2005 Senate Bill text for SB1061

SENATE BILL 1061

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

INTRODUCED BY

Sue Wilson Beffort

AN ACT

RELATING TO HEALTH INSURANCE; AMENDING THE NEW MEXICO INSURANCE CODE TO AUTHORIZE BASIC HEALTH COVERAGE TO BE AVAILABLE TO SMALL EMPLOYERS AND INDIVIDUALS.

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

Section 1. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

"[NEW MATERIAL] BASIC INDIVIDUAL HEALTH INSURANCE.--

A. In lieu of an individual health insurance policy containing those provisions otherwise required under the Insurance Code, each insurer that delivers or issues for delivery in this state an individual health insurance policy shall offer and make available a basic individual health insurance policy.

B. As used in this section, "basic individual health insurance policy" means a policy for individual health insurance issued pursuant to the provisions of Sections 59A-22-1 through 59A-22-32.1 NMSA 1978 and includes benefits provided pursuant to:

(1) Section 59A-22-33 NMSA 1978;

(2) Section 59A-22-34 NMSA 1978;

(3) Section 59A-22-34.1 NMSA 1978;

(4) Section 59A-22-34.2 NMSA 1978;

(5) Section 59A-22-34.3 NMSA 1978;

(6) Section 59A-22-39 NMSA 1978;

(7) Section 59A-22-39.1 NMSA 1978;

(8) Section 59A-22-40 NMSA 1978; and

(9) Section 59A-22-41 NMSA 1978.

C. A policy offered pursuant to Subsection B of this section shall not include benefits provided pursuant to:

(1) Section 59A-22-34.4 NMSA 1978;

(2) Section 59A-22-35 NMSA 1978;

(3) Section 59A-22-36 NMSA 1978;

(4) Section 59A-22-41.1 NMSA 1978;

(5) Section 59A-22-42 NMSA 1978;

(6) Section 59A-22-43 NMSA 1978;

(7) Section 59A-22-44 NMSA 1978;

(8) Section 59A-22-45 NMSA 1978; and

(9) any other provision of law that mandates coverage of specific health care services.

D. A policy offered pursuant to Subsection B of this section shall contain the following deductible provisions:

(1) self-only coverage with an annual deductible of not less than six hundred dollars ($600); and

(2) family coverage with an annual deductible of not less than one thousand two hundred dollars ($1,200)."

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

"[NEW MATERIAL] SMALL EMPLOYER OPTION--BASIC GROUP HEALTH INSURANCE.--

A. In lieu of a group health insurance policy containing those provisions otherwise required under the Insurance Code, each insurer that delivers or issues for delivery in this state a group health insurance policy shall offer and make available a basic group health insurance policy to a small employer for the benefit of the small employer's employees.

B. As used in this section, "basic group health insurance policy" means a policy for group health insurance pursuant to the provisions of Sections 59A-23-1 through 59A-23-5 NMSA 1978:

(1) to which the following provisions are not applicable:

(a) Section 59A-22-32 NMSA 1978;

(b) Section 59A-22-32.1 NMSA 1978;

(d) Section 59A-22-35 NMSA 1978;

(e) Section 59A-22-36 NMSA 1978;

(f) Section 59A-23-6 NMSA 1978;

(g) Section 59A-23E-18 NMSA 1978; and

(h) any other provision of law that mandates coverage of specific health care services; and

(2) that contains the following deductible provisions:

(a) self-only coverage with an annual deductible of not less than six hundred dollars ($600); and

(b) family coverage with an annual deductible of not less than one thousand two hundred dollars ($1,200).

C. As used in this section, "small employer" means any person, firm, corporation, partnership or association actively engaged in business that, on at least fifty percent of its working days during either of the two preceding years, employed no less than two and no more than ten eligible employees; provided that:

(1) in determining the number of eligible employees, the spouse or dependent of an employee may, at the employer's discretion, be counted as a separate employee;

(2) companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state income taxation shall be considered one employer; and

(3) in the case of an employer that was not in existence throughout a preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that it is reasonably expected to employ on working days in the current calendar year."

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

"[NEW MATERIAL] OTHER PROVISIONS APPLICABLE.--

A. A basic group health insurance policy or contract issued or delivered in this state pursuant to Section 2 of this act shall not contain a provision relative to notice or proof of loss or the time for paying benefits or the time within which suit may be brought upon the policy that in the superintendent's opinion is less favorable to the insured than would be permitted in the required or optional provisions for individual health insurance policies as set forth in Chapter 59A, Article 22 NMSA 1978.

