Senate Bill text for SB0976

SENATE BILL 976

48th legislature - STATE OF NEW MEXICO - first session, 2007

INTRODUCED BY

Steve Komadina

AN ACT

RELATING TO HEALTH INSURANCE; ENACTING THE HEALTH INSURANCE EXCHANGE ACT; PROVIDING FOR POWERS AND DUTIES; PROVIDING FOR PARTICIPATING EMPLOYER PLANS AND PARTICIPATING INSURANCE PLANS; PROVIDING FOR ELIGIBILITY AND BENEFITS; PROVIDING FOR STATE RESIDENT PARTICIPATION; REPEALING THE HEALTH INSURANCE ALLIANCE ACT.

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

Section 1. SHORT TITLE.-This act may be cited as the "Health Insurance Exchange Act".

Section 2. DEFINITIONS.--As used in the Health Insurance Exchange Act:

A. "applicant" means an individual seeking to participate in the exchange;

B. "board" means the board of directors of the exchange;

C. "carrier" means a person or organization subject to the authority of the superintendent or the provisions of the New Mexico Insurance Code that provides one or more health benefit or insurance plans in the state;

D. "creditable coverage" means continual coverage of the applicant under any of the following health plans, with no lapse in coverage of more than sixty-three days immediately prior to the date of application; provided that "creditable coverage" does not include coverage consisting solely of coverage of excepted benefits:

(1) a group health plan;

(2) health insurance coverage;

(3) Part A or Part B of Title 18 of the Social Security Act;

(4) Title 19 or Title 21 of the Social Security Act;

(5) tricare, pursuant to Chapter 55 of Title 10, United States Code;

(6) a health care program of the Indian health service or of a tribal organization;

(7) the Medical Insurance Pool Act;

(8) the federal employees health benefits program pursuant to Chapter 89 of Title 5, United States Code;

(9) health coverage pursuant to Section 5(e) of the federal Peace Corps Act;

(10) a public health plan as defined by federal or state law or rule; or

(11) other qualifying coverage required by the federal Health Insurance Portability and Accountability Act of 1996;

E. "dependent" means the spouse of the principal insured or an individual that is related to the principal insured by birth, marriage or adoption and that meets the definition of a dependent pursuant to the federal Internal Revenue Code of 1986;

F. "eligible individual" means an individual that may participate in the exchange by reason of meeting one or more of the following qualifications:

(1) the individual is a resident of the state whereby the individual is and continues to be legally domiciled and physically residing on a full-time basis in a place of habitation in the state that remains the person's principal residence and from which the person is absent only for a temporary or transitory purpose;

(2) the individual is a full-time student attending an institution outside of the state but prior to attending the educational institution met the requirements of Paragraph (1) of this subsection;

(3) the individual is not a resident of the state but is employed, at least twenty hours per week on a regular basis, at a location within the boundaries of the state by a bona fide employer, and the individual's employer does not offer health coverage or the individual is not eligible to participate in any health coverage plan offered by the individual's employer;

(4) the individual, whether a resident or not, is enrolled in, or eligible to enroll in, a participating employer plan;

(5) the individual is self-employed in the state and if the individual is a nonresident self-employed individual, the individual's principal place of business is in the state;

(6) the individual is a full-time student attending an institution of higher education located in the state; or

(7) the individual, whether a resident or not, is a dependent of another individual who is an eligible individual;

G. "employer" means a person, partnership, association, corporation or business trust that employs one or more persons and files payroll tax information on its employees;

H. "excepted benefits" means:

(1) benefits not subject to requirements, including:

(a) coverage only for accident or disability income insurance;

(b) coverage issued as a supplement to liability insurance;

(d) workers' compensation or similar insurance;

(e) medical expense and loss of income benefits;

(f) credit-only insurance;

(g) coverage for on-site medical clinics; or

(h) other similar insurance coverage under which benefits for medical care are secondary or incidental to other insurance benefits;

(2) benefits not subject to requirements if offered separately, including:

(a) limited scope dental or vision benefits;

(b) benefits for long-term care, nursing home care, home health care or community-based care; or

(3) benefits not subject to requirements if offered as independent, noncoordinated benefits, including:

(a) coverage only for a specified disease or illness; and

(b) hospital indemnity or other fixed indemnity insurance; and

(4) benefits not subject to requirements if offered as a separate insurance policy, including:

