New Mexico Statutes
Article 46 - Health Maintenance Organizations
Section 59A-46-49 - General anesthesia and hospitalization for dental surgery.

A. An individual or group health maintenance organization contract delivered, issued for delivery or renewed in this state shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center for dental surgery for the following:
(1) insureds exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results;
(2) insureds for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy;
(3) insured children or adolescents who are extremely uncooperative, fearful, anxious or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised; or
(5) other procedures for which hospitalization or general anesthesia in a hospital or ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies.
C. Coverage for dental surgery may be subject to copayments, deductibles and coinsurance subject to network and prior authorization requirements consistent with those imposed on other benefits under the same policy, plan or certificate.
History: Laws 2007, ch. 218, § 4.
Effective dates. — Laws 2007, ch. 218, § 6 made Laws 2007, ch. 218, § 4 effective July 1, 2007.

Structure New Mexico Statutes

New Mexico Statutes

Chapter 59A - Insurance Code

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-46-24 - Fees.

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-46-29 - Health maintenance organizations; contract or certificate provisions relating to individuals who are eligible for medical benefits under the medicaid program.

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-46-41.1 - Mastectomies and lymph node dissection; minimum hospital stay coverage required.

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-46-50.1 - Coverage for orally administered anticancer medications; limits on patient costs.

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-46-51 - Repealed.

Section 59A-46-52 - Prescription drug prior authorization protocols.

Section 59A-46-52.1 - Prescription drug coverage; step therapy protocols; clinical review criteria; exceptions.

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.

Section 59A-46-57 - Behavioral health services; elimination of cost sharing. (Effective January 1, 2022.)