Health Insurance Contracts

NMSA 1978 ch. 59A, art. 22

in effect

NMSA 1978, § 59A-22-1 Scope of article

59A-22-1. Scope of article Chapter 59A, Article 22 NMSA 1978 applies generally to policies of individual health insurance, including student health plan policies. Nothing in that article shall apply to or affect: A. any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein; B. life insurance, endowment or annuity contracts or contracts supplemental thereto that contain only such provisions relating to health insurance as: (1) provide additional benefits in case of death by accident; and (2) operate to safeguard such contracts against lapse or to give a special surrender value or special benefit or annuity in event the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract; C. group or blanket health insurance, except as stated in Chapter 59A, Article 23 NMSA 1978; or D. reinsurance. Laws 1984, ch. 127, § 422; 2017, ch. 130, § 14.

NMSA 1978, § 59A-22-2 Form and content of policy

59A-22-2. Form and content of policy No policy of individual health insurance shall be delivered or issued for delivery in this state unless: A. the entire money and other considerations therefor are expressed therein; B. the time at which insurance takes effect and terminates is expressed therein; C. it purports to insure only one person, except as provided in Chapter 59A, Article 23 NMSA 1978, and except that a policy or contract may be issued upon application of the head of a family, who shall be deemed the policyholder, covering members of any one family, including husband, wife, dependent children or any children under the age of twenty-six and other dependents living with the family; D. every printed portion of the text matter and of any endorsements or attached papers shall be printed in uniform type of which the face shall be not less than ten point (the "text" shall include all printed matter except the name and address of the insurer, name and title of the policy, captions, subcaptions and form numbers), but notwithstanding any provision of this law, the superintendent shall not disapprove any such policy on the ground that every printed portion of its text matter or of any endorsement or attached paper is not printed in uniform type if it shall be shown that the type used is required to conform to the laws of another state in which the insurer is authorized; E. the exceptions and reductions of indemnity are adequately captioned and clearly set forth in the policy or contract; F. each separate form, including riders and endorsements, shall be identified by a form number and consecutive page numbers in the lower left-hand corner of each page; and G. if any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of insurance laws of such other state shall have advised the superintendent that any such policy is not subject to approval or disapproval by such official, the superintendent may by ruling require that such policy meet the standards set forth in Sections 59A-22-3 through 59A-22-25 NMSA 1978. Laws 1984, ch. 127, § 423; 2021, ch. 108, § 16.

NMSA 1978, § 59A-22-3 Required provisions

59A-22-3. Required provisions A. Except as provided in Subsection B of this section, each such policy delivered or issued for delivery in this state shall contain the provisions specified in Sections 425 through 436 [59A-22-4 to 59A-22-15 NMSA 1978], inclusive, of this article; except, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are in each instance not less favorable in any respect to the insured or beneficiary. Such required provisions shall be preceded individually by the applicable caption shown or, at the insurer's option, by such appropriate individual or group captions or subcaptions as the superintendent may approve. B. If any provision of this article is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the superintendent's approval, shall omit from such policy any inapplicable provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy. Laws 1984, ch. 127, § 424.

NMSA 1978, § 59A-22-4 Entire contract; changes

59A-22-4. Entire contract; changes There shall be a provision as follows: This policy, including the endorsements and attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurance company and unless such approval and countersignature be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions. Laws 1984, ch. 127, § 425.

NMSA 1978, § 59A-22-5 Time limit on certain defenses

59A-22-5. Time limit on certain defenses A. There shall be a provision for comprehensive major medical policies as follows: As of the date of issue of this policy, no misstatements, except willful or fraudulent misstatements, made by the applicant in the application for this policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy). In the event a misstatement in an application is made that is not fraudulent or willful, the issuer of the policy may prospectively rate and collect from the insured the premium that would have been charged to the insured at the time the policy was issued had such misstatement not been made. B. There shall be a provision for policies other than comprehensive major medical policies as follows: After two years from the date of issue of this policy, no misstatements, except fraudulent misstatements, made by the applicant in the application for this policy shall be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) commencing after the expiration of such two-year period. C. The foregoing policy provisions shall not be so construed as to affect any initial two-year period nor to limit the application of Sections 59A-22-17 through 59A-22-19, 59A-22-21 and 59A-22-22 NMSA 1978 in the event of misstatement with respect to age or occupation or other insurance. D. A policy that the insured has the right to continue in force subject to its terms by the timely payment of premium (1) until at least age fifty or (2) in the case of a policy issued after age forty-four, for at least five years from its date of issue, may contain in lieu of the foregoing the following provision, from which the clause in parentheses may be omitted at the insurance company's option, under the caption "Incontestable": After this policy has been in force for a period of two years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application. Laws 1984, ch. 127, § 426; 1990, ch. 110, § 3; 1993, ch. 126, § 4; 1994, ch. 75, § 27; 2008, ch. 87, § 1; 2019, ch. 259, § 4.

NMSA 1978, § 59A-22-6 Grace period

59A-22-6. Grace period There shall be a provision as follows: A grace period of........ (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision, "Unless not less than five days prior to the premium due date the insurance company has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted." Laws 1984, ch. 127, § 427.

NMSA 1978, § 59A-22-7 Reinstatement

59A-22-7. Reinstatement There shall be a provision as follows: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurance company to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurance company or such agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the thirtieth day following the date of such conditional receipt unless the insurance company has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurance company shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty days prior to the date of reinstatement. (The last sentence of the above provision may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date of issue.) Laws 1984, ch. 127, § 428.

NMSA 1978, § 59A-22-8 Notice of claim

59A-22-8. Notice of claim There shall be a provision as follows: Written notice of claim must be given to the insurance company within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurance company at.......... (insert the location of such office as the insurer may designate for the purpose) or to any authorized agent of the insurance company, with information sufficient to identify the insured, shall be deemed notice to the insurance company. (In a policy providing a loss-of-time benefit which may be payable for at least two years, an insurance company may at its option insert the following between the first and second sentences of the above provision: Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, he shall at least once in every six months after having given notice of claim, give to the insurer notice of continuance of said disability, except in the event of legal incapacity. The period of six months following any filing of proof by the insured or any payment by the insurance company on account of such claim or any denial of liability in whole or in part by the insurance company shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured's right to any indemnity which would otherwise have accrued during the period of six months preceding the date on which such notice is actually given.) Laws 1984, ch. 127, § 429.

NMSA 1978, § 59A-22-9 Claim forms

59A-22-9. Claim forms There shall be a provision as follows: The insurance company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made. Laws 1984, ch. 127, § 430.

NMSA 1978, § 59A-22-10 Proofs of loss

59A-22-10. Proofs of loss There shall be a provision as follows: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required. Laws 1984, ch. 127, § 431.

NMSA 1978, § 59A-22-11 Time of payment of claims

59A-22-11. Time of payment of claims There shall be a provision as follows: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid.......... (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the terminatiion [termination] of liability will be paid immediately upon receipt of due written proof. Laws 1984, ch. 127, § 432.

NMSA 1978, § 59A-22-12 Payment of claims

59A-22-12. Payment of claims There shall be a provision as follows: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured. (The following provisions, or either of them, may be included with the foregoing provision at the option of the insurance company.) (If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give valid release, the insurance company may pay such indemnity, up to an amount not exceeding $..... (insert an amount which shall not exceed one thousand dollars ($1,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurance company to be equitably entitled thereto. Any payment made by the insurance company in good faith pursuant to this provision shall fully discharge the insurance company to the extent of such payment.) (Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical or surgical services may, at the insurance company's option and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person.) Laws 1984, ch. 127, § 433.

NMSA 1978, § 59A-22-13 Physical examination and autopsy

59A-22-13. Physical examination and autopsy There shall be a provision as follows: The insurance company at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law. Laws 1984, ch. 127, § 434.

NMSA 1978, § 59A-22-14 Legal actions

59A-22-14. Legal actions There shall be a provision as follows: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished. Laws 1984, ch. 127, § 435.

NMSA 1978, § 59A-22-15 Change of beneficiary

59A-22-15. Change of beneficiary There shall be a provision as follows: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy. Laws 1984, ch. 127, § 436.

NMSA 1978, § 59A-22-16 Optional provisions

59A-22-16. Optional provisions Except as provided in Section 424 [59A-22-3 NMSA 1978] of this article, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in Sections 438 to 446 [59A-22-17 to 59A-22-25 NMSA 1978], inclusive, of this article, unless such provisions are in the words in which the same appear in the applicable such section; except, that the insurer may, at its option, use in lieu of any such provision a corresponding provision of different wording approved by the superintendent which is not less favorable in any respect to the insured or the beneficiary. Any such provisions contained in the policy shall be preceded individually by the appropriate caption appearing with the section in which the provision is set forth or, at the insurer's option, by such appropriate individual or group captions or subcaptions as the superintendent may approve. Laws 1984, ch. 127, § 437.

NMSA 1978, § 59A-22-17 Change of occupation

59A-22-17. Change of occupation There may be a provision as follows: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurance company as more hazardous than that stated in this policy or while doing for compensation anything pertaining to an occupation so classified, the insurance company will pay only such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits fixed by the insurance company for such more hazardous occupation. If the insured changes his occupation to one classified by the insurance company as less hazardous than that stated in this policy, the insurance company, upon receipt of proof of such change of occupation, will reduce the premium rate accordingly, and will return the excess premium calculated on a basis approved by the superintendent from the date of change of occupation or from the policy anniversary date immediately preceding receipt of such proof, whichever is the more recent. In applying this provision, the classification for occupational risk and the premium rates shall be used as have been last filed by the insurance company prior to the occurrence of the loss for which the insurance company is liable or prior to date of proof of change in occupation with the state official having supervision of insurance in the state where the insured resided at the time this policy was issued; but if such filing was not required, then the classification of occupational risk and the premium rates shall be those last made effective by the insurance company in such state prior to the occurrence of the loss or prior to the date of proof of change in occupation. Laws 1984, ch. 127, § 438.

NMSA 1978, § 59A-22-18 Misstatement of age

59A-22-18. Misstatement of age There may be a provision as follows: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age. Laws 1984, ch. 127, § 439.

NMSA 1978, § 59A-22-19 Other insurance in this insurance company

59A-22-19. Other insurance in this insurance company There may be a provision as follows: If an accident or sickness or accident and sickness policy or policies previously issued by the insurance company to the insured be in force concurrently herewith, making the aggregate indemnity for.................. (insert type of coverage or coverages) in excess of $......... (insert maximum limit of indemnity or indemnities) the excess insurance shall be void and all premiums paid for such excess shall be returned to the insured or to his estate, or, in lieu thereof: Insurance effective at any one time on the insured under a like policy or policies in this insurance company is limited to the one such policy elected by the insured, his beneficiary or his estate, as the case may be, and the insurance company will return all premiums paid for all other such policies. Laws 1984, ch. 127, § 440.

NMSA 1978, § 59A-22-20 Insurance with other insurance companies

59A-22-20. Insurance with other insurance companies There may be a provision as follows: If there be other valid coverage, not with this insurance company, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurance company has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurance company had notice bears to the total like amounts under all valid coverages for such loss, and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the "like amount" of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage. (If the foregoing policy provision is included in a policy which also contains the next following policy provision there shall be added to the caption of the foregoing provision the phrase ".................... EXPENSE INCURRED BENEFITS." The insurance company may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the superintendent, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the superintendent. In the absence of such definition such term shall not include group insurance, automobile medical payments insurance or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employers' liability statute) whether provided by a governmental agency or otherwise shall in all cases be deemed to be "other valid coverage" of which the insurance company has had notice. In applying the foregoing policy provision no third party liability coverage shall be included as "other valid coverage." Laws 1984, ch. 127, § 441.

NMSA 1978, § 59A-22-21 Insurance with other insurance companies [; alternative provision]

59A-22-21. Insurance with other insurance companies [; alternative provision] As an alternative to the provision set out in Section 441 [59A-22-20 NMSA 1978] of this article, there may be a provision as follows: If there be other valid coverage, not with this insurance company, providing benefits for the same loss on other than an expense incurred basis and of which this insurance company has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurance company had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined. (If the foregoing policy provision is included in a policy which also contains the next preceding policy provision there shall be added to the caption of the foregoing provision of the phrase ".................... OTHER BENEFITS." The insurance company may, at its option, include in this provision a definition of "other valid coverage," approved as to form by the superintendent, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the superintendent. In the absence of such definition such term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefits provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute) whether provided by a governmental agency or otherwise shall in all cases be deemed to be "other valid coverage" of which the insurance company has had notice. In applying the foregoing policy provision no third party liability coverage shall be included as "other valid coverage.") Laws 1984, ch. 127, § 442.

NMSA 1978, § 59A-22-22 Relation of earnings to insurance

59A-22-22. Relation of earnings to insurance There may be a provision as follows: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurance company will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of two hundred ($200.00) dollars, or the sum of the monthly benefits specified in such coverages, whichever is the lesser, not [nor] shall it operate to reduce benefits other than those payable for loss of time. (The foregoing policy provision may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date of issue. The insurance company may, at its option, include in this provision a definition of "valid loss of time coverage," approved as to form by the superintendent, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the superintendent or any combination of such coverages. In the absence of such definition such term shall not include any coverage provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute) or benefits provided by union welfare plans or by employer or employee benefit organizations.) Laws 1984, ch. 127, § 443.