(a) medicare supplemental health insurance;

(b) coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; or

I. "exchange" means the program for participating employer plans and participating insurance plans created pursuant to the Health Insurance Exchange Act;

J. "participating employer plan" means a group health plan, as defined in the federal Employee Retirement Income Security Act of 1974, that is sponsored by an employer and for which the plan sponsor has entered into an agreement with the exchange for the exchange to offer and administer health coverage benefits for enrollees in the plan;

K. "participating individual" means an individual who has been determined by the exchange to be, and continues to remain, an eligible individual for purposes of obtaining coverage under participating insurance plans offered through the exchange;

L. "participating insurance plan" means a health benefit plan offered through the exchange;

M. "plan year" means the period of time during which the insured is covered under a health benefit plan pursuant to the contract governing the plan;

N. "preexisting conditions provision" means a provision in a health benefit plan that limits, denies or excludes benefits for a period of time for an enrollee for expenses or services related to a medical condition that was present before the date the coverage commenced, whether or not any medical advice, diagnosis, care or treatment was recommended or received before that date. The time period for a preexisting conditions provision begins when application for insurance is made or when an applicant is in a waiting period for coverage under any plan. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information;

O. "producer" means a person required to be licensed in the state to sell, solicit or negotiate insurance;

P. "rate" means the premium or fee charged by a health benefit plan for coverage under a plan; and

Q. "superintendent" means the superintendent of insurance of the insurance division of the public regulation commission.

Section 3. ESTABLISHMENT--PURPOSE AND CORPORATE FORM.--

A. The "health insurance exchange" is created as a nonprofit public corporation, separate and apart from the state, to provide increased access for health insurance in the state.

B. The exchange is created to provide the residents of the state and other individuals that may be eligible to participate with greater access to and choice and portability of health insurance products.

C. The exchange shall operate in accordance with all requirements and restrictions set forth in the Health Insurance Exchange Act, the New Mexico Insurance Code and other applicable state and federal laws.

D. All eligible individuals shall be permitted to obtain health insurance benefits through the exchange, subject to the provisions of the Health Insurance Exchange Act.

Section 4. BOARD OF DIRECTORS.--

A. The exchange shall be governed by a board of directors. The board is a governmental entity for purposes of the Tort Claims Act, but neither the board nor the exchange shall be considered a governmental entity for any other purpose.

B. Each member shall be entitled to one vote in person or by proxy at each meeting.

C. The exchange shall operate subject to the supervision and approval of the board. The board shall consist of:

(1) five directors, elected by the carriers that participate in the exchange, who shall be officers or employees of those carriers;

(2) five directors, appointed by the governor, who shall be officers, general partners or proprietors of employers that participate in the exchange, one director of which shall represent nonprofit corporations;

(3) four directors, appointed by the governor, who shall be employees of employers that participate in the exchange; and

(4) the superintendent or the superintendent's designee, who shall be a nonvoting member.

D. The board shall elect a chair and vice chair of the board.

E. The directors elected by the members shall be elected for initial terms of three years or less, staggered so that the term of at least one director expires on June 30 of each year. The directors appointed by the governor shall be appointed for initial terms of three years or less, staggered so that the term of at least one director expires on June 30 of each year. Following the initial terms, directors shall be elected or appointed for terms of three years. A director whose term has expired shall continue to serve until a successor is elected or appointed.

F. Whenever a vacancy on the board occurs, the electing or appointing authority of the position that is vacant shall fill the vacancy by electing or appointing an individual to serve the balance of the unexpired term; provided that when a vacancy occurs in one of the director's positions elected by the members, the superintendent is authorized to appoint a temporary replacement director until the next scheduled election of directors elected by the members is held. The individual elected or appointed to fill a vacancy shall meet the requirements for initial election or appointment to that position.

G. Directors may be reimbursed by the board as provided in the Per Diem and Mileage Act for nonsalaried public officers, but shall receive no other compensation, perquisite or allowance from the board.

H. The board shall appoint a director of the exchange, who shall:

(1) be a full-time employee of the exchange;

(2) administer all of the exchange's activities and contracts;

(3) supervise staff of the exchange; and

(4) serve at the pleasure of the board.

