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F I S C A L I M P A C T R E P O R T

SPONSOR Jennings

ORIGINAL DATE

LAST UPDATED

01/29/08

02/04/08 HB

SHORT TITLE Revise Medical Insurance Pool Act

SB 391/aSJC

ANALYST Hanika-Ortiz

ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT (dollars in thousands)

FY08

FY09

FY10 3 Year

Total Cost

Recurring

or Non-Rec

Fund

Affected

NM MIP

$.01

Recurring

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From

Medical Insurance Pool (MIP)

Health Policy Commission (HPC)

SUMMARY

Synopsis of SJC Amendment

The Senate Judiciary Committee Amendment strikes the term “prohibiting" and replaces with the

term “clarifying" in the title of the Act, as it relates to lifetime maximum benefit levels for pool

policies.

SIGNIFICANT ISSUES

The title of the act allows for content in the bill that further clarifies a health insurance policy

issued by the pool shall not include a lifetime maximum benefit.

Synopsis of Original Bill

Senate Bill 391 amends the Medical Insurance Pool Act by revising definitions and eligibility

criteria, prohibiting lifetime maximum benefit levels in New Mexico insurance pool policies, and

clarifying small group policies.

FISCAL IMPLICATIONS

The changes proposed within the bill may increase consumer protections that may result in

additional claims.

Senate Bill 391/aSJC – Page

2

SIGNIFICANT ISSUES

Section 59-A-54-3 is amended within definitions:

•

Removes medical care programs of the Indian Health Service from the definition of

“creditable coverage" relating to coverage of a person under plans pursuant to the

Medical Insurance Pool Act; thereby, allowing an insure to continue to receive health

care services from the IHS.

•

Creditable coverage for a “federally defined individual" is as defined by the Health

Insurance Portability Act.

•

Within the definition of “preexisting condition", clarifies that pregnancy is not considered

a preexisting condition for a federally defined eligible individual.

Section 59A-54-12 is amended within eligibility:

•

With respect to enrolling any person under a pool policy; extends the period of

“creditable coverage" to a 95 day continuous period (from 63 days) during which the

individual was not covered thereby increasing portability.

•

Allows for a person, whose health insurance coverage from another state’s high risk pool

policy is terminated because of non-residency, to apply for coverage under the pool as

long as within 95 days (from 31 days).

Section 59A-54-13 is amended within benefits:

•

Adds language to confirm that a pool health insurance policy shall not include a lifetime

maximum benefit.

•

In the case of a small group policy offered by the pool, covered family members shall

have the right to continue the policy upon the death of the named insured or upon

divorce, annulment, dissolution of marriage or upon legal separation.

OTHER SUBSTANTIVE ISSUES

The New Mexico Medical Insurance Pool (NMMIP) was established by the 1987 New Mexico

State Legislature. The Pool was created to provide access to health insurance coverage to

residents of New Mexico who are denied health insurance and considered uninsurable. NMMIP

also provides health benefit portability coverage to New Mexicans who have exhausted COBRA

benefits and have no other portability options available to them. NMMIP is administered by Blue

Cross and Blue Shield of New Mexico who handles eligibility, enrollment, member services and

claims processing.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL

The MIP reflects that there will continue to be lack of clarity on issues of eligibility.

ANA/mt