Section 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 […]
Section 59A-22-57 – Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)
A. Until January 1, 2027, 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: […]
Section 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 […]
Section 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 […]
Section 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 […]
Section 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 […]
Section 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. History: Laws […]
Section 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 […]
Section 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 […]
Section 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 […]