Section 5. HEALTH INSURANCE EXCHANGE--DUTIES.--The exchange shall:

A. publicize the existence of the exchange and disseminate information on its eligibility requirements and enrollment procedures;

B. establish and administer procedures for enrolling eligible individuals in the exchange, including:

(1) creating a standard application form to collect information necessary to determine the eligibility and previous coverage history of an applicant; and

(2) preparing and distributing certificate of eligibility forms and application forms to insurance producers and the general public;

C. establish and administer procedures for the election of coverage by participating individuals during and outside of open season periods upon the occurrence of any qualifying event, including preparing and distributing to participating individuals:

(1) descriptions of the coverage, benefits, limitations, copayments and premiums for all participating insurance plans; and

(2) forms and instructions for electing coverage and arranging payment for coverage;

D. collect and transmit to the applicable participating plans all premium payments or contributions made by or on behalf of participating individuals, including developing mechanisms to:

(1) receive and process automatic payroll deductions for participating individuals enrolled in participating employer plans;

(2) enable participating individuals to pay, in whole or in part, for coverage through the exchange by electing to assign to the exchange any federal earned income tax credit payments due the participating individual; and

(3) receive and process any federal or state tax credits or other premium support payments for health insurance, as may be established by law;

E. upon request, issue certificates of previous coverage in accordance with the provisions of the federal Health Insurance Portability and Accountability Act of 1996 to all individuals who cease to be covered by a participating insurance plan;

F. establish procedures to account for all funds received and disbursed by the exchange, including:

(1) maintaining a separate, segregated management account for the receipt and disbursement of money allocated to fund the administration of the exchange; and

(2) maintaining a separate, segregated operations account for:

(a) the receipt of all premium payments or contributions made by or on behalf of participating individuals; and

(b) the distribution of premium payments to participating insurance plans and of commissions or payments to producers and other organizations that are allowed pursuant to Section 13 of the Health Insurance Exchange Act to receive payments for their services in enrolling eligible individuals or groups in the exchange; and

G. submit to the superintendent, following the end of each plan year, the report of an independent audit of the exchange's accounts for the plan year.

Section 6. HEALTH INSURANCE EXCHANGE--POWERS.--The exchange may:

A. contract with vendors to perform one or more of the functions specified in Section 5 of the Health Information Exchange Act;

B. contract with private or public social service agencies to administer application, eligibility verification, enrollment and premium payments for specified groups or populations of eligible individuals or participating individuals;

C. contract with an employer to act as the plan administrator for participating employer plans to undertake the obligations required by the federal Employee Retirement Income Security Act of 1974 of a plan administrator;

D. set and collect fees from participating individuals, participating employer plans and participating insurance plans sufficient to fund the cost of administering the exchange;

E. seek and directly receive grant funding from the federal, state or local governments or private philanthropic organizations to defray the costs of operating the exchange;

F. establish and administer operating procedures governing the operations of the exchange;

G. establish one or more service centers within the state to facilitate enrollment;

H. sue and be sued or otherwise take any necessary or proper legal action; and

I. establish bank accounts and borrow money.

Section 7. ENROLLMENT AND COVERAGE ELECTION.--

A. Any individual may apply to participate in the exchange. Any public or private employer may apply on behalf of those persons that may be eligible. Upon determination by the exchange that an individual is eligible to participate in the exchange, the individual may enroll or, if applicable, be enrolled by the individual's parent or legal guardian, in a participating insurance plan offered through the exchange during the next open season period or when otherwise provided by the Health Insurance Exchange Act.

B. From November 1 to November 30 of each year the exchange shall administer an open season during which any eligible individual may enroll in any participating insurance plan offered through the exchange without a waiting period and may not be declined coverage.

