SENATE BILL 371

47th legislature - STATE OF NEW MEXICO - first session, 2005

INTRODUCED BY

Phil A. Griego

AN ACT

RELATING TO INSURANCE; PROVIDING FOR ASSIGNMENT OF HEALTH CARE AND DENTAL CLAIMS.

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

     Section 1. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] ASSIGNMENT OF HEALTH CLAIMS.--

          A. Claims shall be paid on the basis of assignment to the purveyor of the health care. The purveyor shall not collect any payment from the subscriber except a copayment, coinsurance, deductible or other amount that the subscriber is liable for under the health care plan.

          B. A health care plan shall not refuse to honor an assignment of a claim. An insurance policy or contract issued or renewed after June 30, 2005 shall not contain a restriction on the subscriber's right to assign a claim to a purveyor of health care.

          C. Claims shall be paid pursuant to the Nonprofit Health Care Plan Law.

          D. As used in this section:

                (1) "assignment" means the transfer from a subscriber of the right to collect a claim payment to the purveyor who rendered the health care; and

                (2) "claim" means a demand for health care expense payment."

     Section 2. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] PURVEYOR DISCRIMINATION PROHIBITED-- LICENSED CLASS.--All individual and group subscriber contracts delivered or issued for delivery in New Mexico by a nonprofit health care plan that, on a service or indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall not contain any provisions that exclude a person licensed pursuant to the Dental Health Care Act and shall not discriminate in the reimbursement levels for same or similar services provided by other purveyors."

     Section 3. A new section of the Prepaid Dental Plan Law is enacted to read:

     "[NEW MATERIAL] ASSIGNMENT OF HEALTH CLAIMS.--

          A. Claims shall be paid on the basis of assignment to the provider of the prepaid dental services. The provider shall not collect any payment from the member except a copayment, coinsurance, deductible or other amount that the member is liable for under the membership coverage.

          B. A prepaid dental plan organization shall not refuse to honor an assignment of a claim. An insurance policy or contract issued or renewed after June 30, 2005 shall not contain a restriction on the member's right to assign a claim to a provider of prepaid dental services.

          C. Claims shall be paid pursuant to the Insurance Code.

          D. As used in this section:

                (1) "assignment" means the transfer from a member of the right to collect a claim payment to the provider who rendered the prepaid dental services; and

                (2) "claim" means a demand for prepaid dental services payment."

     Section 4. A new section of the Prepaid Dental Plan Law is enacted to read:

     "[NEW MATERIAL] PROVIDER DISCRIMINATION PROHIBITED--DENTAL HEALTH CARE.--All individual and group subscriber contracts delivered or issued for delivery in New Mexico by a prepaid dental plan that, on a service or indemnity basis, or both, provide for treatment of persons for the prevention, cure or correction of any illness or physical or mental condition shall not contain any provisions that exclude a person licensed pursuant to the Dental Health Care Act and shall not discriminate in the reimbursement levels for same or similar services provided by other providers."

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