A. The term "industrial health insurance" as used herein means sickness and accident insurance under individual policies for which the premium is payable weekly, and includes any such policy which covers sickness only or accident only.
B. Any insurer authorized to write health insurance in this state shall have the power to issue industrial health policies.
C. No policy of industrial health insurance may be delivered or issued for delivery in the state unless it has printed thereon the words "industrial policy."
D. Each such policy shall be subject to the provisions of this article except that no such policy shall be required to contain any of the policy provisions set forth in Sections 424 through 446 [59A-22-3 to 59A-22-25 NMSA 1978], inclusive, of this article, other than the provisions relating to the presence of a preexisting disease or physical condition; provided, however, that no such policy shall contain any provision relative to notice or proof of loss, or the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the superintendent is less favorable to the insured than would be permitted by such policy provisions; and provided further, that such policy may contain a provision that upon proper written request, a named beneficiary shall be designated in or by endorsement on the policy to receive the proceeds thereof on the death of the insured, and there shall be reserved to the insured the power to change the beneficiary at any time by written notice to the insurer at its home office, accompanied by the policy for endorsement of the change thereon by the insurer; the insurer shall have the right to refuse to designate a beneficiary if evidence satisfactory to the insurer of such beneficiary's insurable interest in the life of the insured is not furnished on request. Any such policy may provide in substance that any payment thereunder may be made to the insured or the insured's estate or to any relative by blood or connection by marriage of the insured, or, to the extent of such portion of any payment under the policy as may reasonably appear to the insurer to be due to such person, to any other person equitably entitled thereto by reason of having incurred expense occasioned by the maintenance or illness or burial of the insured; provided that, if the policy shall be in force at the death of the insured, the proceeds thereof shall be payable to the named beneficiary if living, but upon the expiration of fifteen (15) days after the death of the insured, unless proof of the claim in the manner and form required by the policy, accompanied by the policy for surrender, has theretofore been made by such beneficiary, the insurer may pay to any other person permitted by the policy.
History: Laws 1984, ch. 127, § 452.
Am. Jur. 2d, A.L.R. and C.J.S. references. — 46 C.J.S. Insurance §§ 1367, 1518.
Structure New Mexico Statutes
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-22-39 - Coverage for mammograms.
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-22-49.2 - 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-22-53.2 - 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.