C. The first ninety days after the exchange begins to accept applications shall be considered the initial open season.

D. An eligible individual may enroll in a participating insurance plan offered through the exchange without a waiting period, and may not be declined coverage, at a time other than the annual open season for any of the following reasons; provided the individual does so within sixty-three days of one of the following triggering events:

(1) the individual loses coverage in an existing health insurance plan due to the death of a spouse, parent or legal guardian;

(2) the individual or a covered dependent loses coverage in an existing health insurance plan due to a change in the individual's employment status;

(3) the individual or a covered dependent loses coverage in an existing health insurance plan because of a divorce, separation or other change in familial status;

(4) the individual loses coverage in an existing health insurance plan because the individual reaches an age at which coverage lapses under that plan;

(5) the individual or a covered dependent becomes newly eligible by becoming a resident of the state or because the individual's place of employment has been changed to the state;

(6) the individual becomes newly eligible by becoming the spouse or dependent of an eligible individual by reason of birth, adoption, court order or a change in custody arrangement;

(7) the individual becomes subject to a court order requiring the individual to provide health insurance coverage to certain dependents, or enters into a new arrangement for the custody of dependents that requires the providing of health insurance for those dependents; or

(8) the individual loses coverage in a plan offered through the exchange by reason of the employer plan terminating participation in the exchange prior to the end of the plan year.

Section 8. PARTICIPATION OF PLANS IN THE EXCHANGE.--

A. No health benefit plan may be offered through the exchange unless the superintendent has first certified to the exchange that:

(1) the carrier seeking to offer the plan is licensed to issue health insurance or provide health coverage in the state and is in good standing with the insurance division of the public regulation commission; and

(2) the plan meets the requirements of this section and the employer plan and the carrier are in compliance with all other applicable state health insurance laws.

B. No plan shall be certified that excludes from coverage any individual otherwise determined by the exchange to be eligible.

C. The certification of plans to be offered through the exchange shall not be subject to any state law requiring competitive bidding; provided, however, that this does not apply to participating insurance plans offered pursuant to the Health Care Purchasing Act.

D. Each certification shall be valid for at least one year and may be made automatically renewable from year to year in the absence of notice of either:

(1) withdrawal by the superintendent; or

(2) discontinuation of participation in the exchange by the plan or carrier.

E. Certification of a plan may be withdrawn only after notice to the carrier and opportunity for hearing. The superintendent may decline to renew the certification of any carrier at the end of a certification term.

F. Each plan certified by the superintendent as eligible to be offered through the exchange shall contain a detailed description of benefits offered, including maximums, limitations, exclusions and other benefit limits.

G. Each plan certified by the superintendent as eligible to be offered through the exchange shall provide, subject to the plan's deductibles and coinsurance or copayment schedule, major medical coverage that includes the following:

(1) hospital benefits;

(2) surgical benefits;

(3) in-hospital medical benefits;

(4) ambulatory patient benefits;

(5) prescription drug benefits; and

(6) mental health benefits.

H. Carriers shall offer participating insurance plans through the exchange at rates developed pursuant to Section 59A-18-13.1 NMSA 1978.

I. The rates determined for the first plan year for which the plan is offered through the exchange may be adjusted by the carrier for subsequent plan years based on experience and any later modifications to plan benefits; provided, however, that any adjustments in rates shall be made in advance of the plan year for which they will apply and on a basis that, in the judgment of the superintendent, is consistent with the general practice of carriers that issue health benefit plans to large employers and in compliance with the New Mexico Insurance Code.

J. The exchange shall not decline, refuse to offer or otherwise restrict the offering to any participating individual or any plan that has obtained in a timely fashion in advance of the annual open season certification by the superintendent in accordance with the provisions of this section.

K. The exchange shall not sponsor any insurance or benefit plan, or contract with any carrier to offer any insurance or benefit plan, as a participating insurance plan that has not first been certified by the superintendent in accordance with the provisions of this section.

L. The exchange shall not impose on any participating insurance plan or on any carrier or plan seeking to participate in the exchange any terms or conditions, including any requirements or agreements with respect to rates or benefits, beyond or in addition to those terms and conditions established and imposed by the superintendent in certifying plans under the provisions of this section.

M. The superintendent shall establish and administer regulations and procedures for certifying plans to participate in the exchange.

