New Mexico Statutes
Article 22 - Health Insurance Contracts
Section 59A-22-22 - Relation of earnings to insurance.

There may be a provision as follows:
If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthly earnings of the insured at the time disability commenced or his average monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever is the greater, the insurance company will be liable only for such proportionate amount of such benefits under this policy as the amount of such monthly earnings or such average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all such coverage upon the insured at the time such disability commences and for the return of such part of the premiums paid during such two years as shall exceed the pro rata amount of the premiums for the benefits actually paid hereunder; but this shall not operate to reduce the total monthly amount of benefits payable under all such coverage upon the insured below the sum of two hundred ($200.00) dollars, or the sum of the monthly benefits specified in such coverages, whichever is the lesser, not [nor] shall it operate to reduce benefits other than those payable for loss of time.
(The foregoing policy provision may be inserted only in a policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date of issue. The insurance company may, at its option, include in this provision a definition of "valid loss of time coverage," approved as to form by the superintendent, which definition shall be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, or to any other coverage the inclusion of which may be approved by the superintendent or any combination of such coverages. In the absence of such definition such term shall not include any coverage provided for such insured pursuant to any compulsory benefit statute (including any workmen's compensation or employer's liability statute) or benefits provided by union welfare plans or by employer or employee benefit organizations.)
History: Laws 1984, ch. 127, ยง 443.

Structure New Mexico Statutes

New Mexico Statutes

Chapter 59A - Insurance Code

Article 22 - Health Insurance Contracts

Section 59A-22-1 - Scope of article.

Section 59A-22-2 - Form and content of policy.

Section 59A-22-3 - Required provisions.

Section 59A-22-4 - Entire contract; changes.

Section 59A-22-5 - Time limit on certain defenses.

Section 59A-22-6 - Grace period.

Section 59A-22-7 - Reinstatement.

Section 59A-22-8 - Notice of claim.

Section 59A-22-9 - Claim forms.

Section 59A-22-10 - Proofs of loss.

Section 59A-22-11 - Time of payment of claims.

Section 59A-22-12 - Payment of claims.

Section 59A-22-13 - Physical examination and autopsy.

Section 59A-22-14 - Legal actions.

Section 59A-22-15 - Change of beneficiary.

Section 59A-22-16 - Optional provisions.

Section 59A-22-17 - Change of occupation.

Section 59A-22-18 - Misstatement of age.

Section 59A-22-19 - Other insurance in this insurance company.

Section 59A-22-20 - Insurance with other insurance companies.

Section 59A-22-21 - Insurance with other insurance companies [; alternative provision].

Section 59A-22-22 - Relation of earnings to insurance.

Section 59A-22-23 - Unpaid premium.

Section 59A-22-24 - Cancellation.

Section 59A-22-25 - Conformity with state statutes.

Section 59A-22-26 - Order of certain policy provisions.

Section 59A-22-27 - Third party ownership.

Section 59A-22-28 - Requirements of other jurisdictions.

Section 59A-22-29 - Conforming to statute.

Section 59A-22-30 - Age limit.

Section 59A-22-30.1 - Maximum age of dependent.

Section 59A-22-31 - Industrial health insurance.

Section 59A-22-32 - Freedom of choice of hospital and practitioner.

Section 59A-22-32.1 - Freedom of choice.

Section 59A-22-33 - Children with disabilities; coverage continued.

Section 59A-22-34 - Newly born children coverage.

Section 59A-22-34.1 - Coverage for adopted children.

Section 59A-22-34.2 - Coverage of children.

Section 59A-22-34.3 - Childhood immunization coverage required.

Section 59A-22-34.4 - Coverage of circumcision for newborn males.

Section 59A-22-34.5 - Hearing aid coverage for children required.

Section 59A-22-35 - Maternity transport required.

Section 59A-22-36 - Home health care service option required.

Section 59A-22-37 - Repealed.

Section 59A-22-38 - Individual health insurance; policy provisions relating to individuals who are eligible for medical benefits under the medicaid program.

Section 59A-22-39 - Coverage for mammograms.

Section 59A-22-39.1 - Mastectomies and lymph node dissection; minimum hospital stay coverage required.

Section 59A-22-39.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

Section 59A-22-40 - Coverage for cytologic and human papillomavirus screening.

Section 59A-22-40.1 - Coverage for the human papillomavirus vaccine.

Section 59A-22-41 - Coverage for individuals with diabetes.

Section 59A-22-41.1 - Coverage for medical diets for genetic inborn errors of metabolism.

Section 59A-22-42 - Coverage for prescription contraceptive drugs or devices.

Section 59A-22-43 - Required coverage of patient costs incurred in cancer clinical trials.

Section 59A-22-44 - Coverage for smoking cessation treatment.

Section 59A-22-45 - Coverage of alpha-fetoprotein IV screening test.

Section 59A-22-46 - Coverage of part-time employees.

Section 59A-22-47 - Coverage of colorectal cancer screening.

Section 59A-22-48 - General anesthesia and hospitalization for dental surgery.

Section 59A-22-49 - Coverage for autism spectrum disorder diagnosis and treatment.

Section 59A-22-49.1 - Coverage for orally administered anticancer medications; limits on patient costs.

Section 59A-22-49.2 - Coverage of prescription eye drop refills.

Section 59A-22-49.3 - Coverage for telemedicine services.

Section 59A-22-49.4 - Prescription drugs; prohibited formulary changes; notice requirements.

Section 59A-22-50 - Health insurers; direct services.

Section 59A-22-51 - Dental insurance plan; dental fees not covered; severability.

Section 59A-22-52 - Prescription drug prior authorization protocols.

Section 59A-22-53 - Pharmacy benefits; prescription synchronization.

Section 59A-22-53.1 - Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.

Section 59A-22-53.2 - Pharmacist prescriptive authority services; reimbursement parity.

Section 59A-22-54 - Provider credentialing; requirements; deadline.

Section 59A-22-55 - Coverage exclusion. (Contingent repeal. See note.)

Section 59A-22-56 - Physical rehabilitation services; limits on cost sharing.

Section 59A-22-57 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)