NMSA 1978, § 59A-22-23 Unpaid premium

59A-22-23. Unpaid premium There may be a provision as follows: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom. Laws 1984, ch. 127, § 444.

NMSA 1978, § 59A-22-24 Cancellation

59A-22-24. Cancellation There may be a provision as follows: The insurance company may cancel this policy only pursuant to the provisions of Section 59A-23E-19 NMSA 1978. Laws 1984, ch. 127, § 445; 1998, ch. 41, § 2.

NMSA 1978, § 59A-22-25 Conformity with state statutes

59A-22-25. Conformity with state statutes There may be a provision as follows: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such statutes. Laws 1984, ch. 127, § 446.

NMSA 1978, § 59A-22-26 Order of certain policy provisions

59A-22-26. Order of certain policy provisions The provisions which are the subject of Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the insurer's option, any such provision may appear as a unit in any part of the policy with other provisions to which it may logically be related, provided that the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse or likely to mislead a person to whom the policy is offered, delivered or issued. Laws 1984, ch. 127, § 447.

NMSA 1978, § 59A-22-27 Third party ownership

59A-22-27. Third party ownership The word "insured" as used in this article shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein. Laws 1984, ch. 127, § 448.

NMSA 1978, § 59A-22-28 Requirements of other jurisdictions

59A-22-28. Requirements of other jurisdictions A. Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this article, and which is prescribed or required by the law of the state or country in which the insurer is domiciled. B. Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such state or country. Laws 1984, ch. 127, § 449.

NMSA 1978, § 59A-22-29 Conforming to statute

59A-22-29. Conforming to statute A. Other policy provisions. No policy provision which is not subject to Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this article. B. Policy conflicting with this article. A policy delivered or issued for delivery in this state in violation of this article shall be held valid but shall be construed as provided in this article. When any provision in a policy subject to this article is in conflict with any provision of this article, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this article. Laws 1984, ch. 127, § 450.

NMSA 1978, § 59A-22-30 Age limit

59A-22-30. Age limit If any such policy contains a provision establishing, as an age limit or otherwise, a date after which coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy. Laws 1984, ch. 127, § 451.

NMSA 1978, § 59A-22-30.1 Maximum age of dependent

59A-22-30.1. Maximum age of dependent An individual or group health policy or certificate of insurance delivered, issued for delivery or renewed in New Mexico that provides coverage for an insured's dependent shall not terminate coverage of an unmarried dependent by reason of the dependent's age before the dependent's twenty-sixth birthday, regardless of whether the dependent is enrolled in an educational institution. Laws 2005, ch. 41, § 1; 2021, ch. 108, § 17.

NMSA 1978, § 59A-22-31 Industrial health insurance

59A-22-31. Industrial health insurance A. The term "industrial health insurance" as used herein means sickness and accident insurance under individual policies for which the premium is payable weekly, and includes any such policy which covers sickness only or accident only. B. Any insurer authorized to write health insurance in this state shall have the power to issue industrial health policies. C. No policy of industrial health insurance may be delivered or issued for delivery in the state unless it has printed thereon the words "industrial policy." D. Each such policy shall be subject to the provisions of this article except that no such policy shall be required to contain any of the policy provisions set forth in Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article, other than the provisions relating to the presence of a preexisting disease or physical condition; provided, however, that no such policy shall contain any provision relative to notice or proof of loss, or the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the superintendent is less favorable to the insured than would be permitted by such policy provisions; and provided further, that such policy may contain a provision that upon proper written request, a named beneficiary shall be designated in or by endorsement on the policy to receive the proceeds thereof on the death of the insured, and there shall be reserved to the insured the power to change the beneficiary at any time by written notice to the insurer at its home office, accompanied by the policy for endorsement of the change thereon by the insurer; the insurer shall have the right to refuse to designate a beneficiary if evidence satisfactory to the insurer of such beneficiary's insurable interest in the life of the insured is not furnished on request. Any such policy may provide in substance that any payment thereunder may be made to the insured or the insured's estate or to any relative by blood or connection by marriage of the insured, or, to the extent of such portion of any payment under the policy as may reasonably appear to the insurer to be due to such person, to any other person equitably entitled thereto by reason of having incurred expense occasioned by the maintenance or illness or burial of the insured; provided that, if the policy shall be in force at the death of the insured, the proceeds thereof shall be payable to the named beneficiary if living, but upon the expiration of fifteen (15) days after the death of the insured, unless proof of the claim in the manner and form required by the policy, accompanied by the policy for surrender, has theretofore been made by such beneficiary, the insurer may pay to any other person permitted by the policy. Laws 1984, ch. 127, § 452.

NMSA 1978, § 59A-22-32 Freedom of choice of hospital and practitioner

59A-22-32. Freedom of choice of hospital and practitioner A. Within the area and limits of coverage offered an insured and selected by the insured in the application for insurance, the right of a person to exercise full freedom of choice in the selection of a hospital for hospital care or of a practitioner of the healing arts or optometrist, psychologist, podiatrist, physician assistant, certified nurse-midwife, registered lay midwife or registered nurse in expanded practice, as defined in Subsection B of this section, for treatment of an illness or injury within that person's scope of practice shall not be restricted under any new policy of health insurance, contract or health care plan issued after June 30, 1967 in this state or in the processing of a claim thereunder. A person insured or claiming benefits under any such health insurance policy, contract or health care plan providing within its coverage for payment of service benefits or indemnity for hospital care or treatment of persons for the cure or correction of any physical or mental condition shall be deemed to have complied with the requirements of the policy, contract or health care plan as to submission of proof of loss upon submitting written proof supported by the certificate of any hospital currently licensed by the department of health or any practitioner of the healing arts or optometrist, psychologist, podiatrist, physician assistant, certified nurse-midwife, registered lay midwife or registered nurse in expanded practice. B. As used in this section: (1) "hospital care" means hospital service provided through a hospital that is maintained by the state or a political subdivision of the state or a place that is currently licensed as a hospital by the department of health and has accommodations for resident bed patients, a licensed professional registered nurse always on duty or call, a laboratory and an operating room where surgical operations are performed, but "hospital care" does not include a convalescent or nursing or rest home; (2) "practitioner of the healing arts" means a person holding a license or certificate authorizing the licensee to offer or undertake to diagnose, treat, operate on or prescribe for any human pain, injury, disease, deformity or physical or mental condition pursuant to: (a) the Chiropractic Physician Practice Act [Chapter 61, Article 4 NMSA 1978]; (b) the Dental Health Care Act [Chapter 61, Article 5A NMSA 1978]; (c) the Medical Practice Act [Chapter 61, Article 6 NMSA 1978]; (d) Chapter 61, Article 10 NMSA 1978; and (e) the Acupuncture and Oriental Medicine Practice Act [Chapter 61, Article 14A NMSA 1978]; (3) "optometrist" means a person holding a license provided for in the Optometry Act [Chapter 61, Article 2 NMSA 1978]; (4) "podiatrist" means a person holding a license provided for in the Podiatry Act [Chapter 61, Article 8 NMSA 1978]; (5) "psychologist" means a person who is duly licensed or certified in the state where the service is rendered and has a doctoral degree in psychology and has had at least two years of clinical experience in a recognized health setting or has met the standards of the national register of health service providers in psychology; (6) "physician assistant" means a person who is licensed by the New Mexico medical board to practice as a physician assistant and who provides services to patients under the supervision and direction of a licensed physician; (7) "certified nurse-midwife" means a person licensed by the board of nursing as a registered nurse and who is registered with the public health division of the department of health as a certified nurse-midwife; (8) "registered lay midwife" means a person who practices lay midwifery and is registered as a registered lay midwife by the public health division of the department of health; and (9) "registered nurse in expanded practice" means a person licensed by the board of nursing as a registered nurse approved for expanded practice pursuant to the Nursing Practice Act [Chapter 61, Article 3 NMSA 1978] as a certified nurse practitioner, certified registered nurse anesthetist, certified clinical nurse specialist in psychiatric mental health nursing or clinical nurse specialist in private practice and who has a master's degree or doctorate in a defined clinical nursing speciality and is certified by a national nursing organization. C. This section shall apply to any such policy that is delivered or issued for delivery in this state on or after July 1, 1979 and to any existing group policy or plan on its anniversary or renewal date after June 30, 1979 or at expiration of the applicable collective bargaining contract, if any, whichever is later. Laws 1984, ch. 127, § 454; 1985, ch. 192, § 1; 1987, ch. 81, § 1; 1987, ch. 259, § 21; 1989, ch. 96, § 1; 2003, ch. 343, § 2; 2008, ch. 9, § 5.

NMSA 1978, § 59A-22-32.1 Freedom of choice

59A-22-32.1. Freedom of choice A. Within the area and limits of coverage offered an insured and selected by him in the application for insurance, the right of any person to exercise full freedom of choice in the selection of any independent social worker as defined in Subsection B of this section, for treatment within his scope of practice shall not be restricted under any new policy of health insurance, contract or health care plan issued after July 1, 1989 in this state or in the processing of any claim thereunder. Any person insured or claiming benefits under any such health insurance policy, contract or health care plan providing within its coverage for payment of service benefits or indemnity for treatment of persons for the cure or correction of any mental condition shall be deemed to have complied with the requirements of the policy, contract or health care plan as to submission of proof of loss upon submitting written proof supported by any independent social worker. B. As used in this section "independent social worker" means a person licensed as an independent social worker by the board of social work examiners pursuant to the Social Work Practice Act [61-31-1 to 61-31-24 NMSA 1978]. Laws 1989, ch. 51, § 25.

NMSA 1978, § 59A-22-33 Children with disabilities; coverage continued

59A-22-33. Children with disabilities; coverage continued An individual or group hospital or medical expense insurance policy delivered or issued for delivery in this state that provides that coverage of a dependent child of an insured, or of an employee or other member of the covered group, shall terminate upon attainment of the limiting age for dependent children specified in the policy shall also provide, in substance, that attainment of the limiting age shall not operate to terminate the coverage of a child while the child is, and continues to be both incapable of self-sustaining employment, by reason of intellectual or developmental disability or physical disability, and chiefly dependent upon the policyholder for support and maintenance. However, proof of the incapacity and dependency of the child must be furnished to the insurer by the insured employee or member within thirty-one days of the child's attainment of the limiting age and subsequently, as may be required by the insurer, but not more frequently than annually after the two-year period following the child's attainment of the limiting age. Laws 1984, ch. 127, § 455; 2021, ch. 108, § 18.

NMSA 1978, § 59A-22-34 Newly born children coverage

59A-22-34. Newly born children coverage A. All individual and group health insurance policies delivered or issued for delivery in this state and which provide coverage on an expense-incurred basis for a family member of the insured shall, as to such family members' coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured from the moment of birth. B. All individual and group health insurance policies delivered or issued for delivery in this state that do not provide coverage for a family member of the insured shall provide for an option to add to the coverage any newly born child of the insured provided that the requirements of Subsection D of this section have been met. C. The coverage for newly born children shall consist of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, where necessary to protect the life of the infant, transportation, including air transport, to the nearest available tertiary care facility for newly born infants. D. If payment of a specific premium is required to provide coverage for a child, the policy may require that a notification of birth of a newly born child and payment of the required premium must be furnished to the insurer within thirty-one days after the date of birth in order to have the coverage from birth. E. As used in this section and in Section 59A-22-35 NMSA 1978, "tertiary care facility" means a hospital unit which provides complete perinatal care and intensive care of intrapartum and perinatal high-risk patients with responsibilities for coordination of transport, communication, education and data analysis systems for the geographic area served. Laws 1984, ch. 127, § 456; 1993, ch. 169, § 1.

NMSA 1978, § 59A-22-34.1 Coverage for adopted children

59A-22-34.1. Coverage for adopted children A. No individual or group health insurance policy or contract or health care plan shall be offered, issued or renewed in New Mexico on or after July 1, 1988, unless the policy, plan or contract covers adopted children of the insured, subscriber or enrollee on the same basis as other dependents. B. The coverage required by this section is effective from the date of placement for the purpose of adoption and continues unless the placement is disrupted prior to legal adoption and the child is removed from placement. Coverage shall include the necessary care and treatment of medical conditions existing prior to the date of placement. C. As used in this section, "placement" means in the physical custody of the adoptive parent. Laws 1978 Comp., § 59A-22-34.1, enacted by Laws 1988, ch. 89, § 1.