Section 9. UNDERWRITING RULES.--The following rules shall govern the imposition by carriers of any preexisting conditions provisions and rate surcharges with respect to any participating individual covered by any participating insurance plan:

A. except as otherwise specified in Subsections C and D of this section, during any open season a participating individual who elects to choose a different participating insurance plan or plan option for the next plan year shall not be subject to any preexisting conditions provisions and shall be charged the standard rate of the new participating insurance plan or plan option developed pursuant to Section 59A-18-13.1 NMSA 1978. The provisions of this subsection shall also apply to any election by a participating individual of coverage for any dependent who is also a participating individual;

B. a new participating individual with eighteen months or more of creditable coverage who enrolls in a participating insurance plan shall not be subject to any preexisting conditions provisions and shall be charged the standard rate for the participating insurance plan developed pursuant to Section 59A-18-13.1 NMSA 1978;

C. a new participating individual with creditable coverage of between two and seventeen months may enroll in a participating insurance plan, but the participating individual may be subject to one or more preexisting conditions provisions for a period not to exceed twelve months, the number of months to be reduced by the number of months of creditable coverage, or charged a premium not to exceed one hundred twenty-five percent of the otherwise applicable standard rate for the participating insurance plan; provided that any rate surcharge shall not be applied on or after the third year of the individual's enrollment in any participating insurance plan;

D. a new participating individual with two months or less of creditable coverage may enroll in a participating insurance plan, but the participating individual may be subject to one or more preexisting conditions provisions for a period not to exceed twelve months, the number of months to be reduced by the number of months of creditable coverage or charged a premium not to exceed one hundred fifty percent of the otherwise applicable standard rate for the participating insurance plan; provided that any rate surcharge shall not be applied on or after the third year of the individual's enrollment in any participating insurance plan;

E. in cases where an individual is enrolled in a participating insurance plan as a newly eligible dependent of a participating individual by reason of birth, adoption, court order or a change in custody arrangement, either during open season or outside of open season, a carrier shall not impose any preexisting conditions provisions or any change in the rate charged to the participating individual, except for a difference in the participating insurance plan's standard rates that reflect the addition of a new dependent to the participating individual's coverage;

F. periods of creditable coverage with respect to an individual shall be established through presentation of certifications or in such other manner as may be specified in state or federal law;

G. for new participating individuals without creditable coverage, or with only limited creditable coverage as defined in Subsections C and D of this section, a carrier may elect to waive the imposition of preexisting conditions provisions and instead extend the applicable rate surcharge for an additional year beyond the time provided for in those subsections;

H. for purposes of this section, any individual who is a participating individual by reason of enrollment in a participating employer plan shall be deemed to have eighteen months of creditable coverage; and

I. for purposes of this section, any federal health coverage tax credit eligible individual shall be deemed to have eighteen months of creditable coverage.

Section 10. CONTINUATION OF COVERAGE.--

A. Any participating individual may continue to participate in any participating insurance plan as long as the individual remains an eligible individual, subject to the carrier's rules regarding cancellation for nonpayment of premiums or fraud, and shall not be canceled or nonrenewed because of any change in employer or employment status, marital status, health status, age, membership in any organization or other change that does not affect eligibility as defined in the Health Insurance Exchange Act.

B. A participating individual who is not a resident of the state and who ceases to be an eligible individual due to a qualifying event shall be deemed to remain an eligible individual and shall be deemed to remain a participating individual for a period not to exceed thirty-six months from the date of the qualifying event, if:

(1) the qualifying event consists of a loss of eligible individual status due to:

(a) voluntary or involuntary termination of employment for reasons other than gross misconduct; or

(b) loss of qualified dependent status for any reason; and

(2) the participating individual elects to remain a participating individual and notifies the exchange of such election within sixty-three days of the qualifying event.

Section 11. DISPUTE RESOLUTION.--

A. The superintendent shall establish procedures for resolving disputes arising from the operation of the exchange in accordance with the provisions of the Health Insurance Exchange Act, including disputes with respect to:

(1) the eligibility of an individual to participate in the exchange;

(2) the imposition of a coverage surcharge on a participating individual by a participating insurance plan; and

(3) the imposition of a preexisting conditions provision on a participating individual by a participating insurance plan.

B. In cases where a carrier imposes a preexisting conditions provision or a premium surcharge in connection with enrollment of a participating individual in a participating insurance plan offered by the carrier, and the participating individual disputes the imposition of such a provision or surcharge, the participating individual may request that the superintendent issue a determination as to the validity or extent of such provision or surcharge pursuant to the Health Insurance Exchange Act. The superintendent shall issue a determination within thirty days of the request being filed with the insurance division of the public regulation commission. If either the participating individual or the carrier disagrees with the outcome, a request for a hearing may be made pursuant to Chapter 59A, Article 4 NMSA 1978.

