0001| SENATE BILL 1024 | 0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997 | 0003| INTRODUCED BY | 0004| ROD ADAIR | 0005| | 0006| | 0007| | 0008| | 0009| | 0010| AN ACT | 0011| RELATING TO INSURANCE; MANDATING COVERAGE FOR BONE DENSITOMETRY | 0012| | 0013| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0014| Section 1. A new Section 59A-22-41 NMSA 1978 is enacted | 0015| to read: | 0016| "59A-22-41. [NEW MATERIAL] COVERAGE FOR BONE | 0017| DENSITOMETRY.-- | 0018| A. Each individual and group health insurance | 0019| policy, nonprofit health care plan policy, health maintenance | 0020| organization contract and certificate of insurance delivered or | 0021| issued for delivery in this state shall provide coverage for | 0022| bone densitometry, including single and dual photon | 0023| absorptiometry and dual x-ray absorptiometry. Benefits shall | 0024| be payable at a minimum as follows: | 0025| (1) for a woman with decreasing estrogen | 0001| levels who is not using estrogen replacement therapy, two bone | 0002| density tests in her lifetime under coverage by each insurer; | 0003| provided that if other clinical indications of rapid bone loss | 0004| occur, the lifetime limit shall not apply; and | 0005| (2) for all other persons diagnosed as having | 0006| clinical indications of rapid bone loss, tests as prescribed by | 0007| a health care provider. | 0008| B. Coverage pursuant to this section may be subject | 0009| to deductibles and coinsurance provisions consistent with those | 0010| applicable to other benefits under the same policy, contract or | 0011| certificate. | 0012| C. The provisions of this section do not apply to | 0013| short-term travel, accident-only or limited or specified | 0014| disease policies." | 0015| Section 2. Section 59A-23-4 NMSA 1978 (being Laws 1984, | 0016| Chapter 127, Section 463, as amended) is amended to read: | 0017| "59A-23-4. OTHER PROVISIONS APPLICABLE.-- | 0018| A. No blanket or group health insurance policy or | 0019| contract shall contain any provision relative to notice or | 0020| proof of loss or the time for paying benefits or the time | 0021| within which suit may be brought upon the policy that in the | 0022| superintendent's opinion is less favorable to the insured than | 0023| would be permitted in the required or optional provisions for | 0024| individual health insurance policies as set forth in Chapter | 0025| 59A, Article 22 NMSA 1978. | 0001| B. The following provisions of Chapter 59A, Article | 0002| 22 NMSA 1978 shall also apply as to Chapter 59A, Article 23 | 0003| NMSA 1978 and blanket and group health insurance contracts: | 0004| (1) Section 59A-22-1 NMSA 1978, except | 0005| Subsection C thereof; and | 0006| (2) Section 59A-22-32 NMSA 1978. | 0007| C. The following provisions of Chapter 59A, Article | 0008| 22 NMSA 1978 shall also apply as to group health insurance | 0009| contracts: | 0010| (1) Section 59A-22-33 NMSA 1978; | 0011| (2) Section 59A-22-34 NMSA 1978; | 0012| (3) Section 59A-22-34.1 NMSA 1978; | 0013| (4) Section 59A-22-35 NMSA 1978; | 0014| (5) Section 59A-22-36 NMSA 1978; | 0015| (6) Section 59A-22-39 NMSA 1978; ~~[and]~~ | 0016| (7) Section 59A-22-40 NMSA 1978; and | 0017| (8) Section 59A-22-41 NMSA 1978." | 0018| Section 3. Section 59A-46-30 NMSA 1978 (being Laws 1993, | 0019| Chapter 266, Section 29) is amended to read: | 0020| "59A-46-30. STATUTORY CONSTRUCTION AND RELATIONSHIP TO | 0021| OTHER LAWS.