A. The pool shall be the last payer of benefits whenever any other benefit is available. Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance or health benefit plan, including a self-insured plan and by all hospital and medical expense benefits paid or payable under any workmen's compensation coverage, automobile medical payment or liability insurance, whether provided on the basis of fault or nonfault, and by any hospital or medical benefits paid or payable under or provided pursuant to any state or federal law program.
B. The administrator or the pool shall have a cause of action against an eligible person for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a set-off against any amount recoverable under this subsection.
History: 1978 Comp., § 59A-54-20, enacted by Laws 1987, ch. 154, § 20.
Structure New Mexico Statutes
Article 54 - Medical Insurance Pool
Section 59A-54-1 - Short title.
Section 59A-54-3 - Definitions.
Section 59A-54-4 - Pool created; board.
Section 59A-54-5 - Plan of operation.
Section 59A-54-6 - Notice of pool.
Section 59A-54-7 - Board; powers and duties.
Section 59A-54-7.1 - Prescription drug program; cost-sharing.
Section 59A-54-7.2 - Expansion of programs pursuant to federal law.
Section 59A-54-8 - Examination.
Section 59A-54-9 - Policy forms.
Section 59A-54-10 - Assessments.
Section 59A-54-11 - Pool administrator; selection; duties.
Section 59A-54-12 - Eligibility; policy provisions.
Section 59A-54-14 - Deductibles; coinsurance; maximum out-of-pocket payments.
Section 59A-54-15 - Dependent family member required coverage; employer responsibilities.
Section 59A-54-16 - Pool policy.
Section 59A-54-18 - Collective action.
Section 59A-54-19 - Rates; standard risk rate.