NMSA 1978, § 59A-22-34.2 Coverage of children

59A-22-34.2. Coverage of children A. An insurer shall not deny enrollment of a child under the health plan of the child's parent on the grounds that the child: (1) was born out of wedlock; (2) is not claimed as a dependent on the parent's federal tax return; or (3) does not reside with the parent or in the insurer's service area. B. When a child has health coverage through an insurer of a noncustodial parent, the insurer shall: (1) provide such information to the custodial parent as may be necessary for the child to obtain benefits through that coverage; (2) permit the custodial parent or the provider, with the custodial parent's approval, to submit claims for covered services without the approval of the noncustodial parent; and (3) make payments on claims submitted in accordance with Paragraph (2) of this subsection directly to the custodial parent, the provider or the state medicaid agency. C. When a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage, the insurer shall be required: (1) to permit the parent to enroll, under the family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions; (2) if the parent is enrolled but fails to make application to obtain coverage for the child, to enroll the child under family coverage upon application of the child's other parent, the state agency administering the medicaid program or the state agency administering 42 U.S.C. Sections 651 through 669, the child support enforcement program; and (3) not to disenroll or eliminate coverage of the child unless the insurer is provided satisfactory written evidence that: (a) the court or administrative order is no longer in effect; or (b) the child is or will be enrolled in comparable health coverage through another insurer that will take effect not later than the effective date of disenrollment. D. An insurer shall not impose requirements on a state agency that has been assigned the rights of an individual eligible for medical assistance under the medicaid program and covered for health benefits from the insurer that are different from requirements applicable to an agent or assignee of any other individual so covered. E. An insurer shall provide coverage for children, from birth through three years of age, for or under the family, infant, toddler program administered by the early childhood education and care department, provided eligibility criteria are met, for a maximum benefit of three thousand five hundred dollars ($3,500) annually for medically necessary early intervention services provided as part of an individualized family service plan and delivered by certified and licensed personnel who are working in early intervention programs approved by the early childhood education and care department. No payment under this subsection shall be applied against any maximum lifetime or annual limits specified in the policy, health benefits plan or contract. 1978 Comp., § 59A-22-34.2, enacted by Laws 1994, ch. 64, § 2; 2005, ch. 157, § 2; 2019, ch. 48, § 30.

NMSA 1978, § 59A-22-34.3 Childhood immunization coverage required

59A-22-34.3. Childhood immunization coverage required A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for childhood immunizations, as well as coverage for medically necessary booster doses of all immunizing agents used in child immunizations, in accordance with the current schedule of immunizations recommended by the American academy of pediatrics. B. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies. C. Coverage for childhood immunizations and necessary booster doses may be subject to deductibles and co-insurance consistent with those imposed on other benefits under the same policy, plan or certificate. 1978 Comp., § 59A-22-34.3, enacted by Laws 1997, ch. 250, § 1.

NMSA 1978, § 59A-22-34.4 Coverage of circumcision for newborn males

59A-22-34.4. Coverage of circumcision for newborn males An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for circumcision for newborn males. Laws 2004, ch. 122, § 4.

NMSA 1978, § 59A-22-34.5 Hearing aid coverage for children required

59A-22-34.5. Hearing aid coverage for children required A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for a hearing aid and any related service for the full cost of one hearing aid per hearing-impaired ear up to two thousand two hundred dollars ($2,200) every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid. B. An insurer that delivers, issues for delivery or renews in this state an individual or group health insurance policy, health care plan or certificate of health insurance may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section. C. Hearing aid coverage offered shall include fitting and dispensing services, including providing ear molds as necessary to maintain optimal fit, provided by an audiologist, a hearing aid dispenser or a physician, licensed in New Mexico. D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies. E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate. F. For the purposes of this section, "hearing aid" means durable medical equipment that is of a design and circuitry to optimize audibility and listening skills in the environment commonly experienced by children. Laws 2007, ch. 356, § 2.

NMSA 1978, § 59A-22-35 Maternity transport required

59A-22-35. Maternity transport required All individual and group health insurance policies delivered or issued for delivery in this state which provide maternity coverage on an expense-incurred basis, shall also provide, where necessary to protect the life of the infant or mother, coverage for transportation, including air transport, for the medically high-risk pregnant woman with an impending delivery of a potentially viable infant to the nearest available tertiary care facility (as defined in Section 456 [59A-22-34 NMSA 1978] of this article) for newly-born infants. Laws 1984, ch. 127, § 457.

NMSA 1978, § 59A-22-36 Home health care service option required

59A-22-36. Home health care service option required A. Each insurer which delivers or issues for delivery in this state an individual or group hospital expense or major medical expense insurance policy shall make available to the policyholder the option of home health care coverage which includes benefits for the services described in this section. B. Home health care coverage offered shall include: (1) services provided by a registered nurse or a licensed practical nurse; (2) health services provided by physical, occupational and respiratory therapists and speech pathologists; (3) health services provided by a home health aide; and (4) medical supplies, drugs and medicines and laboratory services, to the extent they would have been covered if provided to the insured on an in-patient basis. C. Home health care coverage may be limited to: (1) services provided on the written order of a licensed physician, provided such order is renewed at least every sixty (60) days; (2) services provided, directly or through contractual agreements, by a home health agency licensed in the state in which the home health services are delivered; and (3) services, as set forth in Subsection B of the section, without which the insured would have to be hospitalized. D. Coverage shall be provided for at least one hundred (100) home visits per insured per year, with each home visit including up to four (4) hours of home health care services. E. For the purposes of this section, "home health care" means health services provided on a part-time, intermittent basis to an individual confined to his home due to physical illness. Laws 1984, ch. 127, § 458.

NMSA 1978, § 59A-22-38 Individual health insurance; policy provisions relating to individuals who are eligible for medical benefits under the medicaid program

59A-22-38. Individual health insurance; policy provisions relating to individuals who are eligible for medical benefits under the medicaid program A. Each individual health insurance policy that is delivered, issued for delivery or renewed in this state shall include provisions that require benefits paid on behalf of a child or other insured person under the policy to be paid to the human services department [health care authority department] when: (1) the human services department [health care authority department] has paid or is paying benefits on behalf of the child or other insured person under the state's medicaid program pursuant to Title XIX of the federal Social Security Act, 42 U.S.C. 1396, et seq.; (2) payment for the services in question has been made by the human services department [health care authority department] to the medicaid provider; and (3) the insurer is notified that the insured individual receives benefits under the medicaid program and that benefits must be paid directly to the human services department [health care authority department]. B. The notice required under Paragraph (3) of Subsection A of this section may be accomplished through an attachment to the claim by the human services department [health care authority department] for insurance benefits when the claim is first submitted by the human services department [health care authority department] to the insurer. C. Notwithstanding any other provisions of law, checks in payment for claims pursuant to any individual health insurance policy for health care services provided to persons who are also eligible for benefits under the medicaid program and provided by medical providers qualified to participate under the policy shall be made payable to the provider. The insurer may be notified that the insured individual is eligible for medicaid benefits through an attachment to the claim by the provider for insurance benefits when the claim is first submitted by the provider to the insurer. D. No individual health insurance policy delivered, issued for delivery or renewed in this state on or after the effective date of this section shall contain any provision denying or limiting insurance benefits because services are rendered to an insured who is eligible for or who has received medical assistance under the medicaid program of this state. E. To the extent that payment for covered expenses has been made pursuant to the state medicaid program for health care items or services furnished to an individual, in any case where an insurer has a legal liability to make payments, the state is considered to have acquired the rights of the individual to payment by the insurer for those health care items or services. 1978 Comp., § 59A-22-38, enacted by Laws 1989, ch. 183, § 2; 1994, ch. 64, § 3.

NMSA 1978, § 59A-22-39 Coverage for mammograms

59A-22-39. Coverage for mammograms Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for low-dose screening mammograms for determining the presence of breast cancer. Such coverage shall make available one baseline mammogram to persons age thirty-five through thirty-nine, one mammogram biennially to persons age forty through forty-nine and one mammogram annually to persons age fifty and over. After July 1, 1992, coverage shall be available only for screening mammograms obtained on equipment designed specifically to perform low-dose mammography in imaging facilities that have met American college of radiology accreditation standards for mammography. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or tax-favored plans as defined pursuant to 26 USC Section 223(c)(2). 1978 Comp., § 59A-22-39, enacted by Laws 1990, ch. 5, § 2; 2023, ch. 12, § 6.

NMSA 1978, § 59A-22-39.1 Mastectomies and lymph node dissection; minimum hospital stay coverage required

59A-22-39.1. Mastectomies and lymph node dissection; minimum hospital stay coverage required A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for not less than forty-eight hours of inpatient care following a mastectomy and not less than twenty-four hours of inpatient care following a lymph node dissection for the treatment of breast cancer. B. Nothing in this section shall be construed as requiring the provision of inpatient coverage where the attending physician and patient determine that a shorter period of hospital stay is appropriate. C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies. D. Coverage for minimum inpatient hospital stays for mastectomies and lymph node dissections for the treatment of breast cancer may be subject to deductibles and co-insurance consistent with those imposed on other benefits under the same policy, plan or certificate. 1978 Comp., § 59A-22-39.1, enacted by Laws 1997, ch. 249, § 1.

NMSA 1978, § 59A-22-39.2 Prior authorization for gynecological or obstetrical ultrasounds prohibited

59A-22-39.2. Prior authorization for gynecological or obstetrical ultrasounds prohibited A. An individual or group health insurance policy, health care plan or certificate of insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for gynecological or obstetrical ultrasounds shall not require prior authorization for gynecological or obstetrical ultrasounds. B. Nothing in this section shall be construed to require payment for a gynecological or obstetrical ultrasound that is not: (1) medically necessary; or (2) a covered benefit. C. As used in this section, "prior authorization" means advance approval that is required by a health insurance policy, health care plan or certificate of insurance as a condition precedent to payment for medical care or related benefits rendered to a covered person, including prospective or utilization review conducted prior to the provision of covered medical care or related benefits. Laws 2019, ch. 182, § 3.

NMSA 1978, § 59A-22-39.3 Diagnostic and supplemental breast examinations

59A-22-39.3. Diagnostic and supplemental breast examinations A. An individual or group health insurance policy, health care plan or certificate of insurance that is delivered, issued for delivery or renewed in this state that provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing for diagnostic and supplemental breast examinations. B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law. C. As used in this section: (1) "cost sharing" means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense; (2) "diagnostic breast examination" means a medically necessary and clinically appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality: (a) seen or suspected from a screening examination for breast cancer; or (b) detected by another means of examination; and (3) "supplemental breast examination" means a medically necessary and clinically appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is: (a) used to screen for breast cancer when there is no abnormality seen or suspected; and (b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer. Laws 2023, ch. 12, § 2.

NMSA 1978, § 59A-22-40 Coverage for cytologic and human papillomavirus screening

59A-22-40. Coverage for cytologic and human papillomavirus screening A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state shall provide coverage for cytologic and human papillomavirus screening for determining the presence of precancerous or cancerous conditions and other health problems. The coverage shall make available cytologic screening, as determined by the health care provider in accordance with national medical standards, for women who are eighteen years of age or older and for women who are at risk of cancer or at risk of other health conditions that can be identified through cytologic screening. The coverage shall make available human papillomavirus screening once every three years for women aged thirty and older. B. Coverage for cytologic and human papillomavirus screening may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate. C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies. D. For the purposes of this section: (1) "cytologic screening" means a Papanicolaou test and a pelvic exam for asymptomatic as well as symptomatic women; (2) "health care provider" means any person licensed within the scope of his practice to perform cytologic and human papillomavirus screening, including physicians, physician assistants, certified nurse midwives and certified nurse practitioners; and (3) "human papillomavirus screening" means a test approved by the federal food and drug administration for detection of the human papillomavirus. 1978 Comp., § 59A-22-40, enacted by Laws 1992, ch. 56, § 2; 2005, ch. 133, § 2.

NMSA 1978, § 59A-22-40.1 Coverage for the human papillomavirus vaccine

59A-22-40.1. Coverage for the human papillomavirus vaccine A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for the human papillomavirus vaccine in accordance with the current standards of the federal centers for disease control and prevention. B. Coverage for the human papillomavirus vaccine may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate. C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified disease policies. D. For the purposes of this section, "human papillomavirus vaccine" means a vaccine approved by the federal food and drug administration used for the prevention of human papillomavirus infection and cervical precancers. Laws 2007, ch. 278, § 1; 2021, ch. 108, § 19.