-- | 0022| A. The provisions of the Insurance Code other than | 0023| Chapter 59A, Article 46 NMSA 1978 shall not apply to health | 0024| maintenance organizations except as expressly provided in the | 0025| Insurance Code and that article. To the extent reasonable and | 0001| not inconsistent with the provisions of that article, the | 0002| following articles and provisions of the Insurance Code shall | 0003| also apply to health maintenance organizations and their | 0004| promoters, sponsors, directors, officers, employees, agents, | 0005| solicitors and other representatives ~~[and]~~. For the | 0006| purposes of such applicability, a health maintenance | 0007| organization may therein be referred to as an "insurer": | 0008| (1) Chapter 59A, Article 1 NMSA 1978; | 0009| (2) Chapter 59A, Article 2 NMSA 1978; | 0010| (3) Chapter 59A, Article 3 NMSA 1978; | 0011| (4) Chapter 59A, Article 4 NMSA 1978; | 0012| (5) Subsection C of Section 59A-5-22 NMSA | 0013| 1978; | 0014| (6) Sections 59A-6-2 through 59A-6-4 and | 0015| 59A-6-6 NMSA 1978; | 0016| (7) Chapter 59A, Article 8 NMSA 1978; | 0017| (8) Chapter 59A, Article 10 NMSA 1978; | 0018| (9) Section 59A-12-22 NMSA 1978; | 0019| (10) Chapter 59A, Article 16 NMSA 1978; | 0020| (11) Chapter 59A, Article 18 NMSA 1978; | 0021| (12) Chapter 59A, Article 19 NMSA 1978; | 0022| (13) Chapter 59A, Article 23B NMSA 1978; | 0023| (14) Section 59A-22-41 NMSA 1978; | 0024| ~~[(14)]~~ (15) Sections 59A-34-9 through | 0025| 59A-34-13, 59A-34-23, 59A-34-36 and 59A-34-37 NMSA 1978; and | 0001| ~~[(15)]~~ (16) Chapter 59A, Article 37 NMSA | 0002| 1978. | 0003| B. Solicitation of enrollees by a health | 0004| maintenance organization granted a certificate of authority, or | 0005| its representatives, shall not be construed as violating any | 0006| provision of law relating to solicitation or advertising by | 0007| health professionals, but health professionals shall be | 0008| individually subject to the laws, rules, regulations and | 0009| ethical provisions governing their individual professions. | 0010| C. Any health maintenance organization authorized | 0011| under the provisions of the Health Maintenance Organization Law | 0012| shall not be deemed to be practicing medicine and shall be | 0013| exempt from the provisions of laws relating to the practice of | 0014| medicine." | 0015| Section 4. Section 59A-47-33 NMSA 1978 (being Laws 1984, | 0016| Chapter 127, Section 879.32, as amended by Laws 1994, Chapter | 0017| 64, Section 10 and also by Laws 1994, Chapter 75, Section 34) | 0018| is amended to read: | 0019| "59A-47-33. OTHER PROVISIONS APPLICABLE.--The provisions | 0020| of the Insurance Code other than Chapter 59A, Article 47 NMSA | 0021| 1978 shall not apply to health care plans except as expressly | 0022| provided in the Insurance Code and that article. To the extent | 0023| reasonable and not inconsistent with the provisions of that | 0024| article, the following articles and provisions of the Insurance | 0025| Code shall also apply to health care plans, their promoters, | 0001| sponsors, directors, officers, employees, agents, solicitors | 0002| and other representatives; and, for the purposes of such | 0003| applicability, a health care plan may therein be referred to as | 0004| an "insurer": | 0005| A. Chapter 59A, Article 1 NMSA 1978; | 0006| B. Chapter 59A, Article 2 NMSA 1978; | 0007| C. Chapter 59A, Article 4 NMSA 1978; | 0008| D. Subsection C of Section 59A-5-22 NMSA 1978; | 0009| E. Sections 59A-6-2 through 59A-6-4 and | 0010| 59A-6-6 NMSA 1978; | 0011| F. Section 59A-7-11 NMSA 1978; | 0012| G. Chapter 59A, Article 8 NMSA 1978; | 0013| H. Chapter 59A, Article 10 NMSA 1978; | 0014| I. Section 59A-12-22 NMSA 1978; | 0015| J. Chapter 59A, Article 16 NMSA 1978; | 0016| K. Chapter 59A, Article 18 NMSA 1978; | 0017| L. Chapter 59A, Article 19 NMSA 1978; | 0018| M. Subsections B through E of Section | 0019| 59A-22-5 NMSA 1978; | 0020| N. Section 59A-22-34.1 NMSA 1978; | 0021| O. Section 59A-22-39 NMSA 1978; | 0022| P. Section 59A-22-40 NMSA 1978; | 0023| Q. Section 59A-22-41 NMSA 1978; | 0024| ~~[Q.]~~ R. Sections 59A-34-9 through 59A-34-13 | 0025| ~~[NMSA 1978]~~ and ~~[Section]~~ 59A-34-23 NMSA 1978; | 0001| ~~[R.]~~ S. Chapter 59A, Article 37 NMSA 1978, | 0002| except Section 59A-37-7 NMSA 1978; and | 0003| ~~[S.]~~ T. Section 59A-46-15 NMSA 1978." | 0004| | 0005| |