A. A corporation may be organized under the laws of this state which provide for the organization of nonprofit corporations, as a nonprofit corporation organized for making health care expense payments on a service benefit basis or an indemnity basis, or both, for subscribers under contract with such corporation.
B. The articles of incorporation of each domestic health care plan shall have endorsed thereon or annexed thereto the consent of the superintendent prior to filing. The amendment of the articles of incorporation of any domestic health care plan shall have endorsed thereon or annexed thereto the consent of the superintendent prior to filing.
C. The directors of a domestic health care plan shall be chosen in accordance with the bylaws of the corporation, subject to the following:
(1) at least twenty-five percent of the directors shall be members of the general public; and
(2) the balance of the directors shall be either representatives of purveyors or members of the general public.
D. No domestic health care plan shall be converted into a corporation organized for pecuniary profit; and any such plan shall be maintained and operated primarily for the benefit of its subscribers.
E. A domestic health care plan may merge only with another domestic health care plan in accordance with applicable provisions of the Insurance Holding Company Law [Chapter 59A, Article 37 NMSA 1978] and the Nonprofit Corporation Act [Chapter 53, Article 8 NMSA 1978].
History: Laws 1984, ch. 127, § 879.2; 1999, ch. 133, § 2.
The 1999 amendment, effective June 18, 1999, added "Merger and Consolidation of Health Care Plans" in the section heading; inserted "domestic" throughout the section; rewrote former Subsection E which read: "No health care plan shall furnish or contract to furnish health care expense payments in this state unless organized under the laws of this state as above provided and so authorized to operate under the provisions of this article. No foreign health care plan may be authorized to conduct business in this state".
Law reviews. — For note, "Nonprofit Health Care Corporations Are Not Insurance Providers," see 10 N.M.L. Rev. 481 (1980).
Structure New Mexico Statutes
Article 47 - Nonprofit Health Care Plans
Section 59A-47-1 - Short title.
Section 59A-47-2 - Purpose; exemptions.
Section 59A-47-3 - Definitions.
Section 59A-47-5 - Qualifications for health care plan authority.
Section 59A-47-6 - Preliminary permit for solicitations.
Section 59A-47-7 - Escrow of preliminary premiums.
Section 59A-47-8 - Certificate of authority required; application and conditions; exceptions.
Section 59A-47-9 - Issuance and denial of initial certificate of authority.
Section 59A-47-10 - Trust deposit.
Section 59A-47-11 - Expiration, continuance of certificate of authority.
Section 59A-47-12 - Suspension, revocation or refusal to continue certificate of authority.
Section 59A-47-13 - Service of process; superintendent as attorney.
Section 59A-47-14 - Annual statement.
Section 59A-47-17 - Examination.
Section 59A-47-18 - Investments.
Section 59A-47-19 - Limitation upon acquisition and administration expenses.
Section 59A-47-20 - Conflicts of interest as to certain transactions.
Section 59A-47-21 - Joint coverage, reinsurance.
Section 59A-47-22 - Transfer of subscribership.
Section 59A-47-23 - Subscriber contracts; coverage period.
Section 59A-47-24 - Subscriber contracts; requirements and provisions.
Section 59A-47-25 - Subscriber contracts; filing, approval.
Section 59A-47-26 - Premium rates; filing and approval.
Section 59A-47-27 - Coverage for newly born children, maternity transport, home health care.
Section 59A-47-27.1 - Coverage of circumcision for newborn males.
Section 59A-47-28 - Coverage for service of chiropractor.
Section 59A-47-28.1 - Coverage for service of certified nurse-midwives and registered lay midwives.
Section 59A-47-28.2 - Doctor of oriental medicine discrimination prohibited.
Section 59A-47-28.3 - Provider discrimination prohibited.
Section 59A-47-28.4 - Coverage for collaborative practice; dental therapists; dental hygienists.
Section 59A-47-29 - Settlement of disputes; appeal.
Section 59A-47-31 - Rehabilitation, liquidation or dissolution.
Section 59A-47-32 - Unauthorized contract or adjustment transactions; penalty.
Section 59A-47-33 - Other provisions applicable.
Section 59A-47-34 - Continuation of coverage and conversion rights; health care plans.
Section 59A-47-35 - Alcohol dependency coverage.
Section 59A-47-37 - Coverage of children. (Effective July 1, 2020.)
Section 59A-47-37.1 - Hearing aid coverage for children required.
Section 59A-47-38 - Coverage for medical diets for genetic inborn errors of metabolism.
Section 59A-47-39 - Employer utilization and loss experience availability.
Section 59A-47-40 - Maximum age of dependent.
Section 59A-47-41 - Coverage of alpha-fetoprotein IV screening test.
Section 59A-47-41.1 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 59A-47-42 - Coverage of part-time employees.
Section 59A-47-43 - Coverage of colorectal cancer screening.
Section 59A-47-44 - General anesthesia and hospitalization for dental surgery.
Section 59A-47-45 - Coverage for autism spectrum disorder diagnosis and treatment.
Section 59A-47-45.2 - Coverage of prescription eye drop refills.
Section 59A-47-45.3 - Coverage for telemedicine services.
Section 59A-47-45.4 - Prescription drugs; prohibited formulary changes; notice requirements.
Section 59A-47-45.5 - Coverage for contraception.
Section 59A-47-45.6 - Coverage exclusion. (Contingent repeal. See note.)
Section 59A-47-45.7 - Heart artery calcium scan coverage.
Section 59A-47-47 - Prescription drug prior authorization protocols.
Section 59A-47-47.2 - Pharmacist prescriptive authority services; reimbursement parity.
Section 59A-47-48 - Pharmacy benefit; prescription synchronization.
Section 59A-47-49 - Provider credentialing; requirements; deadline.
Section 59A-47-50 - Physical rehabilitation services; limits on cost sharing.