NMSA 1978, § 59A-22-41 Coverage for individuals with diabetes

59A-22-41. Coverage for individuals with diabetes A. Each individual and group health insurance policy, health care plan, certificate of health insurance and managed health care plan delivered or issued for delivery in this state shall provide coverage for individuals with insulin-using diabetes, with non-insulin-using diabetes and with elevated blood glucose levels induced by pregnancy. This coverage shall be a basic health care benefit and shall entitle each individual to the medically accepted standard of medical care for diabetes and benefits for diabetes treatment as well as diabetes supplies, and this coverage shall not be reduced or eliminated. B. Except as otherwise provided in this subsection, coverage for individuals with diabetes may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate, as long as the annual deductibles or coinsurance for benefits are no greater than the annual deductibles or coinsurance established for similar benefits within a given policy. The amount an individual with diabetes is required to pay for a preferred formulary prescription insulin drug or a medically necessary alternative is an amount not to exceed a total of twenty-five dollars ($25.00) per thirty-day supply. C. When prescribed or diagnosed by a health care practitioner with prescribing authority, all individuals with diabetes as described in Subsection A of this section enrolled in health policies described in that subsection shall be entitled to the following equipment, supplies and appliances to treat diabetes: (1) blood glucose monitors, including those for individuals with disabilities, including the legally blind; (2) test strips for blood glucose monitors; (3) visual reading urine and ketone strips; (4) lancets and lancet devices; (5) insulin; (6) injection aids, including those adaptable to meet the needs of individuals with disabilities, including the legally blind; (7) syringes; (8) prescriptive oral agents for controlling blood sugar levels; (9) medically necessary podiatric appliances for prevention of feet complications associated with diabetes, including therapeutic molded or depth-inlay shoes, functional orthotics, custom molded inserts, replacement inserts, preventive devices and shoe modifications for prevention and treatment; and (10) glucagon emergency kits. D. When prescribed or diagnosed by a health care practitioner with prescribing authority, all individuals with diabetes as described in Subsection A of this section enrolled in health policies described in that subsection shall be entitled to the following basic health care benefits: (1) diabetes self-management training that shall be provided by a certified, registered or licensed health care professional with recent education in diabetes management, which shall be limited to: (a) medically necessary visits upon the diagnosis of diabetes; (b) visits following a diagnosis from a health care practitioner that represents a significant change in the patient's symptoms or condition that warrants changes in the patient's self-management; and (c) visits when re-education or refresher training is prescribed by a health care practitioner with prescribing authority; (2) medical nutrition therapy related to diabetes management; and (3) medically necessary treatment of active diabetic foot ulcers, including topical oxygen therapy. E. When new or improved equipment, appliances, prescription drugs for the treatment of diabetes, insulin or supplies for the treatment of diabetes are approved by the federal food and drug administration, all individual or group health insurance policies as described in Subsection A of this section shall: (1) maintain an adequate formulary to provide those resources to individuals with diabetes; and (2) guarantee reimbursement or coverage for the equipment, appliances, prescription drug, insulin or supplies described in this subsection within the limits of the health care plan, policy or certificate. F. An insurer that requires a covered person to use a specific network provider or to purchase equipment, appliances, supplies or insulin or prescription drugs for the treatment or management of diabetes from a specific durable medical equipment supplier or other supplier as a condition of coverage, payment or reimbursement shall: (1) maintain an adequate network of durable medical equipment suppliers and other suppliers to provide covered persons with medically necessary diabetes resources, whether covered under the health policy's prescription drug or medical benefit; (2) have network contracts in place for the entire policy or plan period and shall not allow contracts with network providers, durable medical equipment suppliers and other suppliers to lapse or terminate without ensuring the availability of a replacement and continuity of care; provided that single-case agreements do not satisfy the requirements of Paragraph (1) of this subsection or this paragraph; (3) monitor network providers, durable medical equipment suppliers and other network suppliers to ensure that medically necessary equipment, appliances, supplies and insulin or other prescription drugs are being delivered to a covered person in a timely manner and when needed by the covered person; (4) guarantee reimbursement to a covered person within thirty days following receipt of a written demand from the covered person who pays out of pocket for necessary equipment, appliances, supplies and insulin or other prescription drugs described in this section that are not delivered timely to the covered person, and the portion of payment for which the patient is responsible shall not exceed the amount for the same covered benefit obtained from a contracted supplier; (5) pay interest at the rate of eighteen percent per year on the amount of reimbursement due to a covered person if not paid within thirty days as required by Paragraph (4) of this subsection; (6) beginning on April 1, 2024, submit a written report each quarter to the superintendent for the previous quarter on the following metrics: (a) the number of written demands for reimbursement of out-of-pocket expenses from covered persons received by the health care insurer; (b) the number of out-of-pocket claims for reimbursement paid and the aggregate amount of claims reimbursed by the health care insurer within the time required by Paragraph (4) of this subsection; (c) the number of out-of-pocket claims for reimbursement paid more than thirty days following receipt of a written demand and the aggregate amount of these payments, excluding interest; and (d) the aggregate amount of interest paid by the health care insurer pursuant to Paragraph (5) of this subsection; and (7) beginning on April 1, 2024, submit a written report each quarter for the previous quarter to the superintendent with the following information for each durable medical equipment supplier or other supplier that was under contract with the health care insurer or its agent during the previous quarter: (a) the name, address and telephone number of each supplier and, if applicable, the corresponding date upon which the respective supplier's contract expired, lapsed or was terminated during the previous quarter; (b) the percentage of total deliveries, by description of item, that did not meet the delivery requirements specified in Paragraph (3) of this subsection; and (c) the number of complaints received by the health care insurer or its agent during the previous quarter related to late deliveries, incomplete orders or incorrect orders, respectively. G. The superintendent shall annually audit all health insurers offering policies, plans or certificates as described in Subsection A of this section for compliance with the requirements of this section. If the superintendent determines that a health care insurer has not complied with the requirements of this section, the superintendent shall impose corrective action or use any other enforcement mechanism available to the superintendent to obtain the health care insurer's compliance with this section. H. Absent a change in diagnosis or in a covered person's management or treatment of diabetes or its complications, a health care insurer shall not require more than one prior authorization per policy period for any single drug or category of item enumerated in this section if prescribed as medically necessary by the covered person's health care practitioner. Changes in the prescribed dose of a drug; quantities of supplies needed to administer a prescribed drug; quantities of blood glucose self-testing equipment and supplies; or quantities of supplies needed to use or operate devices for which a covered person has received prior authorization during the policy year shall not be subject to additional prior authorization requirements in the same policy year if prescribed as medically necessary by the covered person's health care practitioner. Nothing in this subsection shall be construed to require payment for diabetes resources that are not covered benefits. I. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies. J. For purposes of this section: (1) "basic health care benefits": (a) means benefits for medically necessary services consisting of preventive care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory and diagnostic and therapeutic radiological services; and (b) does not include services for alcohol or drug abuse, dental or long-term rehabilitation treatment; and (2) "managed health care plan" means a health benefit plan offered by a health care insurer that provides for the delivery of comprehensive basic health care services and medically necessary services to individuals enrolled in the plan through its own employed health care providers or by contracting with selected or participating health care providers. A managed health care plan includes only those plans that provide comprehensive basic health care services to enrollees on a prepaid, capitated basis, including the following: (a) health maintenance organizations; (b) preferred provider organizations; (c) individual practice associations; (d) competitive medical plans; (e) exclusive provider organizations; (f) integrated delivery systems; (g) independent physician-provider organizations; (h) physician hospital-provider organizations; and (i) managed care services organizations. 1978 Comp., § 59A-22-41, enacted by Laws 1997, ch. 7, § 1 and by Laws 1997, ch. 255, § 1; 2020, ch. 36, § 2; 2023, ch. 50, § 2; 2025, ch. 36, § 1.

NMSA 1978, § 59A-22-41.1 Coverage for medical diets for genetic inborn errors of metabolism

59A-22-41.1. Coverage for medical diets for genetic inborn errors of metabolism A. As of July 1, 2003, each individual and group health insurance policy, health care plan, certificate of health insurance and managed health care plan delivered, issued for delivery, renewed, extended or modified in this state shall provide coverage for the treatment of genetic inborn errors of metabolism that involve amino acid, carbohydrate and fat metabolism and for which medically standard methods of diagnosis, treatment and monitoring exist. B. Coverage shall include expenses of diagnosing, monitoring and controlling disorders by nutritional and medical assessment, including clinical services, biochemical analysis, medical supplies, prescription drugs, corrective lenses for conditions related to the genetic inborn error of metabolism, nutritional management and special medical foods used in treatment to compensate for the metabolic abnormality and to maintain adequate nutritional status. C. Services required to be covered pursuant to this section are subject to the terms and conditions of the applicable individual or group policy or plan that establishes durational limits, dollar limits, deductibles and co-payments as long as the terms are not less favorable than for physical illness generally. D. As used in this section: (1) "genetic inborn error of metabolism" means a rare, inherited disorder that: (a) is present at birth; (b) if untreated, results in intellectual or developmental disability or death; and (c) causes the necessity for consumption of special medical foods; (2) "special medical foods" means nutritional substances in any form that are: (a) formulated to be consumed or administered internally under the supervision of a physician; (b) specifically processed or formulated to be distinct in one or more nutrients present in natural food; (c) intended for the medical and nutritional management of patients with limited capacity to metabolize ordinary foodstuffs or certain nutrients contained in ordinary foodstuffs or who have other specific nutrient requirements as established by medical evaluation; and (d) essential to optimize growth, health and metabolic homeostasis; and (3) "treatment" means medical services provided by licensed health care professionals, including physicians, dieticians and nutritionists, with specific training in managing patients diagnosed with genetic inborn errors of metabolism. Laws 2003, ch. 192, § 1; 2021, ch. 108, § 20.

NMSA 1978, § 59A-22-42 Coverage for prescription contraceptive drugs or devices

59A-22-42. Coverage for prescription contraceptive drugs or devices A. Each individual and group health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit shall provide, at a minimum, the following coverage: (1) at least one product or form of contraception in each of the contraceptive method categories identified by the federal food and drug administration; (2) a sufficient number and assortment of oral contraceptive pills to reflect the variety of oral contraceptives approved by the federal food and drug administration; and (3) clinical services related to the provision or use of contraception, including consultations, examinations, procedures, ultrasound, anesthesia, patient education, counseling, device insertion and removal, follow-up care and side-effects management. B. Except as provided in Subsection C of this section, the coverage required pursuant to this section shall not be subject to: (1) cost sharing for insureds; (2) utilization review; (3) prior authorization or step-therapy requirements; or (4) any other restrictions or delays on the coverage. C. An insurer may discourage brand-name pharmacy drugs or items by applying cost sharing to brand-name drugs or items when at least one generic or therapeutic equivalent is covered within the same method of contraception without patient cost sharing; provided that when an insured's health care provider determines that a particular drug or item is medically necessary, the individual or group health insurance policy, health care plan or certificate of insurance shall cover the brand-name pharmacy drug or item without cost sharing. Medical necessity may include considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider. D. An insurer shall grant an insured an expedited hearing to appeal any adverse determination made relating to the provisions of this section. The process for requesting an expedited hearing pursuant to this subsection shall: (1) be easily accessible, transparent, sufficiently expedient and not unduly burdensome on an insured, the insured's representative or the insured's health care provider; (2) defer to the determination of the insured's health care provider; and (3) provide for a determination of the claim according to a time frame and in a manner that takes into account the nature of the claim and the medical exigencies involved for a claim involving an urgent health care need. E. An insurer shall not require a prescription for any drug, item or service that is available without a prescription. F. An insurer shall provide coverage and shall reimburse a health care provider or dispensing entity on a per-unit basis for dispensing a six-month supply of contraceptives at one time; provided that the contraceptives are prescribed and self-administered. G. Nothing in this section shall be construed to: (1) require a health care provider to prescribe six months of contraceptives at one time; or (2) permit an insurer to limit coverage or impose cost sharing for an alternate method of contraception if an insured changes contraceptive methods before exhausting a previously dispensed supply. H. The provisions of this section shall not apply to short-term travel, accident-only hospital-indemnity-only, limited-benefit or specified-disease policies. I. The provisions of this section apply to individual and group health insurance policies, health care plans and certificates of insurance delivered or issued for delivery after January 1, 2020. J. For the purposes of this section: (1) "contraceptive method categories identified by the federal food and drug administration": (a) means tubal ligation; sterilization implant; copper intrauterine device; intrauterine device with progestin; implantable rod; contraceptive shot or injection; combined oral contraceptives; extended or continuous use oral contraceptives; progestin-only oral contraceptives; patch; vaginal ring; diaphragm with spermicide; sponge with spermicide; cervical cap with spermicide; male and female condoms; spermicide alone; vasectomy; ulipristal acetate; levonorgestrel emergency contraception; and any additional contraceptive method categories approved by the federal food and drug administration; and (b) does not mean a product that has been recalled for safety reasons or withdrawn from the market; (2) "cost sharing" means a deductible, copayment or coinsurance that an insured is required to pay in accordance with the terms of an individual or group health insurance policy, health care plan or certificate of insurance; and (3) "health care provider" means an individual licensed to provide health care in the ordinary course of business. K. A religious entity purchasing individual or group health insurance coverage may elect to exclude prescription contraceptive drugs or devices from the health coverage purchased. Laws 2001, ch. 14, § 1; 2003, ch. 202, § 12; 2019, ch. 263, § 3.