B. Except for Subsection C of Section 59A-22-1 NMSA 1978, the following provisions of Chapter 59A, Articles 22 and 23 NMSA 1978 shall also apply to basic group health insurance contracts issued for delivery in this state:

(1) Sections 59A-22-1 through 59A-22-31 NMSA 1978;

(2) Section 59A-22-33 NMSA 1978;

(3) Section 59A-22-34 NMSA 1978;

(4) Section 59A-22-34.1 NMSA 1978;

(5) Section 59A-22-34.2 NMSA 1978;

(6) Section 59A-22-34.3 NMSA 1978;

(7) Section 59A-22-39 NMSA 1978;

(8) Section 59A-22-39.1 NMSA 1978;

(9) Section 59A-22-40 NMSA 1978;

(10) Section 59A-22-41 NMSA 1978;

(11) Section 59A-23-7 NMSA 1978; and

(12) Section 59A-23-7.2 NMSA 1978.

C. The following provisions of Chapter 59A, Articles 22 and 23 NMSA 1978 shall not apply as to basic group health insurance contracts:

(1) Section 59A-22-32 NMSA 1978;

(2) Section 59A-22-32.1 NMSA 1978;

(3) Section 59A-22-34.4 NMSA 1978;

(4) Section 59A-22-35 NMSA 1978;

(5) Section 59A-22-36 NMSA 1978;

(6) Section 59A-22-41.1 NMSA 1978;

(7) Section 59A-22-42 NMSA 1978;

(8) Section 59A-22-43 NMSA 1978;

(9) Section 59A-22-44 NMSA 1978;

(10) Section 59A-22-45 NMSA 1978; and

(11) Section 59A-23-6 NMSA 1978."

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

"[NEW MATERIAL] BASIC SERVICES.--

A. A health maintenance organization may deliver or offer to deliver a contract for basic services to individuals and small employers pursuant to Sections 59A-46-1 through 59A-46-34 NMSA 1978 and this section that includes benefits described in:

(1) Section 59A-46-37 NMSA 1978;

(2) Section 59A-46-38 NMSA 1978;

(3) Section 59A-46-38.1 NMSA 1978;

(4) Section 59A-46-38.2 NMSA 1978;

(5) Section 59A-46-41 NMSA 1978;

(6) Section 59A-46-41.1 NMSA 1978;

(7) Section 59A-46-42 NMSA 1978; and

(8) Section 59A-46-43 NMSA 1978.

B. Contracts delivered or offered for delivery pursuant to Subsection A of this section shall not contain benefits offered pursuant to the following sections:

(1) Section 59A-46-35 NMSA 1978;

(2) Section 59A-46-36 NMSA 1978;

(3) Section 59A-46-39 NMSA 1978; and

(4) Section 59A-46-40 NMSA 1978.

C. As used in this section:

(1) "basic services" means those basic health care services provided pursuant to Section 59A-46-8 NMSA 1978 and includes benefits required in Subsection A of this section; and

(2) "small employer" means any person, firm, corporation, partnership or association actively engaged in business that, on at least fifty percent of its working days during either of the two preceding years, employed no less than two and no more than ten eligible employees; provided that:

(a) in determining the number of eligible employees, the spouse or dependent of an employee may, at the employer's discretion, be counted as a separate employee;

(b) companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state income taxation shall be considered one employer; and

(c) in the case of an employer that was not in existence throughout a preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that it is reasonably expected to employ on working days in the current calendar year."

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

"[NEW MATERIAL] BASIC BENEFIT CONTRACT.--

A. A health care plan may deliver or offer to deliver a basic benefit contract to individuals or small employers to make health care payments pursuant to Sections 59A-47-1 through 59A-47-26, 59A-47-29 through 59A-47-34 and 59A-47-36 NMSA 1978 and for benefits provided pursuant to Sections 59A-47-27 and 59A-47-37 NMSA 1978.

B. Basic benefit contracts delivered or offered for delivery pursuant to this section shall not include benefits provided pursuant to the following sections:

(1) Section 59A-47-28 NMSA 1978;

(2) Section 59A-47-28.1 NMSA 1978;

(3) Section 59A-47-28.2 NMSA 1978;

(4) Section 59A-47-28.3 NMSA 1978; and

(5) Section 59A-47-35 NMSA 1978.

C. As used in this section:

(1) "basic benefit contract" means a contract to make health care payments pursuant to Subsections A and B of this section; and

(a) in determining the number of eligible employees, the spouse or dependent of an employee may, at the employer's discretion, be counted as a separate employee;

(b) companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state income taxation shall be considered one employer; and

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