Section 59A-16-18 – Receipt of rebates and inducements; penalty.
Any person not a licensed agent, broker, solicitor or other representative, who at any time knowingly receives any rebate of any premium specified in any insurance policy or coverage, or any special favor or advantage of any kind or nature whatsoever not plainly designated in the policy, or receive any dividends or profits, except dividends […]
Section 59A-16-30 – Private right of action.
Any person covered by Chapter 59A, Article 16 NMSA 1978 who has suffered damages as a result of a violation of that article by an insurer or agent is granted a right to bring an action in district court to recover actual damages. Costs shall be allowed to the prevailing party unless the court otherwise […]
Section 59A-16-19 – Monopolistic practices prohibited.
No person shall enter into any agreement to commit, or by any concerted action commit, any act of boycott, coercion or intimidation resulting or tending to result in unreasonable restraint of, or monopoly in, the business of insurance in this state, or in the business of health care services, prepaid dental services, motor clubs or […]
Section 59A-16-20 – Unfair claims practices defined and prohibited.
Any and all of the following practices with respect to claims, by an insurer or other person, knowingly committed or performed with such frequency as to indicate a general business practice, are defined as unfair and deceptive practices and are prohibited: A. misrepresenting to insureds pertinent facts or policy provisions relating to coverages at issue; […]
Section 59A-16-20.1 – Homeowner’s casualty insurance; premium rate and policy; protection after natural disaster.
A. A homeowner’s casualty insurance policy shall not be canceled or denied renewal because of a homeowner’s claim made as a result of damages caused by a natural disaster to the homeowner’s private residence, provided that the homeowner’s policy expressly provides for such coverage. B. The provisions of this section apply to all insurance carriers […]
Section 59A-16-21 – Payment of claim by check, draft or electronic transfer; failure to pay; interest.
A. An insurer shall pay promptly claims arising under its policies with checks or drafts, or, if a claimant requests, may pay by electronic transfer of funds. Without amending other statutes dealing with checks, drafts or electronic transfer of funds, a resident of New Mexico is granted a cause of action for ten percent of […]
Section 59A-16-21.1 – Health plan requirements.
A. As used in this section: (1) “clean claim” means a manually or electronically submitted claim from an eligible provider that: (a) contains substantially all the required data elements necessary for accurate adjudication without the need for additional information from outside of the health plan’s system; (b) is not materially deficient or improper, including lacking […]
Section 59A-16-21.2 – Health benefits plans; prohibition; unlicensed health benefits plans; unapproved health benefits plans.
A. No person or entity shall sell or issue, or cause to be sold or issued, a health benefits plan that is unlicensed or unapproved for sale or delivery in the state. B. No person or entity shall sell or issue, or cause to be sold or issued, health insurance coverage that is not permitted […]
Section 59A-16-21.3 – Health care providers; surprise billing prohibited.
A. A provider shall not knowingly submit to a covered person a surprise bill for health care services, which surprise bill demands payment for any amount in excess of the cost-sharing amounts that would have been imposed by the covered person’s health benefits plan if the health care service from which the surprise bill arises […]
Section 59A-16-22 – Record of complaints required.
An insurer shall maintain a complete record of all complaints it has received during the next preceding three (3) years, or since date of last examination by the superintendent or other similar supervisory authority, whichever period is shorter. The record shall show the total number of complaints, classification by line of coverage, nature of each […]