NMSA 1978, § 59A-22-43 Required coverage of patient costs incurred in cancer clinical trials

59A-22-43. Required coverage of patient costs incurred in cancer clinical trials A. A health plan shall provide coverage for routine patient care costs incurred as a result of the patient's participation in a cancer clinical trial if: (1) the clinical trial is undertaken for the purposes of the prevention of or the prevention of reoccurrence of cancer or the early detection or treatment of cancer for which no equally or more effective standard cancer treatment exists; (2) the clinical trial is not designed exclusively to test toxicity or disease pathophysiology and it has a therapeutic intent; (3) the clinical trial is being provided in this state as part of a scientific study of a new therapy or intervention and is for the prevention, prevention of reoccurrence, early detection, treatment or palliation of cancer in humans and in which the scientific study includes all of the following: (a) specific goals; (b) a rationale and background for the study; (c) criteria for patient selection; (d) specific direction for administering the therapy or intervention and for monitoring patients; (e) a definition of quantitative measures for determining treatment response; (f) methods for documenting and treating adverse reactions; and (g) a reasonable expectation that the treatment will be at least as efficacious as standard cancer treatment; (4) the clinical trial is being conducted with approval of at least one of the following: (a) one of the federal national institutes of health; (b) a federal national institutes of health cooperative group or center; (c) the federal department of defense; (d) the federal food and drug administration in the form of an investigational new drug application; (e) the federal department of veterans affairs; or (f) a qualified research entity that meets the criteria established by the federal national institutes of health for grant eligibility; (5) the clinical trial is being provided as part of a cancer clinical trial; (6) the proposed clinical trial or study has been reviewed and approved by an institutional review board that has an active federal-wide assurance of protection for human subjects; (7) the personnel providing the clinical trial or conducting the study: (a) are providing the clinical trial or conducting the study within their scope of practice, experience and training and are capable of providing the clinical trial because of their experience, training and volume of patients treated to maintain their expertise; (b) agree to accept reimbursement as payment in full from the health plan at the rates that are established by that plan and are not more than the level of reimbursement applicable to other similar services provided by health care providers within the plan's provider network; and (c) agree to provide written notification to the health plan when a patient enters or leaves a clinical trial; (8) there is no non-investigational treatment equivalent to the clinical trial; (9) the available clinical or preclinical data provide a reasonable expectation that the clinical trial will be at least as efficacious as any non-investigational alternative; and (10) there is a reasonable expectation based on clinical data that the medical treatment provided in the clinical trial will be at least as effective as any other medical treatment. B. Pursuant to the patient informed consent document, no third party is liable for damages associated with the treatment provided during a phase of a cancer clinical trial. C. If a patient is denied coverage of a cost and contends that the denial is in violation of this section, the patient may appeal the decision to deny the coverage of a cost to the superintendent, and that appeal shall be expedited to ensure resolution of the appeal within no more than thirty days after the date of appeal to the superintendent. Programs pursuant to Title 19 or Title 21 of the federal Social Security Act, which have their respective expedited appeal processes, shall be exempt from this subsection. D. A health plan shall not provide benefits that supplant a portion of a cancer clinical trial that is customarily paid for by government, biotechnical, pharmaceutical or medical device industry sources. E. The provisions of this section do not create a private right or cause of action for or on behalf of a patient against the health plan providing coverage. This section provides only an administrative remedy to the superintendent for violation of this section or a related rule promulgated by the superintendent. F. A health plan may impose deductibles, coinsurance requirements or other standard cost-sharing provisions on benefits provided pursuant to this section. G. In no event shall the health plan be responsible for out-of-state or out-of-network costs unless the health plan pays for standard treatment out of state or out of network. In no event shall the health plan be responsible for out-of-state costs for any trials undertaken for the purposes of the prevention of or the prevention of reoccurrence of cancer. H. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease contracts or policies issued by a health plan. I. As used in this section: (1) "clinical trial" means a course of treatment provided to a patient for the purpose of prevention, prevention of reoccurrence, early detection or treatment of cancer; (2) "cooperative group" means a formal network of facilities that collaborate on research projects and have an established federal national institutes of health-approved peer review program operating within the group; (3) "health plan": (a) means: 1) a health insurer; 2) a nonprofit health service provider; 3) a health maintenance organization; 4) a managed care organization; 5) a provider service organization; or 6) the state's medical assistance program, whether providing services on a managed care or fee-for-service basis; and (b) does not include individual policies intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident only, hospital indemnity or other limited-benefit health insurance policies; (4) "institutional review board" means a board, committee or other group that is both: (a) formally designated by an institution to approve the initiation of and to conduct periodic review of biomedical research involving human subjects and in which the primary purpose of the review is to assure the protection of the rights and welfare of the human subjects and not to review a clinical trial for scientific merit; and (b) approved by the federal national institutes of health for protection of the research risks; (5) "investigational drug or device" means a drug or device that has not been approved by the federal food and drug administration; (6) "federal-wide assurance of protection for human subjects" means a contract between an institution and the office for human research protections of the federal department of health and human services that defines the relationship of the institution to that department and sets out the responsibilities of the institution and the procedures that will be used by the institution to protect human subjects participating in clinical trials; (7) "patient" means an individual who participates in a cancer clinical trial and who is an insured, a member or a beneficiary of a health plan; and (8) "routine patient care cost": (a) means: 1) a medical service or treatment that is a benefit under a health plan that would be covered if the patient were receiving standard cancer treatment; or 2) a drug provided to a patient during a cancer clinical trial if the drug has been approved by the federal food and drug administration, whether or not that organization has approved the drug for use in treating the patient's particular condition, but only to the extent that the drug is not paid for by the manufacturer, distributor or provider of the drug; and (b) does not include: 1) the cost of an investigational drug, device or procedure; 2) the cost of a non-health care service that the patient is required to receive as a result of participation in the cancer clinical trial; 3) costs associated with managing the research that is associated with the cancer clinical trial; 4) costs that would not be covered by the patient's health plan if non-investigational treatments were provided; 5) costs of those extra tests that would not be performed except for participation in the cancer clinical trial; and 6) costs paid or not charged for by the cancer clinical trial providers. Laws 2001, ch. 27, § 1; 2002, ch. 30, § 1; 2009, ch. 212, § 2.

NMSA 1978, § 59A-22-44 Coverage for smoking cessation treatment

59A-22-44. Coverage for smoking cessation treatment A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered or issued for delivery in this state and that offers maternity benefits shall offer coverage for smoking cessation treatment. B. Coverage for smoking cessation treatment may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate. C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies. Laws 2003, ch. 337, § 1.

NMSA 1978, § 59A-22-45 Coverage of alpha-fetoprotein IV screening test

59A-22-45. Coverage of alpha-fetoprotein IV screening test An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in the state shall provide coverage for an alpha-fetoprotein IV screening test for pregnant women, generally between sixteen and twenty weeks of pregnancy, to screen for certain genetic abnormalities in the fetus. Laws 2004, ch. 122, § 3.

NMSA 1978, § 59A-22-46 Coverage of part-time employees

59A-22-46. Coverage of part-time employees An insurer that provides group health insurance pursuant to Chapter 59A, Article 22 NMSA 1978 shall make available, upon an employer's request prior to issuance, delivery or renewal, coverage for regular part-time employees who work or are expected to work an average of at least twenty hours per week over a six-month period. Nothing in this section shall be construed to require an employer to offer or provide coverage for regular part-time employees. Laws 2005, ch. 42, § 1.

NMSA 1978, § 59A-22-47 Coverage of colorectal cancer screening

59A-22-47. Coverage of colorectal cancer screening A. An individual or group health insurance policy, health care plan and certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for colorectal screening for determining the presence of precancerous or cancerous conditions and other health problems. The coverage shall make available colorectal cancer screening, as determined by the health care provider in accordance with the evidence-based recommendations established by the United States preventive services task force. B. Coverage for colorectal screening may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate. C. The provisions of this section shall not apply to short-term travel, accident-only or limited or specified-disease policies. Laws 2007, ch. 17, § 1.

NMSA 1978, § 59A-22-48 General anesthesia and hospitalization for dental surgery

59A-22-48. General anesthesia and hospitalization for dental surgery A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center for dental surgery for the following: (1) insureds exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results; (2) insureds for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy; (3) insured children or adolescents who are extremely uncooperative, fearful, anxious or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity; (4) insureds with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised; or (5) other procedures for which hospitalization or general anesthesia in a hospital or ambulatory surgical center is medically necessary. B. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies. C. Coverage for dental surgery may be subject to copayments, deductibles and coinsurance subject to network and prior authorization requirements consistent with those imposed on other benefits under the same policy, plan or certificate. Laws 2007, ch. 218, § 2.

NMSA 1978, § 59A-22-49 Coverage for autism spectrum disorder diagnosis and treatment

59A-22-49. Coverage for autism spectrum disorder diagnosis and treatment A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage to an insured for: (1) well-baby and well-child screening for diagnosing the presence of autism spectrum disorder; and (2) treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy and applied behavioral analysis. B. Coverage required pursuant to Subsection A of this section: (1) shall be limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan; (2) shall not be subject to annual or lifetime dollar limits; (3) shall not be denied on the basis that the services are habilitative or rehabilitative in nature; (4) may be subject to other general exclusions and limitations of the insurer's policy or plan, including coordination of benefits, participating provider requirements, restrictions on services provided by family or household members and utilization review of health care services, including the review of medical necessity, case management and other managed care provisions; and (5) may be limited to exclude coverage for services received under the federal Individuals with Disabilities Education Improvement Act of 2004 and related state laws that place responsibility on state and local school boards for providing specialized education and related services to children three to twenty-two years of age who have autism spectrum disorder. C. Coverage for treatment of autism spectrum disorder through speech therapy, occupational therapy, physical therapy and applied behavioral analysis shall not be denied to an insured on the basis of the insured's age. D. The coverage required pursuant to Subsection A of this section shall not be subject to deductibles or coinsurance provisions that are less favorable to an insured than the deductibles or coinsurance provisions that apply to physical illnesses that are generally covered under the individual or group health insurance policy, health care plan or certificate of health insurance, except as otherwise provided in Subsection B of this section. E. An insurer shall not deny or refuse to issue health insurance coverage for medically necessary services or refuse to contract with, renew, reissue or otherwise terminate or restrict health insurance coverage for an individual because the individual is diagnosed as having autism spectrum disorder. F. The treatment plan required pursuant to Subsection B of this section shall include all elements necessary for the health insurance plan to pay claims appropriately. These elements include: (1) the diagnosis; (2) the proposed treatment by types; (3) the frequency and duration of treatment; (4) the anticipated outcomes stated as goals; (5) the frequency with which the treatment plan will be updated; and (6) the signature of the treating physician. G. This section shall not be construed as limiting benefits and coverage otherwise available to an insured under a health insurance plan. H. The provisions of this section shall not apply to policies intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policies. I. As used in this section: (1) "autism spectrum disorder" means: (a) a condition that meets the diagnostic criteria for autism spectrum disorder published in the current edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American psychiatric association; or (b) a condition diagnosed as autistic disorder, Asperger's disorder, pervasive development disorder not otherwise specified, Rett's disorder or childhood disintegrative disorder pursuant to diagnostic criteria published in a previous edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American psychiatric association; (2) "habilitative or rehabilitative services" means treatment programs that are necessary to develop, maintain and restore to the maximum extent practicable the functioning of an individual; and (3) "high school" means a school providing instruction for any of the grades nine through twelve. Laws 2009, ch. 74, § 1; 2019, ch. 119, § 3.

NMSA 1978, § 59A-22-49.1 Coverage for orally administered anticancer medications; limits on patient costs

59A-22-49.1. Coverage for orally administered anticancer medications; limits on patient costs A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for cancer treatment shall provide coverage for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits by the plan. B. An insurer shall not increase patient cost-sharing for anticancer medications in order to achieve compliance with the provisions of this section. C. Coverage of orally administered anticancer medication shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medication used to kill or slow the growth of cancerous cells. D. As used in this section, "insurer" or "health plan": (1) means: (a) a health insurer; (b) a nonprofit health service provider; (c) a health maintenance organization; (d) a managed care organization; or (e) a provider service organization; and (2) does not include individual policies intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policies. Laws 2011, ch. 55, § 2.

NMSA 1978, § 59A-22-49.2 Coverage of prescription eye drop refills

59A-22-49.2. Coverage of prescription eye drop refills A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for prescription eye drops shall not deny coverage for a renewal of prescription eye drops when: (1) the renewal is requested by the insured at least twenty-three days for a thirty-day supply of eye drops, forty-five days for a sixty-day supply of eye drops or sixty-eight days for a ninety-day supply of eye drops from the later of the date that the original prescription was dispensed to the insured or the date that the last renewal of the prescription was dispensed to the insured; and (2) the prescriber indicates on the original prescription that additional quantities are needed and that the renewal requested by the insured does not exceed the number of additional quantities needed. B. As used in this section, "prescriber" means a person who is authorized pursuant to the New Mexico Drug, Device and Cosmetic Act [Chapter 26, Article 1 NMSA 1978] to prescribe prescription eye drops. Laws 2012, ch. 27, § 2.

