Section 59A-54-8 – Examination.
The pool shall be subject to and responsible for examination by the superintendent. Not later than June 1 of each year, the board shall submit to the superintendent an audited financial report for the preceding calendar year in a form approved by the superintendent. History: 1978 Comp., § 59A-54-8, enacted by Laws 1987, ch. 154, […]
Section 59A-54-9 – Policy forms.
All policy forms issued by the pool shall conform in substance to prototype forms developed by the pool and shall be filed with and approved by the superintendent before they are issued. History: 1978 Comp., § 59A-54-9, enacted by Laws 1987, ch. 154, § 9; 1991, ch. 200, § 6. ANNOTATIONS The 1991 amendment, effective […]
Section 59A-54-10 – Assessments.
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 […]
Section 59A-54-11 – Pool administrator; selection; duties.
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) […]
Section 59A-54-12 – Eligibility; policy provisions.
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 […]
Section 59A-54-13 – Benefits.
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 […]
Section 59A-54-14 – Deductibles; coinsurance; maximum out-of-pocket payments.
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 […]
Section 59A-54-1 – Short title.
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. […]
Section 59A-54-2 – Purpose.
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 […]
Section 59A-54-3 – Definitions.
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 […]