 0013| Ben D. Altamirano, Chairman | 0014| | 0015| | 0016| | 0017| Adopted_______________________ Not Adopted_______________________ | 0018| (Chief Clerk) (Chief Clerk) | 0019| | 0020| | 0021| Date ________________________ | 0022| | 0023| | 0024| The roll call vote was 8 For 0 Against | 0025| Yes: 8 | 0001| No: 0 | 0002| Excused: Donisthorpe, Duran, Ingle, Kidd, Kysar | 0003| Absent: None | 0004| | 0005| | 0006| S0199FC1 111639.1 | 0007| | 0008| FORTY-SECOND LEGISLATURE | 0009| SECOND SESSION | 0010| | 0011| | 0012| February 5, 1996 | 0013| | 0014| | 0015| SENATE FLOOR AMENDMENT number _______ to SENATE BILL 199, as amended | 0016| | 0017| Amendment sponsored by Senator Janice D. Paster | 0018| | 0019| | 0020| 1. Strike Senate Finance Committee Amendments 3, 4 and 5. | 0021| | 0022| 2. On page 5, strike lines 11 through 15 and insert in lieu | 0023| thereof: | 0024| | 0025| "I. A person's eligibility for a policy issued under the | 0001| Health Insurance Alliance Act shall not preclude a person from remaining | 0002| on a pool policy, and a self-employed person who qualifies for an | 0003| approved health plan under the Health Insurance Alliance Act by using a | 0004| dependent as the second employee may choose a pool policy in lieu of the | 0005| health plan under that act."". | 0006| | 0007| | 0008| | 0009| | 0010| | 0011| | 0012| __________________________ | 0013| Janice D. Paster | 0014| | 0015| | 0016| | 0017| Adopted ___________________ Not Adopted _____________________ | 0018| (Chief Clerk) (Chief Clerk) | 0019| | 0020| | 0021| Date _________________ | 0022| State of New Mexico | 0023| House of Representatives | 0024| | 0025| FORTY-SECOND LEGISLATURE | 0001| SECOND SESSION, 1996 | 0002| | 0003| | 0004| February 11, 1996 | 0005| | 0006| | 0007| Mr. Speaker: | 0008| | 0009| Your BUSINESS AND INDUSTRY COMMITTEE, to whom has been | 0010| referred | 0011| | 0012| SENATE BILL 199, as amended | 0013| | 0014| has had it under consideration and reports same with | 0015| recommendation that it DO PASS. | 0016| | 0017| Respectfully submitted, | 0018| | 0019| | 0020| | 0021| | 0022| Fred Luna, Chairman | 0023| | 0024| | 0025| Adopted Not Adopted | 0001| (Chief Clerk) (Chief Clerk) | 0002| | 0003| Date | 0004| | 0005| The roll call vote was 9 For 0 Against | 0006| Yes: 9 | 0007| Excused: None | 0008| Absent: Gubbels, J.G.Taylor, Varela | 0009| | 0010| | 0011| | 0012| S0199BI1 |