Section 59A-46-55 – Coverage exclusion. (Contingent repeal. See note below.)
Coverage of vasectomy and male condoms pursuant to Section 7 [59A-46-44 NMSA 1978] of this 2019 act is excluded for high-deductible individual or group health maintenance organization contracts with health savings accounts delivered or issued for delivery in this state until an enrollee’s deductible has been met. History: Laws 2019, ch. 263, § 8. ANNOTATIONS […]
Section 59A-46-56 – Physical rehabilitation services; limits on cost sharing.
A. An individual or group health maintenance contract 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 […]
Section 59A-46-57 – Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)
A. Until January 1, 2027, an individual or group health maintenance organization contract 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 […]
Section 59A-46-53 – Pharmacy benefits; prescription synchronization.
A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state and that provides prescription drug benefits shall allow an enrollee 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 […]
Section 59A-46-54 – 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. A carrier shall not require a provider to submit information not required by a credentialing application established […]
Section 59A-46-50 – Coverage for autism spectrum disorder diagnosis and treatment.
A. An individual or group health maintenance contract that is delivered, issued for delivery or renewed in this state shall provide coverage to an enrollee 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 […]
Section 59A-46-50.1 – Coverage for orally administered anticancer medications; limits on patient costs.
A. An individual or group health maintenance organization contract 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 […]
Section 59A-46-50.2 – Coverage of prescription eye drop refills.
A. An individual or group health maintenance organization contract 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 […]
Section 59A-46-50.3 – Coverage for telemedicine services.
A. An individual or group health maintenance organization contract 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 contract covers the same services when those services are provided via in-person consultation or contact. A carrier shall not impose any […]
Section 59A-46-50.4 – Prescription drugs; prohibited formulary changes; notice requirements.
A. As of January 1, 2014, an individual or group health maintenance organization contract 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 […]