SENATE CORPORATIONS AND TRANSPORTATION COMMITTEE SUBSTITUTE FOR
SENATE BILL 257
48th legislature - STATE OF NEW MEXICO - first session, 2007
AN ACT
RELATING TO HEALTH INSURERS; REQUIRING INSURERS TO PROVIDE CLAIMS EXPERIENCE INFORMATION TO EMPLOYERS.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. Section 59A-23-3.1 NMSA 1978 (being Laws 1985, Chapter 167, Section 1, as amended) is amended to read:
"59A-23-3.1. GROUP INSURANCE REPORTS REQUIRED.--
A. At least quarterly, upon request by the employer, each insurer who has delivered or issued for delivery a policy of group insurance covering twenty-six or more employees, all or a portion of the premiums for which is paid by the employer of the insureds, shall submit to the employer a financial summary report by coverage of expenses incurred by or on behalf of the employees of that employer since the last report. The report shall include the number and amount of monthly paid claims, monthly covered lives and an accounting of reserves and retention costs [together with such other information as the superintendent may require by regulation].
B. Upon request by the employer, each insurer shall provide to the employer claims information that provides sufficient detail to enable the employer to obtain and compare group health insurance rates from multiple insurers or establish a plan of self-insurance.
C. The report and claims information required by this section shall be provided with sufficient time to enable the employer to obtain and compare group health insurance rates from other insurers.
D. The superintendent shall promulgate rules to carry out the provisions of this section."
Section 2. Section 59A-46-26.1 NMSA 1978 (being Laws 2003, Chapter 252, Section 4) is amended to read:
"59A-46-26.1. EMPLOYER UTILIZATION AND LOSS [DATA] EXPERIENCE AVAILABILITY.--Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 46 NMSA 1978 shall be made available by the carrier only upon the written request of and to employers of enrollees with such coverage [within sixty days of an employer's written request for such information to the carrier], provided the employer's coverage extends to no less than twenty-five individual enrollees, regardless of whether family coverage is included. [In providing such utilization data, carriers shall not reveal information that permits identification of an individual enrollee or the enrollee's family or the specific conditions for which coverage was provided.] Each carrier shall provide to the employer claims information that provides sufficient detail to enable the employer to obtain and compare rates from multiple carriers or establish a plan of self-insurance. The report and claims information required by this section shall be provided with sufficient time to enable the employer to obtain and compare rates from other carriers. The superintendent shall promulgate rules to carry out the provisions of this section."
Section 3. Section 59A-47-39 NMSA 1978 (being Laws 2003, Chapter 252, Section 5) is amended to read:
"59A-47-39. EMPLOYER UTILIZATION AND LOSS [DATA] EXPERIENCE AVAILABILITY.--Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 47 NMSA 1978 shall be made available by the carrier only upon the written request of and to employers of subscribers with such coverage [within sixty days of an employer's written request to the carrier for such information], provided the employer's coverage extends to no less than twenty-five individual subscribers, regardless of whether family coverage is included. [In providing such utilization data, carriers shall not reveal information that permits identification of an individual subscriber or the subscriber's family or the specific conditions for which coverage was provided.] Each carrier shall provide to the employer claims information that provides sufficient detail to enable the employer to obtain and compare rates from multiple carriers or establish a plan of self-insurance. The report and claims information required by this section shall be provided with sufficient time to enable the employer to obtain and compare rates from other carriers. The superintendent shall promulgate rules to carry out the provisions of this section."
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