Section 59A-58-6 – Security required for registration of provider.
A. To ensure the faithful performance of a provider’s obligations to the provider’s service contract holders, a provider shall comply with the requirements of one of the following: (1) maintain a deposit with the superintendent as provided in this paragraph: (a) a provider of a service contract shall deposit fifty thousand dollars ($50,000) unless the […]
Section 59A-58-7 – Transactions exempt from premium tax.
The premium tax imposed pursuant to Chapter 59A, Article 6 NMSA 1978 does not apply to any business transacted pursuant to the provisions of the Service Contract Regulation Act. History: Laws 2001, ch. 206, § 7. ANNOTATIONS Cross references. — For exemption of the Service Contract Regulation Act, see 59A-58-7 NMSA 1978. Effective dates. — […]
Section 59A-57A-7 – Nonparticipating providers; rebates and inducements; prohibition.
A nonparticipating provider shall not, either directly or indirectly, knowingly waive, rebate, give, pay or offer to waive, rebate, give or pay all or part of a cost-sharing amount owed by a covered person pursuant to the terms of the covered person’s health benefits plan as an inducement for the covered person to seek a […]
Section 59A-57A-8 – Health care provider reimbursement rates; surprise billing.
A. The superintendent shall convene appropriate stakeholders, including rural providers, insurers and consumer advocates, and review the reimbursement rate for surprise bills annually to ensure fairness to providers and to evaluate the impact on health insurance premiums and health benefits plan networks. B. Calculation of the date of health insurance carrier receipt of a claim […]
Section 59A-57A-9 – Reasonable health care cost management permitted.
Nothing in the Surprise Billing Protection Act shall be construed to prohibit a health insurance carrier from appropriately using reasonable health care cost management techniques. History: Laws 2019, ch. 227, § 9. ANNOTATIONS Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
Section 59A-57A-10 – Private cause of action.
Except as provided in Subsection C of Section 6 [59A-57A-6 NMSA 1978] of the Surprise Billing Protection Act, nothing in that act shall be construed to create or imply a private cause of action for a violation of that act. History: Laws 2019, ch. 227, § 10. ANNOTATIONS Effective dates. — Laws 2019, ch. 227, […]
Section 59A-57A-1 – Short title.
Sections 1 through 13 [59A-57A-1 to 59A-57A-13 NMSA 1978] of this act may be cited as the “Surprise Billing Protection Act”. History: Laws 2019, ch. 227, § 1. ANNOTATIONS Effective dates. — Laws 2019, ch. 227, § 16 made Laws 2019, ch. 227 effective January 1, 2020.
Section 59A-57A-2 – Definitions.
As used in the Surprise Billing Protection Act: A. “allowed amount” means the maximum portion of a billed charge that a health insurance carrier will pay, including any applicable covered person cost-sharing responsibility, for a covered health care service or item rendered by a participating provider or by a nonparticipating provider; B. “balance billing” means […]
Section 59A-57A-3 – Emergency care; reimbursement; limitation on charges.
A. A health insurance carrier shall reimburse a nonparticipating provider for emergency care necessary to evaluate and stabilize a covered person if a prudent layperson would reasonably believe that emergency care is necessary, regardless of eventual diagnosis. B. A health insurance carrier shall not require that prior authorization for emergency care be obtained by, or […]
Section 59A-57A-4 – Non-emergency care; limitation on charges.
A. Other than applicable cost sharing that would apply if a participating provider had rendered the same services, a health insurance carrier shall provide reimbursement for and a covered person shall not be liable for charges and fees for covered non-emergency care rendered by a nonparticipating provider that are delivered when: (1) the covered person […]