A. No health care plan shall make health care expense payments unless and until it has obtained from the superintendent a certificate of authority to do business. Violation of this provision shall constitute a misdemeanor punishable upon conviction by a fine of not to exceed one thousand dollars ($1,000).
B. A newly formed health care plan's application for initial certificate of authority must be filed with the superintendent prior to expiration of one year from date of issuance of the preliminary permit referred to in Section 59A-47-6 NMSA 1978.
C. The application for certificate of authority shall be in the form prescribed and furnished by the superintendent consistent with Chapter 59A, Article 47 NMSA 1978, and be verified by two of the applicant's officers. The application shall include or be accompanied by such proof as the superintendent may reasonably require that the applicant is qualified for the certificate of authority under this article. At filing of the application the applicant shall pay to the superintendent the applicable filing fee as specified in Section 59A-6-1 NMSA 1978. The filing fee shall not be refundable.
D. No such certificate of authority shall be required for a health care plan formerly so authorized, to enable it to investigate and settle losses under its contracts lawfully written in New Mexico, or to liquidate assets and liabilities (other than collection of new premiums) resulting from its former authorized operations in this state. A health care plan not transacting new business in this state but continuing collection of premiums on and servicing contracts remaining in force as to residents of or risks located in this state, is transacting business in New Mexico for the purpose of premium tax requirements only and is not required to have a certificate of authority.
History: Laws 1984, ch. 127, § 879.6; 1999, ch. 133, § 4.
The 1999 amendment, effective June 18, 1999, subdivided former Subsection B into Subsections B and C; substituted "A newly formed" for "The" and "Section 59A-47-6 NMSA 1978" for "Section 879.4 of this article" in Subsection B; inserted "for certificate of authority", substituted "Chapter 59A, Article 47 NMSA 1978" for "this article", inserted "the" preceding "applicant's", and substituted "Section 59A-6-1 NMSA 1978" for "Section 101 (fee schedule) of the Insurance Code" in Subsection C, and redesignated former Subsection C as Subsection D.
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.