NMSA 1978, § 59A-22-49.3 Coverage for telemedicine services

59A-22-49.3. Coverage for telemedicine services A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for services provided via telemedicine to the same extent that the health insurance plan, policy or contract covers the same services when those services are provided via in-person consultation or contact. An insurer shall not impose any unique condition for coverage of services provided via telemedicine. B. An insurer shall not impose an originating-site restriction with respect to telemedicine services or distinguish between telemedicine services provided to patients in rural locations and those provided to patients in urban locations; provided that the provisions of this section shall not be construed to require coverage of an otherwise noncovered benefit. C. A determination by an insurer that health care services delivered through the use of telemedicine are not covered under the plan shall be subject to review and appeal pursuant to the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978]. D. The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section. E. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary. F. An insurer shall not limit coverage of services delivered via telemedicine only to those health care providers who are members of the health insurance plan, policy or contract provider network where no in-network provider is available and accessible, as availability and accessibility are defined in network adequacy standards issued by the superintendent. G. An insurer may charge a deductible, copayment, or coinsurance for a health care service delivered via telemedicine if it does not exceed the deductible, copayment or coinsurance applicable to a service delivered via in-person consultation or contact. H. An insurer shall not impose any annual or lifetime dollar maximum on coverage for services delivered via telemedicine, other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the health insurance plan, policy or contract, or impose upon any person receiving benefits pursuant to this section any copayment, coinsurance or deductible amounts, or any plan, policy or contract year, calendar year, lifetime or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the health insurance plan, policy or contract. I. An insurer shall reimburse for health care services delivered via telemedicine on the same basis and at least the same rate that the insurer reimburses for comparable services delivered via in-person consultation or contact. J. Telemedicine used to provide clinical services shall be encrypted and shall conform to state and federal privacy laws. K. The provisions of this section shall not apply to an individual policy, plan or contract intended to supplement major medical group-type coverage, such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy. L. As used in this section: (1) "consulting telemedicine provider" means a health care provider that delivers telemedicine services from a location remote from an originating site; (2) "health care provider" means a duly licensed hospital or other licensed facility, physician or other health care professional authorized to furnish health care services within the scope of the professional's license; (3) "in real time" means occurring simultaneously, instantaneously or within seconds of an event so that there is little or no noticeable delay between two or more events; (4) "originating site" means a place at which a patient is physically located and receiving health care services via telemedicine; (5) "store-and-forward technology" means electronic information, imaging and communication, including interactive audio, video and data communication, that is transferred or recorded or otherwise stored for asynchronous use; and (6) "telemedicine" means the use of telecommunications and information technology to provide clinical health care from a distance. "Telemedicine" allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications and information technology in real time or asynchronously, including the use of interactive simultaneous audio and video or store-and-forward technology, or remote patient monitoring and telecommunications in order to deliver health care services to a site where the patient is located, along with the use of electronic media and health information. "Telemedicine" allows patients in remote locations to access medical expertise without travel. Laws 2013, ch. 105, § 2; 2019, ch. 255, § 2.

NMSA 1978, § 59A-22-49.4 Prescription drugs; prohibited formulary changes; notice requirements

59A-22-49.4. Prescription drugs; prohibited formulary changes; notice requirements A. As of January 1, 2014, an individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides prescription drug benefits categorized or tiered for purposes of cost-sharing through deductibles or coinsurance obligations shall not make any of the following changes to coverage for a prescription drug within one hundred twenty days of any previous change to coverage for that prescription drug, unless a generic version of the prescription drug is available: (1) reclassify a drug to a higher tier of the formulary; (2) reclassify a drug from a preferred classification to a non-preferred classification, unless that reclassification results in the drug moving to a lower tier of the formulary; (3) increase the cost-sharing, copayment, deductible or co-insurance charges for a drug; (4) remove a drug from the formulary; (5) establish a prior authorization requirement; (6) impose or modify a drug's quantity limit; or (7) impose a step-therapy restriction. B. The insurer shall give the affected insured at least sixty days' advance written notice of the impending change when it is determined that one of the following modifications will be made to a formulary: (1) reclassification of a drug to a higher tier of the formulary; (2) reclassification of a drug from a preferred classification to a non-preferred classification, unless that reclassification results in the drug moving to a lower tier of the formulary; (3) an increase in the cost-sharing, copayment, deductible or coinsurance charges for a drug; (4) removal of a drug from the formulary; (5) addition of a prior authorization requirement; (6) imposition or modification of a drug's quantity limit; or (7) imposition of a step-therapy restriction for a drug. C. Notwithstanding the provisions of Subsections A and B of this section, the insurer may immediately and without prior notice remove a drug from the formulary if the drug: (1) is deemed unsafe by the federal food and drug administration; or (2) has been removed from the market for any reason. D. The insurer shall provide to each affected insured the following information in plain language regarding prescription drug benefits: (1) notice that the insurer uses one or more drug formularies; (2) an explanation of what the drug formulary is; (3) a statement regarding the method the insurer uses to determine the prescription drugs to be included in or excluded from a drug formulary; and (4) a statement of how often the insurer reviews the contents of each drug formulary. E. As used in this section: (1) "formulary" means the list of prescription drugs covered by a policy, plan or certificate of health insurance; and (2) "step therapy" means a protocol that establishes the specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular patient are to be prescribed. Laws 2013, ch. 138, § 2.

NMSA 1978, § 59A-22-50 Health insurers; direct services

59A-22-50. Health insurers; direct services A. A health insurer shall reimburse direct services as follows: (1) for small groups, at no less than eighty percent of aggregate premiums for all such products; and (2) for large groups, at no less than eighty-five percent of aggregate premiums for all such products. B. Reimbursement for direct services shall be determined based on services provided over the preceding three calendar years, but not earlier than calendar year 2010, as determined by reports filed with the office of superintendent of insurance. Reimbursement calculations shall include short-term plans, but exclude all other excepted benefits plans governed by the provisions of Chapter 59A, Article 23G NMSA 1978. C. For individually underwritten health care policies, plans or contracts, the superintendent shall establish, after notice and informal hearing, the level of reimbursement for direct services, as determined by the reports filed with the office of superintendent of insurance, as a percent of premiums. Additional informal hearings may be held at the superintendent's discretion. In establishing the level of reimbursement for direct services, the superintendent shall consider the costs associated with the individual marketing and medical underwriting of these policies, plans or contracts at a level not less than seventy-five percent of premiums. A health insurer writing these policies shall make reimbursement for direct services at a level not less than that level established by the superintendent pursuant to this subsection over the three calendar years preceding the date upon which that rate is established, but not earlier than calendar year 2010. Nothing in this subsection shall be construed to preclude a purchaser of one of these policies, plans or contracts from negotiating an agreement with a health insurer that requires a higher amount of premiums paid to be used for reimbursement for direct services. D. An insurer that fails to comply with the reimbursement requirements pursuant to this section shall issue a dividend or credit against future premiums to all policyholders in an amount sufficient to ensure that the benefits paid in the preceding three calendar years plus the amount of the dividends or credits are equal to the required direct services reimbursement level pursuant to Subsection A of this section for group health coverage and blanket health coverage or the required direct services reimbursement level pursuant to Subsection B of this section for individually underwritten health policies, contracts or plans for the preceding three calendar years. If the insurer fails to issue the dividend or credit in accordance with the requirements of this section, the superintendent shall enforce these requirements and may pursue any other penalties as provided by law, including general penalties pursuant to Section 59A-1-18 NMSA 1978. E. After notice and hearing, the superintendent may adopt and promulgate reasonable rules necessary and proper to carry out the provisions of this section. F. For the purposes of this section: (1) "direct services" means services rendered to an individual by a health insurer or a health care practitioner, facility or other provider, including case management, disease management, health education and promotion, preventive services, quality incentive payments to providers and any portion of an assessment that covers services rather than administration and for which an insurer does not receive a tax credit pursuant to the Medical Insurance Pool Act [Chapter 59A, Article 54 NMSA 1978]; provided, however, that "direct services" does not include care coordination, utilization review or management or any other activity designed to manage utilization or services; (2) "health insurer" means a person duly authorized to transact the business of health insurance in the state pursuant to the Insurance Code [Chapter 59A NMSA 1978], including a person that issues a short-term plan and a person that only issues an excepted benefit policy intended to supplement major medical coverage, including medicare supplement, vision, dental, disease-specific, accident-only or hospital indemnity-only insurance policies, or that only issues policies for long-term care or disability income; (3) "premium" means all income received from individuals and private and public payers or sources for the procurement of health coverage, including capitated payments, self-funded administrative fees, self-funded claim reimbursements, recoveries from third parties or other insurers and interests less any tax paid pursuant to the Insurance Premium Tax Act [7-40-1 to 7-40-10 NMSA 1978] and fees associated with participating in a health insurance exchange that serves as a clearinghouse for insurance; and (4) "short-term plan" means a nonrenewable health benefits plan covering a resident of the state, regardless of where the plan is delivered, that: (a) has a maximum specified duration of not more than three months after the effective date of the plan; (b) is issued only to individuals who have not been enrolled in a health benefits plan that provides the same or similar nonrenewable coverage from any health insurance carrier within the three months preceding enrollment in the short-term plan; and (c) is not an excepted benefit or combination of excepted benefits. Laws 2010, ch. 94, § 1; 2013, ch. 74, § 26; 2018, ch. 57, § 20; 2019, ch. 235, § 8; 2019, ch. 235, § 9; 2021, ch. 108, § 21.

NMSA 1978, § 59A-22-51 Dental insurance plan; dental fees not covered; severability

59A-22-51. Dental insurance plan; dental fees not covered; severability A. As used in this section: (1) "covered services" means dental care services for which a reimbursement is available under an enrollee's plan contract or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments or any other limitation; and (2) "dental insurance plan" means any policy of insurance that is issued by a health care service contractor that provides for coverage of dental services not in connection with a medical plan. B. No contract of any health care service contractor that covers any dental services and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the health care service contractor unless the dental services are covered services. C. A health care service contractor or other person providing third party administrator services shall not make available any providers in its dentist network to a plan that sets dental fees for any services except covered services. D. If any part or application of this section is held invalid, the remainder or its application to other situations or persons shall not be affected. Laws 2011, ch. 128, § 1.

NMSA 1978, § 59A-22-52 Prescription drug prior authorization protocols

59A-22-52. Prescription drug prior authorization protocols A. After January 1, 2014, a health insurer shall accept the uniform prior authorization form developed pursuant to Sections 2 [59A-2-9.8 NMSA 1978] and 3 [61-11-6.2 NMSA 1978] of this 2013 act as sufficient to request prior authorization for prescription drug benefits. B. No later than twenty-four months after the adoption of national standards for electronic prior authorization, a health insurer shall exchange prior authorization requests with providers who have e-prescribing capability. C. If a health insurer fails to use or accept the uniform prior authorization form or fails to respond within three business days upon receipt of a uniform prior authorization form, the prior authorization request shall be deemed to have been granted. D. As used in this section, "health insurer": (1) means: (a) a health insurer; (b) a nonprofit health service provider; (c) a health maintenance organization; (d) a managed care organization; or (e) a provider service organization; and (2) does not include: (a) a person that delivers, issues for delivery or renews an individual policy intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policy; (b) a physician or a physician group to which a health insurer has delegated financial risk for prescription drugs and that does not use a prior authorization process for prescription drugs; or (c) a health insurer or its affiliated providers if the health insurer owns and operates its pharmacies and does not use a prior authorization process for prescription drugs. Laws 2013, ch. 170, § 5.

NMSA 1978, § 59A-22-53 Pharmacy benefits; prescription synchronization

59A-22-53. Pharmacy benefits; prescription synchronization A. An individual health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides a prescription drug benefit shall allow an insured to fill or refill a prescription for less than a thirty-day supply of the prescription drug, and apply a prorated daily copayment or coinsurance for the fill or refill, if: (1) the prescribing practitioner or the pharmacist determines the fill or refill to be in the best interest of the insured; (2) the insured requests or agrees to receive less than a thirty-day supply of the prescription drug; and (3) the reduced fill or refill is made for the purpose of synchronizing the insured's prescription drug fills. B. An individual health insurance policy, health care plan or certificate of health insurance that offers a prescription drug benefit shall not: (1) deny coverage for the filling of a chronic medication when the fill is made in accordance with a plan to synchronize multiple prescriptions for the insured pursuant to Subsection A of this section established among the insurer, the prescribing practitioner and a pharmacist. The insurer shall allow a pharmacy to override any denial indicating that a prescription is being refilled too soon for the purposes of medication synchronization; and (2) prorate a dispensing fee to a pharmacy that fills a prescription with less than a thirty-day supply of prescription drug pursuant to Subsection A of this section. The insurer shall pay in full a dispensing fee for a partially filled or refilled prescription for each prescription dispensed, regardless of any prorated copayment or coinsurance that the insured may pay for prescription synchronization services. Laws 2015, ch. 65, § 3.

