A. An individual or group health maintenance organization contract delivered, issued for delivery or renewed in this state shall provide coverage for a hearing aid and any related service for the full cost of one hearing aid per hearing-impaired ear up to two thousand two hundred dollars ($2,200) every thirty-six months for hearing aids for insured children under eighteen years of age or under twenty-one years of age if still attending high school. The insured may choose a higher priced hearing aid and may pay the difference in cost above the two-thousand-two-hundred-dollar ($2,200) limit as provided in this subsection without financial or contractual penalty to the insured or to the provider of the hearing aid.
B. An insurer that delivers, issues for delivery or renews in this state an individual or group health maintenance organization contract may make available to the policyholder the option of purchasing additional hearing aid coverage that exceeds the services described in this section.
C. Hearing aid coverage offered shall include fitting and dispensing services, including providing ear molds as necessary to maintain optimal fit, provided by an audiologist, a hearing aid dispenser or a physician, licensed in New Mexico. A health maintenance organization has the discretion to determine the provider of hearing aids with which it contracts. Nothing in this section shall be construed to preclude a health maintenance organization from conducting medical necessity or utilization review for hearing aids and related services.
D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies.
E. Coverage for hearing aids may be subject to deductibles and coinsurance consistent with those imposed on other benefits under the same policy, plan or certificate.
F. For the purposes of this section, "hearing aid" means durable medical equipment that is of a design and circuitry to optimize audibility and listening skills in the environment commonly experienced by children.
History: Laws 2007, ch. 356, § 4.
Effective dates. — Laws 2007, ch. 356, § 6 made this section effective July 1, 2007.
Structure New Mexico Statutes
Article 46 - Health Maintenance Organizations
Section 59A-46-1 - Short title.
Section 59A-46-2 - Definitions.
Section 59A-46-3 - Establishment of health maintenance organizations.
Section 59A-46-4 - Issuance of certificate of authority.
Section 59A-46-5 - Powers of health maintenance organizations.
Section 59A-46-6 - Fiduciary responsibilities; fidelity bond.
Section 59A-46-7 - Quality assurance program.
Section 59A-46-8 - Requirements for group contract, individual contract and evidence of coverage.
Section 59A-46-9 - Annual report.
Section 59A-46-10 - Information to enrollees or subscribers.
Section 59A-46-11 - Grievance procedures.
Section 59A-46-12 - Investments.
Section 59A-46-13 - Protection against insolvency.
Section 59A-46-14 - Uncovered expenditures insolvency deposit.
Section 59A-46-15 - Enrollment period; replacement coverage in the event of insolvency.
Section 59A-46-16 - Filing requirements for rating information.
Section 59A-46-17 - Regulation of health maintenance organization insurance producers.
Section 59A-46-18 - Powers of insurers.
Section 59A-46-19 - Examinations.
Section 59A-46-20 - Suspension or revocation of certificate of authority.
Section 59A-46-21 - Rehabilitation, liquidation or conservation of health maintenance organizations.
Section 59A-46-22 - Summary orders and supervision.
Section 59A-46-22.1 - Repealed.
Section 59A-46-23 - Regulations.
Section 59A-46-25 - Penalties and enforcement.
Section 59A-46-26 - Filings and reports as public documents.
Section 59A-46-26.1 - Employer utilization and loss experience availability.
Section 59A-46-27 - Confidentiality of medical information and limitation of liability.
Section 59A-46-28 - Authority to contract.
Section 59A-46-30 - Statutory construction and relationship to other laws.
Section 59A-46-31 - Coordination of benefits.
Section 59A-46-32 - Continuation of coverage and conversion rights; health care plans.
Section 59A-46-32.1 - Recompiled.
Section 59A-46-33 - Governing body.
Section 59A-46-34 - Prohibited practices.
Section 59A-46-35 - Provider discrimination prohibited.
Section 59A-46-36 - Doctor of oriental medicine; discrimination prohibited.
Section 59A-46-37 - Coverage for adopted children.
Section 59A-46-38 - Newly born children coverage.
Section 59A-46-38.1 - Coverage of children.
Section 59A-46-38.2 - Childhood immunization coverage required.
Section 59A-46-38.3 - Maximum age of dependent.
Section 59A-46-38.4 - Coverage of circumcision for newborn males.
Section 59A-46-38.5 - Hearing aid coverage for children required.
Section 59A-46-39 - Maternity transport required.
Section 59A-46-40 - Home health care service option required.
Section 59A-46-41 - Coverage for mammograms.
Section 59A-46-41.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 59A-46-42 - Coverage for cytologic and human papillomavirus screening.
Section 59A-46-42.1 - Coverage for the human papillomavirus vaccine.
Section 59A-46-43 - Coverage for individuals with diabetes.
Section 59A-46-43.2 - Coverage for medical diets for genetic inborn errors of metabolism.
Section 59A-46-44 - Coverage for contraception.
Section 59A-46-45 - Coverage for smoking cessation treatment.
Section 59A-46-46 - Coverage of alpha-fetoprotein IV screening test.
Section 59A-46-47 - Coverage of part-time employees.
Section 59A-46-48 - Coverage of colorectal cancer screening.
Section 59A-46-49 - General anesthesia and hospitalization for dental surgery.
Section 59A-46-50 - Coverage for autism spectrum disorder diagnosis and treatment.
Section 59A-46-50.2 - Coverage of prescription eye drop refills.
Section 59A-46-50.3 - Coverage for telemedicine services.
Section 59A-46-50.4 - Prescription drugs; prohibited formulary changes; notice requirements.
Section 59A-46-52 - Prescription drug prior authorization protocols.
Section 59A-46-52.2 - Pharmacist prescriptive authority services; reimbursement parity.
Section 59A-46-53 - Pharmacy benefits; prescription synchronization.
Section 59A-46-54 - Provider credentialing; requirements; deadline.
Section 59A-46-55 - Coverage exclusion. (Contingent repeal. See note below.)
Section 59A-46-56 - Physical rehabilitation services; limits on cost sharing.