A. A newly-formed health care plan shall not solicit any subscriber or enter into any proposed contract for health care expense payments unless and until it obtains from the superintendent a preliminary permit to do so. The proposed health care plan shall file with the superintendent its application in writing for the permit in form as prescribed and furnished by the superintendent and calling for information as follows:
(1) name and business address of applicant;
(2) area of this state proposed to be served;
(3) names, residence addresses, occupations, business experience, biographical data, and such proof of identity as the superintendent may require of the incorporators, sponsors, directors, officers and proposed management personnel;
(4) health care coverage proposed to be provided and premium rates therefor, as shown by two (2) copies of proposed subscribers' contracts and premium rate schedules filed with the application;
(5) financial resources, present or prospective, of applicant; and
(6) such other information as to applicant's qualifications as the superintendent may reasonably require.
The application shall be accompanied by a copy of applicant's articles of incorporation and its bylaws, its current financial statement, and such other documentation as the form of application may require. Upon filing the application the applicant shall pay to the superintendent the filing fee specified therefor in Section 101 [59A-6-1 NMSA 1978] (fee schedule) of the Insurance Code.
B. If after such investigation of the applicant and its sponsors and personnel, and hearings held, as he deems advisable the superintendent finds that the applicant meets the qualifications stated in Section 879.3 [59A-47-5 NMSA 1978] of this article and is otherwise in compliance with this article, he shall issue a preliminary permit in appropriate terms; otherwise he shall deny the permit by his written order stating the reasons for the denial.
History: Laws 1984, ch. 127, ยง 879.4.
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.