NMSA 1978, § 59A-22-53.1 Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions

59A-22-53.1. Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions A. Each individual health insurance policy, health care plan and certificate of health insurance delivered or issued for delivery in this state that provides a prescription drug benefit for which any step therapy protocols are required shall establish clinical review criteria for those step therapy protocols. The clinical review criteria shall be based on clinical practice guidelines that: (1) recommend that the prescription drugs subject to step therapy protocols be taken in the specific sequence required by the step therapy protocol; (2) are developed and endorsed by an interdisciplinary panel of experts that manages conflicts of interest among the members of the panel of experts by: (a) requiring members to: 1) disclose any potential conflicts of interest with insurers, health maintenance organizations, health care plans, pharmacy benefits managers and any other entities; and 2) recuse themselves if there is a conflict of interest; and (b) using analytical and methodological experts to work to provide objectivity in data analysis and ranking of evidence through the preparation of evidence tables and facilitating consensus; (3) are based on high-quality studies, research and medical practice; (4) are created pursuant to an explicit and transparent process that: (a) minimizes bias and conflicts of interest; (b) explains the relationship between treatment options and outcomes; (c) rates the quality of the evidence supporting recommendations; and (d) considers relevant patient subgroups and preferences; and (5) take into account the needs of atypical patient populations and diagnoses. B. In the absence of clinical guidelines that meet the requirements of Subsection A of this section, peer-reviewed publications may be substituted. C. When a health insurance policy, health care plan or certificate of insurance restricts coverage of a prescription drug for the treatment of any medical condition through the use of a step therapy protocol, an insured and the practitioner prescribing the prescription drug shall have access to a clear, readily accessible and convenient process to request a step therapy exception determination. An insurer may use its existing medical exceptions process in accordance with the provisions of Subsections D through I of this section to satisfy this requirement. The process shall be made easily accessible for insureds and practitioners on the insurer's publicly accessible website. D. An insurer shall expeditiously grant an exception to the health insurance policy's, health care plan's or certificate of insurance's step therapy protocol, based on medical necessity and a clinically valid explanation from the patient's prescribing practitioner as to why a drug on the health insurance policy's, health care plan's or certificate of insurance's formulary that is therapeutically equivalent to the prescribed drug should not be substituted for the prescribed drug, if: (1) the prescription drug that is the subject of the exception request is contraindicated or will likely cause an adverse reaction by or physical or mental harm to the patient; (2) the prescription drug that is the subject of the exception request is expected to be ineffective based on the known clinical characteristics of the patient and the known characteristics of the prescription drug regimen; (3) while under the insured's current health insurance policy, health care plan or certificate of insurance, or under the insured's previous health coverage, the insured has tried the prescription drug that is the subject of the exception request or another prescription drug in the same pharmacologic class or with the same mechanism of action as the prescription drug that is the subject of the exception request and that prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect or an adverse event; or (4) the prescription drug required pursuant to the step therapy protocol is not in the best interest of the patient, based on clinical appropriateness, because the patient's use of the prescription drug is expected to: (a) cause a significant barrier to the patient's adherence to or compliance with the patient's plan of care; (b) worsen a comorbid condition of the patient; or (c) decrease the patient's ability to achieve or maintain reasonable functional ability in performing daily activities. E. Upon the granting of an exception to a health insurance policy's, health care plan's or certificate of insurance's step therapy protocol, an insurer shall authorize coverage for the prescription drug that is the subject of the exception request for no less than the duration of the therapeutic effect of the drug. An insurer shall include in its evidence of coverage language describing an insured's rights pursuant to this subsection. F. An insurer shall respond with its decision on an insured's exception request within seventy-two hours of receipt. In cases where exigent circumstances exist, an insurer shall respond within twenty-four hours of receipt of the exception request. In the event the insurer does not respond to an exception request within the time frames required pursuant to this subsection, the exception request shall be granted. G. An insurer's denial of a request for an exception for step therapy protocols shall be subject to review and appeal pursuant to the Patient Protection Act [Chapter 59A, Article 57 NMSA 1978]. H. After an insured has made an exception request in accordance with the provisions of this section, an insurer shall authorize continued coverage of a prescription drug that is the subject of the exception request pending the determination of the exception request. I. The provisions of this section shall not be construed to prevent: (1) a health insurance policy, health care plan or certificate of insurance from requiring a patient to try a biosimilar, interchangeable biologic or generic equivalent of a prescription drug before providing coverage for the equivalent brand-name prescription drug; or (2) a practitioner from prescribing a prescription drug that the practitioner has determined to be medically necessary. J. The superintendent shall promulgate rules as may be necessary to appropriately implement the provisions of this section. K. Nothing in this section shall be interpreted to interfere with the superintendent's authority to regulate prescription drug coverage benefits under other state and federal law. L. As used in this section, "medical necessity" or "medically necessary" means health care services determined by a practitioner, in consultation with the insurer, to be appropriate or necessary, according to: (1) any applicable, generally accepted principles and practices of good medical care; (2) practice guidelines developed by the federal government or national or professional medical societies, boards or associations; or (3) any applicable clinical protocols or practice guidelines developed by the insurer consistent with federal, national and professional practice guidelines. These standards shall be applied to decisions related to the diagnosis or direct care and treatment of a physical or behavioral health condition, illness, injury or disease. Laws 2018, ch. 9, § 3; 2024, ch. 42, § 3.

NMSA 1978, § 59A-22-53.2 Pharmacist prescriptive authority services; reimbursement parity

59A-22-53.2. Pharmacist prescriptive authority services; reimbursement parity An insurer shall reimburse a participating provider that is a certified pharmacist clinician or pharmacist certified to provide a prescriptive authority service who provides a service pursuant to a health insurance plan, policy or certificate of health insurance at the standard contracted rate that the health insurance policy, health care plan or certificate of health insurance reimburses, for the same service pursuant to that policy, plan or certificate, any licensed physician or physician assistant licensed pursuant to the Medical Practice Act [Chapter 41, Article 5 NMSA 1978] or any advanced practice certified nurse practitioner licensed pursuant to the Nursing Practice Act [Chapter 61, Article 3 NMSA 1978]. Laws 2020, ch. 58, § 3; 2021, ch. 54, § 11.

NMSA 1978, § 59A-22-53.3 Calculating an insured's cost-sharing obligation for prescription drug coverage

59A-22-53.3. Calculating an insured's cost-sharing obligation for prescription drug coverage A. When calculating an insured's cost-sharing obligation for covered prescription drugs, pursuant to an individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state, the insurer shall credit the insured for the full value of any discounts provided or payments made by third parties at the time of the prescription drug claim. B. Beginning on or after January 1, 2024, an insurer shall not charge a different cost-sharing amount for: (1) prescription drugs or pharmacy services obtained at a non-affiliated pharmacy; or (2) administration of prescription drugs at different infusion sites; provided that an insurer may communicate with an insured regarding lower-cost sites of service. C. Beginning on or after January 1, 2024, an insurer shall not require an insured to make a payment at the point of sale for a covered prescription drug in an amount greater than the least of the: (1) applicable cost-sharing amount for the prescription drug; (2) amount an insured would pay for the prescription drug if the insured purchased the prescription drug without using a health benefits plan or any other source of prescription drug benefits or discounts; (3) total amount the pharmacy will be reimbursed for the prescription drug from the insurer, including the cost-sharing amount paid by an insurer; or (4) value of the rebate from the manufacturer provided to the insurer or its pharmacy benefits manager for the prescribed drug. D. Beginning on or after January 1, 2024, if a prescription drug rebate is more than the amount needed to reduce the insured's copayment to zero on a particular drug, the remainder shall be credited to the insurer. E. Beginning on or after January 1, 2024, any rebate amount shall be counted toward the insured's out-of-pocket prescription drug costs. F. For purposes of this section, "cost sharing" means any: (1) copayment; (2) coinsurance; (3) deductible; (4) out-of-pocket maximum; (5) other financial obligation, other than a premium or share of a premium; or (6) combination thereof. G. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans, tax-favored plans or high-deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law. Laws 2023, ch. 206, § 3.

NMSA 1978, § 59A-22-54 Provider credentialing; requirements; deadline

59A-22-54. Provider credentialing; requirements; deadline A. The superintendent shall adopt and promulgate rules to provide for a uniform and efficient provider credentialing process. The superintendent shall approve no more than two forms of application to be used for the credentialing of providers. B. An insurer shall not require a provider to submit information not required by a credentialing application established pursuant to Subsection A of this section. C. The provisions of this section apply equally to initial credentialing applications and applications for recredentialing. D. The rules that the superintendent adopts and promulgates shall require primary credential verification no more frequently than every three years and allow provisional credentialing for a period of one year. E. Nothing in this section shall be construed to require an insurer to credential or provisionally credential a provider. F. The rules that the superintendent adopts and promulgates shall establish that an insurer or an insurer's agent shall: (1) assess and verify the qualifications of a provider applying to become a participating provider within thirty calendar days of receipt of a complete credentialing application and issue a decision in writing to the applicant approving or denying the credentialing application; (2) be permitted to extend the credentialing period to assess and issue a determination by an additional fifteen calendar days if, upon review of a complete application, it is determined that the circumstance presented, including an admission of sanctions by the state licensing board, investigation or felony conviction, revocation of clinical privileges or denial of insurance coverage, requires additional consideration; (3) within ten working days after receipt of a credentialing application, send a written notification, via United States certified mail, to the applicant requesting any information or supporting documentation that the insurer requires to approve or deny the credentialing application. The notice to the applicant shall include a complete and detailed description of all of the information or supporting documentation required and the name, address and telephone number of a person who serves as the applicant's point of contact for completing the credentialing application process. Any information required pursuant to this section shall be reasonably related to the information in the application; and (4) no later than thirty calendar days as described in Paragraph (1) of this subsection or an additional fifteen days as described in Paragraph (2) of this subsection, load into the insurer's provider payment system all provider information, including all information needed to correctly reimburse a newly approved provider according to the provider's contract. The insurer or insurer's agent shall add the approved provider's data to the provider directory upon loading the provider's information into the insurer's provider payment system. G. An insurer shall reimburse a provider for covered health care services for any claims from the provider that the insurer receives with a date of service more than thirty calendar days after the date on which the insurer received a complete credentialing application for that provider if: (1) the provider: (a) has submitted a complete credentialing application and any supporting documentation that the insurer has requested in writing within the time frame established in Paragraph (3) of Subsection F of this section; (b) has no past or current license sanctions or limitations, as reported by the New Mexico medical board or another pertinent licensing and regulatory agency, or by a similar out-of-state licensing and regulatory entity for a provider licensed in another state; and (c) has professional liability insurance or is covered under the Medical Malpractice Act [Chapter 41, Article 5 NMSA 1978]; and (2) the insurer: (a) has approved, or has failed to approve or deny, the applicant's complete credentialing application within the time frame established pursuant to Paragraph (1) or (2) of Subsection F of this section; or (b) fails to load the approved applicant's information into the insurer's provider payment system in accordance with Paragraph (4) of Subsection F of this section. H. A provider who, at the time services were rendered, was not employed by a practice or group that has contracted with the insurer to provide services at specified rates of reimbursement shall be paid by the insurer in accordance with the insurer's standard reimbursement rate. I. A provider who, at the time services were rendered, was employed by a practice or group that has contracted with the insurer to provide services at specified rates of reimbursement shall be paid by the insurer in accordance with the terms of that contract. J. The superintendent shall adopt and promulgate rules to provide for the resolution of disputes relating to reimbursement and credentialing arising in cases where credentialing is delayed beyond thirty days after application. K. An insurer shall reimburse a provider pursuant to Subsections G, H and I of this section until the earlier of the following occurs: (1) the insurer's approval or denial of the provider's complete credentialing application; or (2) the passage of three years from the date the insurer received the provider's complete credentialing application. L. As used in this section: (1) "credentialing" means the process of obtaining and verifying information about a provider and evaluating that provider when that provider seeks to become a participating provider; and (2) "provider" means a physician or other individual licensed or otherwise authorized to furnish health care services in a state. Laws 2015, ch. 111, § 1; 2016, ch. 20, § 2; 2023, ch. 175, § 1.

NMSA 1978, § 59A-22-55 Coverage exclusion. (Contingent repeal. See note.)

59A-22-55. Coverage exclusion. (Contingent repeal. See note.) Coverage of vasectomy and male condoms pursuant to Section 3 [59A-22-42 NMSA 1978] of this 2019 act is excluded for high-deductible individual and group health insurance policies, health care plans or certificates of insurance with health savings accounts delivered or issued for delivery in this state until an insured's deductible has been met. Laws 2019, ch. 263, § 4.

NMSA 1978, § 59A-22-56 Physical rehabilitation services; limits on cost sharing

59A-22-56. Physical rehabilitation services; limits on cost sharing A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall not impose a member cost share for physical rehabilitation services that is greater than that for primary care services on a coinsurance percentage basis when coinsurance is applied or on an absolute dollar amount when a copay is applied. B. As used in this section: (1) "physical rehabilitation services" means services aimed at maximizing an individual's level of function, returning to a prior level of function or maintaining or slowing the decline of function, which services are provided by or under the direction of a licensed physical therapist, occupational therapist or speech therapist; and (2) "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate. Laws 2019, ch. 188, § 2.

NMSA 1978, § 59A-22-57 Behavioral health services; elimination of cost sharing

59A-22-57. Behavioral health services; elimination of cost sharing A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that offers coverage of behavioral health services shall not impose cost sharing on those behavioral health services. B. For the purposes of this section: (1) "behavioral health services" means professional and ancillary services for the treatment, habilitation, prevention and identification of mental illnesses, substance abuse disorders and trauma spectrum disorders, including inpatient, detoxification, residential treatment and partial hospitalization, intensive outpatient therapy, outpatient therapy and all medications, including brand-name pharmacy drugs when generics are unavailable; (2) "coinsurance" means a cost-sharing method that requires the insured to pay a stated percentage of medical expenses after any deductible amount is paid; provided that coinsurance rates may differ for different types of services under the same individual or group health insurance policy, health care plan or certificate of health insurance; (3) "copayment" means a cost-sharing method that requires the insured to pay a fixed dollar amount when health care services are received, with the insurer paying the balance of the allowable amount; provided that there may be different copayment requirements for different types of services under the same individual or group health insurance policy, health care plan or certificate of health insurance; and (4) "cost sharing" means a copayment, coinsurance, deductible or any other form of financial obligation of the insured other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health insurance policy, health care plan or certificate of health insurance. C. The provisions of this section do not apply to excepted benefit plans as provided under the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978], catastrophic plans as defined under 42 USCA Section 18022(e) or high-deductible health plans with health savings accounts until an insured's deductible has been met, unless otherwise permitted by federal law. Laws 2021, ch. 136, § 6; 2025, ch. 115, § 2.

