46th legislature - STATE OF NEW MEXICO - first session, 2003

RELATING TO INSURANCE; PROVIDING EMPLOYERS WITH INCREASED ACCESS TO UTILIZATION AND LOSS EXPERIENCE INFORMATION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

Section 1. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

"[NEW MATERIAL] EMPLOYER UTILIZATION AND LOSS DATA AVAILABILITY.--Claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 23 NMSA 1978 shall be made available only upon the request of and to employers of employees with such coverage within sixty days of an employer's written request for such information, provided the employer's coverage extends to no less than twenty-five individual employees, regardless of whether family coverage is included. In providing such utilization data, carriers shall not reveal information that allows identification of an individual employee or the employee's family or the specific conditions for which coverage was provided."

Section 2. A new section of Chapter 59A, Article 23B NMSA 1978 is enacted to read:

"[NEW MATERIAL] EMPLOYER UTILIZATION AND LOSS DATA AVAILABILITY.--Employer claims information, including utilization and loss experience under a health insurance policy or plan provided under Chapter 59A, Article 23B NMSA 1978 shall be made available only upon the request of and to employers of employees with such coverage within sixty days of an employer's written request for such information, provided the employer's coverage extends to no less than twenty-five individual employees, regardless of whether family coverage is included. In providing such utilization data, carriers shall not reveal information that allows identification of an individual insured or the insured's family or the specific conditions for which coverage was provided."

Section 3. A new section of Chapter 59A, Article 23C NMSA 1978 is enacted to read:

"[NEW MATERIAL] EMPLOYER UTILIZATION AND LOSS DATA AVAILABILITY.--Employer claims information, including utilization and loss experience under health insurance under a group health plan, a health benefit plan or a plan provided under Chapter 59A, Article 23C NMSA 1978 shall be made available only upon the request of and to employers of employees 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 employees, regardless of whether family coverage is included. In providing such utilization data, carriers shall not reveal information that permits identification of an individual insured or the insured's family or the specific conditions for which coverage was provided."

Section 4. A new section of Chapter 59A, Article 46 NMSA 1978 is enacted to read:

"[NEW MATERIAL] EMPLOYER UTILIZATION AND LOSS DATA AVAILABILITY.--Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 46 NMSA 1978 shall be made available only upon the 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."

Section 5. A new section of Chapter 59A, Article 47 NMSA 1978 is enacted to read:

"[NEW MATERIAL] EMPLOYER UTILIZATION AND LOSS DATA AVAILABILITY.--Employer claims information, including utilization and loss experience under health insurance provided under Chapter 59A, Article 47 NMSA 1978 shall be made available only upon the 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."