Section 12. PARTICIPATING EMPLOYER PLANS.--

A. Any employer may apply to the exchange to be the sponsor of a participating employer plan.

B. Any employer seeking to be the sponsor of a participating employer plan shall, as a condition of participation in the exchange, enter into a binding agreement with the exchange, which shall include the following conditions:

(1) the sponsoring employer designates the exchange director to be the plan's administrator for the employer's group health plan and the exchange director agrees to undertake the obligations required of a plan administrator under federal law;

(2) only the coverage and benefits offered by participating insurance plans shall constitute the coverage and benefits of the participating employer plan;

(3) any individuals eligible to participate in the exchange by reason of their eligibility for coverage under the employer's participating employer plan, regardless of whether any such individuals would otherwise qualify as eligible individuals if not enrolled in the participating employer plan, may elect coverage under any participating insurance plan and neither the employer nor the exchange shall limit the individual's choice of coverage from among all the participating insurance plans;

(4) the employer reserves the right to offer benefits supplemental to the benefits offered through the exchange, but any supplemental benefits offered by the employer shall constitute a separate plan or plans under federal law, for which the exchange director shall not be the plan administrator and for which neither the exchange director nor the exchange shall be responsible in any manner;

(5) the employer agrees that, for the term of the agreement, the employer will not offer to individuals eligible to participate in the exchange by reason of their eligibility for coverage under the employer's participating employer plan any separate or competing group health plan offering the same or substantially similar benefits as those provided by participating insurance plans through the exchange, regardless of whether any such individuals would otherwise qualify as eligible individuals if not enrolled in the participating employer plan;

(6) the employer reserves the right to determine the criteria for eligibility, enrollment and participation in the participating employer plan and the terms and amounts of the employer's contributions to that plan; provided that for the term of the agreement with the exchange, the employer agrees not to alter or amend any criteria or contribution amounts at any time other than during an annual period designated by the exchange for participating employer plans to make such changes in conjunction with the exchange's annual open season;

(7) the employer agrees to make available to the exchange any of the employer's documents, records or information, including copies of the employer's federal and state tax and wage reports that the superintendent reasonably determines are necessary for the exchange to verify:

(a) that the employer is in compliance with the terms of its agreement with the exchange governing the employer's sponsorship of a participating employer plan;

(b) that the participating employer plan is in compliance with applicable laws relating to employee welfare benefit plans; and

(c) the eligibility under the terms of the employer's plan of those individuals enrolled in the participating employer plan; and

(8) the employer agrees to also sponsor a "cafeteria plan" as permitted pursuant to 26 USCA Section 125 for all employees eligible for coverage under the employer's participating employer plan.

C. The exchange may not enter into any agreement with any employer with respect to any participating employer plan if the agreement does not, at a minimum, incorporate the conditions specified in Subsection B of this section.

D. The exchange may not enter into any agreement with any employer with respect to any participating employer plan for the exchange to provide the participating employer plan with any additional or different services or benefits not otherwise provided or offered to all other participating employer plans.

Section 13. PRODUCERS.--

A. In cases when a producer licensed in the state enrolls in the exchange an eligible individual or group, the plan chosen by each individual shall pay the producer a commission as set by the board.

B. In cases when a membership organization enrolls in the exchange its eligible members or the eligible members of its member entities, the plan chosen by each individual shall pay the organization a fee equal to a commission as set by the board. Nothing in this section shall be deemed either to require a membership organization that enrolls persons in the exchange to be licensed by the state as a producer or to permit such an organization to provide any other services requiring licensure as a producer without first obtaining such license.

Section 14. STATEMENT OF COVERAGE FORM.--

A. Each employer in the state shall annually file with the superintendent a form for each employee employed within the state indicating the health insurance coverage status of the employee and the employee's dependents, including the source of coverage and the name of the insurer or plan sponsor, and, if no coverage is indicated:

(1) the employee's election to, in lieu of insurance coverage, post a bond or establish an account in accordance with Section 16 of the Health Insurance Exchange Act;

(2) the employee's election to apply or not apply for coverage through the exchange; and

(3) the employee's election to be considered or not be considered for any publicly financed health insurance program or premium subsidy program administered by the state.