NMSA 1978, § 59A-22-58 Anatomical gift nondiscrimination

59A-22-58. Anatomical gift nondiscrimination A. For purposes of this section: (1) "covered person" means a policyholder or other person covered by a health benefit plan; and (2) "organ transplant" includes parts or the whole of organs, eyes or tissue. B. All individual and group health insurance policies delivered or issued for delivery in this state that provide coverage for organ transplants and associated care shall not: (1) deny that coverage solely on the basis of a covered person's physical or mental disability; (2) deny to a covered person with a physical or mental disability eligibility or continued eligibility to enroll or to renew coverage under the terms of the health benefit policy or plan solely for the purpose of avoiding the requirements of this section; (3) penalize or otherwise reduce or limit the reimbursement or provide monetary or nonmonetary incentives to a health care provider to induce that health care provider not to provide an organ transplant or associated care to a covered person with a physical or mental disability; or (4) reduce or limit coverage benefits to a covered person with a physical or mental disability for the associated care related to organ transplantation as determined in consultation with the physician and patient. Laws 2023, ch. 171, § 3.

NMSA 1978, § 59A-22-59 Chiropractic physician services; limits on cost sharing and coinsurance

59A-22-59. Chiropractic physician services; limits on cost sharing and coinsurance A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that offers coverage of the services of a chiropractic physician shall not impose a copayment or coinsurance on those chiropractic physician services that exceeds the copayment or coinsurance imposed for primary care services. B. As used in this section, "primary care services" means the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiation of referrals for other health care services and maintenance of the continuity of care when appropriate. C. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies. Laws 2023, ch. 51, § 2.

NMSA 1978, § 59A-22-60 Sexually transmitted infection care; cost sharing eliminated

59A-22-60. Sexually transmitted infection care; cost sharing eliminated A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that offers coverage for preventive care or treatment of sexually transmitted infections shall not impose cost sharing on insureds. B. Pursuant to this section, preventive care or treatment of sexually transmitted infections shall not be conditioned upon the gender identity of the insured. C. The provisions of Subsection A of this section do not apply to high-deductible health care plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law. D. For the purposes of this section: (1) "cost sharing" means policy deductibles, copayments or coinsurance; (2) "preventive care" means screening, testing, examination or counseling and the administration, dispensing or prescribing of preventive drugs, devices or supplies incidental to the prevention of a sexually transmitted infection; (3) "sexually transmitted infection" means chlamydia, syphilis, gonorrhea, HIV and relevant types of hepatitis, as well as any other sexually transmitted infection regardless of mode of transportation, as designated by rule upon making a finding that the particular sexually transmitted infection is contagious; and (4) "treatment" means medically necessary care for the management of an existing sexually transmitted infection. Laws 2023, ch. 99, § 2.

NMSA 1978, § 59A-22-61 Biomarker testing coverage

59A-22-61. Biomarker testing coverage A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for insureds to receive biomarker testing for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of an insured's disease or condition when the test is supported by medical and scientific evidence. B. Coverage provided pursuant to this section shall be for the purposes of diagnosis, treatment, appropriate management or ongoing monitoring of an insured's disease or condition when the test is supported by medical and scientific evidence, including: (1) labeled indications for a United States food and drug administration-approved or -cleared test; (2) indicated tests for a United States food and drug administration-approved drug; (3) warnings and precautions on United States food and drug administration labels; (4) federal centers for medicare and medicaid services national coverage determinations or medicare administrative contractor local coverage determinations; or (5) nationally recognized clinical practice guidelines. C. An individual or group health policy, health care plan or certificate of health insurance providing coverage for biomarker testing pursuant to this section shall ensure that: (1) coverage is provided in a manner that limits disruptions in care, including coverage for multiple biopsies or biospecimen samples; and (2) a patient and a practitioner who prescribe biomarker testing have clear, accessible and convenient processes to request an appeal of a benefit denial by the insurer and that those processes are accessible on the insurer's website. D. Coverage for biomarker testing may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate. E. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies, plans or certificates of health insurance. F. As used in this section: (1) "biomarker" means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes or pharmacologic responses to a specific therapeutic intervention, including known gene-drug interactions for medications being considered for use or already being administered. "Biomarker" includes gene mutations, characteristics of genes or protein expression; (2) "biomarker testing" means analysis of a patient's tissue, blood or other biospecimen for the presence of a biomarker and includes single-analyte tests, multi-plex panel tests, protein expression and whole exome, whole genome and whole transcriptome sequencing; and (3) "nationally recognized clinical practice guidelines" means evidence-based clinical practice guidelines that are: (a) developed by independent organizations or medical professional societies using a transparent methodology and reporting structure and with a conflict-of-interest policy; and (b) used to establish standards of care informed by a systematic review of evidence and an assessment of the benefits and risks of alternative care options and include recommendations intended to optimize patient care. Laws 2023, ch. 138, § 3.

NMSA 1978, § 59A-22-62 Medical necessity and nondiscrimination standards for coverage of prosthetic devices, custom orthotic devices or complex rehabilitation technology devices

59A-22-62. Medical necessity and nondiscrimination standards for coverage of prosthetic devices, custom orthotic devices or complex rehabilitation technology devices A. An individual health plan that is delivered, issued for delivery or renewed in this state that offers coverage for prosthetic devices, custom orthotic devices or complex rehabilitation technology devices shall consider these benefits habilitative or rehabilitative benefits for purposes of any state or federal requirement for coverage of essential health benefits. B. When performing a utilization review for a request for coverage of prosthetic device, custom orthotic device or complex rehabilitation technology device benefits, an insurer shall apply the most recent version of evidence-based treatment and fit criteria as recognized by relevant clinical specialists or their organizations. Such standards may be named by the superintendent in rule. C. An insurer shall render utilization review determinations in a nondiscriminatory manner and shall not deny coverage for habilitative or rehabilitative benefits, including prosthetic devices, custom orthotic devices or complex rehabilitation technology devices, solely on the basis of an insured's actual or perceived disability. D. An insurer shall not deny a prosthetic device, a custom orthotic device or a complex rehabilitation technology device benefit for a person with limb loss, limb absence or mobility limitation that would otherwise be covered for a non-disabled person seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity. E. An individual health plan that is delivered, issued for delivery or renewed in this state that offers coverage for prosthetic devices, custom orthotic devices or complex rehabilitation technology devices shall include language describing an insured's rights pursuant to Subsections C and D of this section in its evidence of coverage and any benefit denial letters. F. Prosthetic device, custom orthotic device or complex rehabilitation technology device coverage shall not be subject to separate financial requirements that are applicable only with respect to that coverage. An individual health plan may impose cost sharing on prosthetic devices, custom orthotic devices or complex rehabilitation technology devices; provided that any cost-sharing requirements shall not be more restrictive than the cost-sharing requirements applicable to the plan's coverage for inpatient physician and surgical services. G. An individual health plan that provides coverage for services related to prosthetic devices, custom orthotic devices or complex rehabilitation technology devices shall ensure access to medically necessary clinical care and to prosthetic devices, custom orthotic devices or complex rehabilitation technology devices and technology from not less than two distinct prosthetic device, custom orthotic device or complex rehabilitation technology device providers in the plan's provider network located in the state. In the event that medically necessary covered prosthetic devices, custom orthotic devices or complex rehabilitation technology devices are not available from an in-network provider, the insurer shall provide processes to refer an insured to an out-of-network provider and shall fully reimburse the out-of-network provider at a mutually agreed upon rate less insured cost sharing determined on an in-network basis. H. If coverage for prosthetic devices, custom orthotic devices or complex rehabilitation technology devices is provided, payment shall be made for the replacement of a prosthetic device, a custom orthotic device or a complex rehabilitation technology device or for the replacement of any part of such devices, without regard to continuous use or useful lifetime restrictions, if an ordering health care provider determines that the provision of a replacement device, or a replacement part of such a device, is necessary because of any of the following: (1) a change in the physiological condition of the patient; (2) an irreparable change in the condition of the device or in a part of the device; or (3) the condition of the device or the part of the device requires repairs, and the cost of such repairs would be more than sixty percent of the cost of a replacement device or of the part being replaced. I. Covered benefits for prosthetic devices and custom orthotic devices shall provide for more than one prosthetic device or custom orthotic device when medically necessary, but shall include no more than three prosthetic devices or custom orthotic devices per affected limb per covered person; provided that if after three years, a prosthetic device or custom orthotic device is no longer the appropriate device to meet the insured's needs for the insured's preferred physical activity, coverage and payment for new or replacement devices shall not be limited to three prosthetic or custom orthotic devices per affected limb per covered person. An individual health plan shall cover: (1) the most appropriate prosthetic device or custom orthotic device determined to be medically necessary by the insured's treating physician and associated medical providers to restore or maintain the ability to complete activities of daily living or essential job-related activities. This coverage shall include all services and supplies necessary for the effective use of a prosthetic device or a custom orthotic device, including: (a) formulation of the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments; (b) all materials and components necessary to use the device; (c) instructing the insured in the use of the device; and (d) the repair and replacement of the device; (2) a prosthetic device or a custom orthotic device determined by the insured's provider to be the most appropriate model that meets the medical needs of the insured for performing physical activities, including running, biking and swimming, and to maximize the insured's upper limb function. This coverage shall include all services and supplies necessary for the effective use of a prosthetic device or a custom orthotic device, including: (a) formulation of the device's design, fabrication, material and component selection, measurements, fittings and static and dynamic alignments; (b) all materials and components necessary to use the device; (c) instructing the insured in the use of the device; and (d) the repair and replacement of the device; and (3) a prosthetic device or custom orthotic device determined by the insured's prosthetic or orthotic care provider to be the most appropriate prosthetic device or custom orthotic device that meets the medical needs of the insured for purposes of showering or bathing. J. Coverage for complex rehabilitation technology devices shall be based on an insured's specific medical, physical, functional and environmental needs and capacities to engage in normal life activities and shall allow an insured to obtain more than one complex rehabilitation technology device, but no more than two complex rehabilitation technology devices per covered person; provided that if after three years, a complex rehabilitation technology device is no longer the appropriate device to meet the insured's needs for the insured's preferred physical activity, coverage and payment for new or replacement devices shall not be limited to two complex rehabilitation technology devices per covered person. An individual health plan shall cover: (1) complex rehabilitation technology devices for daily use that meets the insured's mobility and positioning needs; (2) complex rehabilitation technology devices to enable the insured to participate in physical activities necessary to achieve or maintain health goals; and (3) all services and supplies necessary for the effective use of a complex rehabilitation technology device, including: (a) configuring, fitting, programming, adjusting or adapting the particular device for use by a person, including the formulation of the device's design, fabrication, material and component selection and measurements; (b) all materials and components necessary to use the device; (c) instructing the insured in the use of the device; and (d) the repair and replacement of the device. K. A complex rehabilitation technology device that is a manual or power wheelchair shall only be covered pursuant to this section if the: (1) insured has undergone a complex rehabilitation technology device evaluation conducted by a licensed physical therapist or occupational therapist who has no financial relationship with the supplier of the complex rehabilitation technology device; and (2) complex rehabilitation technology device is provided by a complex rehabilitation technology device supplier that: (a) employs at least one assistive technology professional certified by the rehabilitation engineering and assistive technology society of North America who specialized in seating, positioning and mobility and has direct, in-person involvement in the wheelchair selection for the insured; and (b) makes at least one qualified complex rehabilitation technology device service technician available in each service area served by the supplier to service and repair devices that are furnished by the supplier. L. Confirmation from a prescribing health care provider may be required if the prosthetic device, custom orthotic device or complex rehabilitation technology device or part being replaced is less than three years old. M. The provisions of this section do not apply to excepted benefits plans subject to the Short-Term Health Plan and Excepted Benefit Act [Chapter 59A, Article 23G NMSA 1978]. N. As used in this section, "complex rehabilitation technology device" means a subset of durable medical equipment that: (1) consists of complex rehabilitation manual and power wheelchairs and mobility devices, including specialized seating and positioning items, options and accessories; (2) is designed, manufactured, configured, adjusted or modified for a specific person to meet that person's unique medical, physical, functional and environmental needs and capacities; (3) is generally not useful to a person in the absence of a disability, illness, injury or other medical condition; and (4) requires specialized services to ensure appropriate use of the item, including: (a) an evaluation of the features and functions necessary to assist the person who will use the device; or (b) configuring, fitting, programming, adjusting or adapting the particular device for use by a person. Laws 2023, ch. 196, § 3; 2026, ch. 41, § 3.

Source: New Mexico Compilation Commission (nmonesource.com)URL: https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.doFetched: 10/20/2026