New Mexico Statutes
Article 23 - Group and Blanket Health Insurance Contracts
Section 59A-23-3.1 - Group insurance reports required.

A. At least quarterly, upon request by the employer, each insurer who has delivered or issued for delivery a policy of group insurance covering twenty-six or more employees, all or a portion of the premiums for which is paid by the employer of the insureds, shall submit to the employer a financial summary report by coverage of expenses incurred by or on behalf of the employees of that employer since the last report. The report shall include the number and amount of monthly paid claims, monthly covered lives and an accounting of reserves and retention costs.
B. Upon request by the employer, each insurer shall provide to the employer claims information that provides sufficient detail, subject to state and federal privacy laws, to enable the employer to obtain and compare group health insurance rates from multiple insurers or establish a plan of self-insurance.
C. The report and claims information required by this section shall be provided within thirty days from the date of request.
History: 1978 Comp., § 59A-23-3.1, enacted by Laws 1985, ch. 167, § 1; 1987, ch. 281, § 2; 1993, ch. 164, § 1; 2007, ch. 53, § 1.
The 2007 amendment, effective June 15, 2007, required insurers to provide claims experience information to employers to permit the employer to obtain and compare group health care rates and coverage from other carriers.
The 1993 amendment, effective June 18, 1993, substituted "twenty-six" for "fifty" in the first sentence, inserted "and amount" in the second sentence, and deleted former Subsection B, relating to submission to the employer of premium and claim data 180 days after expiration of a policy covering more than 24 but less than 50 employees for which all or a portion of the premium is paid by the employer.

Structure New Mexico Statutes

New Mexico Statutes

Chapter 59A - Insurance Code

Article 23 - Group and Blanket Health Insurance Contracts

Section 59A-23-1 - Scope of article.

Section 59A-23-2 - Blanket health insurance.

Section 59A-23-3 - Group health insurance.

Section 59A-23-3.1 - Group insurance reports required.

Section 59A-23-4 - Other provisions applicable.

Section 59A-23-5 - Extended disability benefit.

Section 59A-23-6 - Alcohol dependency coverage.

Section 59A-23-6.1 - Coverage of alpha-fetoprotein IV screening test.

Section 59A-23-6.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.

Section 59A-23-7 - Blanket or group health policy or certificate; provisions relating to individuals who are eligible for medical benefits under the medicaid program.

Section 59A-23-7.2 - Coverage of children.

Section 59A-23-7.3 - Maximum age of dependent.

Section 59A-23-7.4 - Coverage of circumcision for newborn males.

Section 59A-23-7.5 - Coverage of part-time employees.

Section 59A-23-7.6 - Coverage of colorectal cancer screening.

Section 59A-23-7.7 - General anesthesia and hospitalization for dental surgery.

Section 59A-23-7.8 - Hearing aid coverage for children required.

Section 59A-23-7.9 - Coverage for autism spectrum disorder diagnosis and treatment.

Section 59A-23-7.10 - Coverage for orally administered anticancer medications; limits on patient costs.

Section 59A-23-7.11 - Coverage of prescription eye drop refills.

Section 59A-23-7.12 - Coverage for telemedicine services.

Section 59A-23-7.13 - Prescription drugs; prohibited formulary changes; notice requirements.

Section 59A-23-7.14 - Coverage for contraception.

Section 59A-23-7.15 - Coverage exclusion. (Contingent repeal. See note.)

Section 59A-23-7.16 - Heart artery calcium scan coverage.

Section 59A-23-8 - Group formed to purchase health insurance; limitations.

Section 59A-23-9 - Repealed.

Section 59A-23-10 - Employer utilization and loss data availability.

Section 59A-23-11 - Private health insurance cooperatives; incorporation.

Section 59A-23-12 - Prescription drug prior authorization protocols.

Section 59A-23-12.1 - Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.

Section 59A-23-12.2 - Pharmacist prescriptive authority services; reimbursement parity.

Section 59A-23-13 - Pharmacy benefits; prescription synchronization.

Section 59A-23-14 - Provider credentialing; requirements; deadline.

Section 59A-23-15 - Physical rehabilitation services; limits on cost sharing.

Section 59A-23-16 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)