B. Each form shall be signed by the individual to whom it pertains.

C. Each self-employed individual in the state shall annually file the same form with the superintendent.

D. The secretary of human services shall annually file the same form with the superintendent on behalf of all individuals receiving benefits under the state's medicaid and state children's health insurance program and any other state coverage program not including individuals who are covered by Part A or Part B of Title 18 of the Social Security Act.

E. For purposes of this section, health insurance coverage shall not include any coverage consisting solely of one or more excepted benefits.

F. The superintendent shall prepare and distribute the statement of coverage forms.

Section 15. INSURANCE MARKET CONSOLIDATION.--

A. A carrier shall not issue or renew an individual health benefit plan, other than through the exchange, after the first day of the plan year following the first regular open season conducted by the exchange.

B. A carrier shall not issue or renew a group health benefit plan to an employer with less than fifty employees, other than through the exchange after the first day of the plan year following the first regular open season conducted by the exchange.

C. Subsections A and B of this section shall not apply to any health benefit plan that consists solely of one or more excepted benefits.

Section 16. PERSONAL RESPONSIBILITY.--

A. Residents of the state who are over the age of eighteen and under the age of sixty-five shall offer proof of their ability to pay for medical care for themselves and their dependents.

B. Individuals subject to the requirement in Subsection A of this section shall be deemed to be in compliance if they:

(1) indicate coverage under any health benefit plan pursuant to Section 14 of the Health Insurance Exchange Act; or

(2) demonstrate proof of financial security in accordance with Subsection C of this section.

C. Individuals electing to demonstrate proof of financial security to pay for medical expenditures shall provide to the department of finance and administration proof of a bond in the amount of ten thousand dollars ($10,000) or shall deposit with the department ten thousand dollars ($10,000) in an escrow account.

D. If an individual subject to the requirement, in Subsection A of this section fails to comply with the requirement, the secretary of finance and administration shall:

(1) establish an escrow account in the name of the individual; or

(2) retain and deposit in the account all funds that may be owed to the individual by the state, including any overpayment by the individual of taxes imposed by the state.

E. With respect to any escrow account established pursuant to this section, either by reason of an individual making the election specified in Subsection C of this section or by reason of an individual being subject to Subsection D of this section, the amount deposited, retained or collected shall not exceed ten thousand dollars ($10,000) in the aggregate for any individual. Nothing in this section shall be construed to authorize the secretary of finance and administration to retain any amount for purposes that otherwise would be paid to a state agency.

F. Money held in escrow pursuant to this section shall be disbursed only to pay for medical claims for health care services provided to the individual during the period when the individual was not in compliance with Subsection A of this section. The secretary of finance and administration shall close the account and remit the remaining funds to the individual within six months of receiving notification that the individual has:

(1) elected to comply with the requirement in Subsection A of this section by submitting proof of insurance coverage pursuant to Subsection B of this section; or

(2) is no longer subject to Subsection A of this section by reason of no longer being a resident of the state.

G. If the secretary of finance and administration determines that an individual for whom an account has been established has not been a resident of the state for a consecutive period of thirty-six months or more, the secretary shall close the account and remit the remaining funds to the individual. If the secretary cannot locate the individual within twelve months, the secretary shall dispose of the funds pursuant to the Uniform Unclaimed Property Act (1995).

H. Any judgment payable by an individual to a hospital, physician or other health care provider for charges incurred during a period when the individual failed to comply with Subsection A of this section shall include an order permitting the attachment of the wages of such individual to satisfy such judgment.

Section 17. TEMPORARY PROVISION--MEDICAL INSURANCE POOL--HEALTH INSURANCE ALLIANCES.--The board of directors of the health insurance exchange shall meet with the board of directors of the health insurance alliance by October 1, 2007 and at least quarterly through June 30, 2008 to:

A. provide portability of coverage for individuals covered through the health insurance alliance to the extent possible through the health insurance exchange;

B. provide for the transition of other functions of the health insurance alliance to the health insurance exchange as permitted by law or rule; and

C. prepare a report to the second session of the forty-eighth legislature on the transition of functions to the health insurance exchange and on any recommendations to the legislature for continued and expanded health coverage of the state's residents.

Section 18. REPEAL.--Sections 59A-56-1 through 59A-56-25 NMSA 1978 (being laws 1994, Chapter 75, Sections 1 through 25, as amended) are repealed effective July 1, 2008.

Section 19. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 2007.

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