Chapter 59A, Article 54 NMSA 1978 may be cited as the “Medical Insurance Pool Act”. Any reference in any law, rule, division bulletin or other legal document to the Comprehensive Health Insurance Pool Act shall be deemed to refer to the Medical Insurance Pool Act. History: 1978 Comp., § 59A-54-1, enacted by Laws 1987, ch. […]
A. Following the close of each fiscal year, the pool administrator shall determine the net premium, being premiums less administrative expense allowances, the pool expenses and claim expense losses for the year, taking into account investment income and other appropriate gains and losses. The assessment for each insurer shall be determined by multiplying the total […]
A. The board shall select a pool administrator through a competitive bidding process. The board shall evaluate bids based on criteria established by the board, which shall include: (1) proven ability to handle accident and health insurance; (2) efficiency of claim paying procedures; (3) an estimate of total charges for administering the plan; and (4) […]
A. Except as provided in Subsection B of this section, a person is eligible for a pool policy only if on the effective date of coverage or renewal of coverage the person is a New Mexico resident, and: (1) is not eligible as an insured or covered dependent for a health plan that provides coverage […]
A. The health insurance policy issued by the pool shall pay for medically necessary eligible health care services rendered or furnished for the diagnoses or treatment of illness or injury that exceed the deductible and coinsurance amounts applicable under Section 59A-54-14 NMSA 1978 and are not otherwise limited or excluded. Eligible expenses are the charges […]
A. Subject to the limitation provided in Subsection C of this section, a pool policy offered in accordance with the Medical Insurance Pool Act shall impose a deductible on a per-person calendar-year basis. Deductible plans of five hundred dollars ($500) and one thousand dollars ($1,000) shall initially be offered. The board may authorize deductibles in […]
A. An employer is authorized to make a payroll deduction from the compensation of an employee for the portion of the pool policy premium the employee is responsible for, and an employer shall contribute the same dollar amount of the cost of that policy on behalf of the employee that the employer contributes for other […]
A. A pool policy offered under the Medical Insurance Pool Act shall contain provisions under which the pool is obligated to renew the contract until the day on which the individual in whose name the contract is issued first becomes eligible for medicare coverage, except that in a family policy covering both husband and wife, […]
The superintendent shall: A. adopt rules that provide for disclosure by members of the pool of the availability of insurance coverage from the pool; B. adopt rules that implement the provisions of the Medical Insurance Pool Act; and C. adopt any other rules deemed necessary in order to carry out the provisions of the Medical […]
Neither the participation by insurers in the pool, the establishment of rates, forms or procedures for coverages issued by the pool nor any other joint or collective action required by the Medical Insurance Pool Act shall be the basis of any legal action, civil or criminal liability or penalty against the members of the pool […]
A. The pool shall determine a standard risk rate by actuarially calculating the individual rate that an insurer would charge for an individual policy with the pool benefits issued to a person who was a standard risk. Separate schedules of standard risk rates based on age and other appropriate demographic characteristics may be used. In […]
The purpose of the Medical Insurance Pool Act is to provide access to health insurance coverage to all residents of New Mexico who are denied adequate health insurance and are considered uninsurable. History: 1978 Comp., § 59A-54-2, enacted by Laws 1987, ch. 154, § 2; 2001, ch. 352, § 2. ANNOTATIONS The 2001 amendment, effective […]
A. The pool shall be the last payer of benefits whenever any other benefit is available. Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance or health benefit plan, including a self-insured plan and by all hospital and medical expense benefits paid or payable […]
The pool is exempt from payment of all fees and all taxes levied by this state or any of its political subdivisions. History: 1978 Comp., § 59A-54-21, enacted by Laws 1987, ch. 154, § 21.
As used in the Medical Insurance Pool Act: A. “board” means the board of directors of the pool; B. “creditable coverage” means, with respect to an individual, coverage of the individual pursuant to: (1) a group health plan; (2) health insurance coverage; (3) Part A or Part B of Title 18 of the Social Security […]
A. There is created a nonprofit entity to be known as the “New Mexico medical insurance pool”. All insurers shall organize and remain members of the pool as a condition of their authority to transact insurance business in this state. The board is a governmental entity for purposes of the Tort Claims Act [41-4-1 to […]
The plan of operation submitted by the board to the superintendent shall: A. establish procedures for the handling and accounting of assets and money of the pool; B. establish regular times and places for meetings of the board; C. establish procedures for records to be kept of all financial transactions and for annual fiscal reporting […]
A. Every insurer shall provide a notice and an application for coverage by the pool to any person who receives: (1) a rejection of coverage for health insurance or health care services; (2) a notice that the rate for health insurance or coverage for health care services provided will exceed the rates of a pool […]
The board shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact health insurance business. In addition, the board shall have the specific authority to: A. enter into contracts as are necessary or proper to carry out the provisions and purposes of the Medical Insurance […]
A. The board may establish a prescription drug program, in whole or in part, including a pilot or phase-in program, to offer selected eligible persons the ability to purchase prescription drugs. The board may establish varying levels of eligibility and cost-sharing criteria as needed for selected eligible persons and, if established, shall ensure that cost-containment […]
