HOUSE BILL 96
49th legislature - STATE OF NEW MEXICO - second session, 2010
INTRODUCED BY
Danice Picraux
FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE
AN ACT
RELATING TO HEALTH INSURANCE; AMENDING THE HEALTH MAINTENANCE ORGANIZATION LAW, THE NONPROFIT HEALTH CARE PLAN LAW AND OTHER SECTIONS OF THE NMSA 1978 TO PROVIDE FOR GUARANTEED ISSUE OF HEALTH COVERAGE WITHOUT PERMANENT EXCLUSION OF COVERAGE FOR PREEXISTING CONDITIONS.
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] HEALTH INSURERS--GUARANTEED ISSUE--
PREEXISTING CONDITIONS.--
A. Effective January 1, 2011, a health insurer that provides group health insurance pursuant to Chapter 59A, Article 22 NMSA 1978 shall issue coverage to any individual who requests and offers to purchase the coverage without permanent exclusion of coverage for preexisting conditions.
B. A health insurer may impose a waiting period not to exceed six months before payment for any service related to a preexisting condition.
C. A health insurer may continue until renewal an individual policy in existence on January 1, 2011 that has a permanent exclusion of payment for a preexisting condition. Upon renewal of that policy, an insured, at the sole discretion of the insured, may opt to continue the existing individual policy with the exclusion of payment for the preexisting condition.
D. A health insurer shall ensure that an insured's privacy and confidentiality are protected and made applicable to individual policies, similar to privacy requirements pursuant to the federal Health Insurance Portability and Accountability Act of 1996 for other policies.
E. For the purposes of this section:
(1) "coverage" does not include short-term, accident, fixed indemnity, specified disease policy or disability income, limited-benefit, credit, workers' compensation, automobile, medical or other insurance under which benefits are payable with or without regard to fault and that is required by law to be contained in any liability insurance policy;
(2) "health insurer" means a person duly authorized to transact the business of health insurance in the state pursuant to the Insurance Code but does not include a person that only issues a limited-benefit policy intended to supplement major medical coverage, including medicare supplement, long-term care, disability income, disease-specific, accident-only or hospital-indemnity-only insurance policies; and
(3) "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for health insurance within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition for federally defined individuals."
Section 2. A new section of Chapter 59A, Article 23 NMSA
1978 is enacted to read:
"[NEW MATERIAL] HEALTH INSURERS--GUARANTEED ISSUE--
PREEXISTING CONDITIONS.--
A. Effective January 1, 2011, a health insurer that provides group health insurance pursuant to Chapter 59A, Article 23 NMSA 1978 shall issue coverage to any individual who requests and offers to purchase the coverage without permanent exclusion of coverage for preexisting conditions.
B. A health insurer may impose a waiting period not to exceed six months before payment for any service related to a preexisting condition.
C. A health insurer may continue until renewal an individual policy in existence on January 1, 2011 that has a permanent exclusion of payment for a preexisting condition. Upon renewal of that policy, an insured, at the sole discretion of the insured, may opt to continue the existing individual policy with the exclusion of payment for the preexisting condition.
D. A health insurer shall ensure that an insured's privacy and confidentiality are protected and made applicable to individual policies, similar to privacy requirements pursuant to the federal Health Insurance Portability and Accountability Act of 1996 for other policies.
E. For the purposes of this section:
(1) "coverage" does not include short-term, accident, fixed indemnity, specified disease policy or disability income, limited-benefit, credit, workers' compensation, automobile, medical or other insurance under which benefits are payable with or without regard to fault and that is required by law to be contained in any liability insurance policy;
(2) "health insurer" means a person duly authorized to transact the business of health insurance in the state pursuant to the Insurance Code but does not include a person that only issues a limited-benefit policy intended to supplement major medical coverage, including medicare supplement, long-term care, disability income, disease-specific, accident-only or hospital-indemnity-only insurance policies; and
(3) "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for health insurance within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition for federally defined individuals."
Section 3. A new section of the Health Maintenance Organization Law is enacted to read:
"[NEW MATERIAL] HEALTH MAINTENANCE ORGANIZATIONS--GUARANTEED ISSUE--PREEXISTING CONDITIONS.--
A. Effective January 1, 2011, a health maintenance organization that provides coverage for health care services pursuant to the Health Maintenance Organization Law shall issue coverage to any individual who requests and offers to purchase the coverage without permanent exclusion of coverage for preexisting conditions.
B. A health maintenance organization may impose a waiting period not to exceed six months before payment for any service related to a preexisting condition.
C. A health maintenance organization may continue until renewal an individual contract in existence on January 1, 2011 that has a permanent exclusion of payment for a preexisting condition. Upon renewal of that contract, an enrollee, at the sole discretion of the enrollee, may opt to continue the existing individual contract with the exclusion of payment for the preexisting condition.
D. A health maintenance organization shall ensure that an enrollee's privacy and confidentiality are protected and made applicable to individual contracts, similar to privacy requirements pursuant to the federal Health Insurance Portability and Accountability Act of 1996 for other policies.
E. For the purposes of this section:
(1) "coverage" does not include short-term, accident, fixed indemnity, specified disease policy or disability income, limited-benefit, credit, workers' compensation, automobile, medical or other insurance under which benefits are payable with or without regard to fault and that is required by law to be contained in any liability insurance policy; and
(2) "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for health insurance within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition for federally defined individuals."
Section 4. A new section of the Nonprofit Health Care Plan Law is enacted to read:
"[NEW MATERIAL] NONPROFIT HEALTH CARE PLANS--GUARANTEED ISSUE--PREEXISTING CONDITIONS.--
A. Effective January 1, 2011, a health insurer that provides coverage pursuant to the Nonprofit Health Care Plan Law shall issue coverage to any individual who requests and offers to purchase the coverage without permanent exclusion of coverage for preexisting conditions.
B. A health insurer may impose a waiting period not to exceed six months before payment for any service related to a preexisting condition.
C. A health insurer may continue until renewal an individual policy in existence on January 1, 2011 that has a permanent exclusion of payment for a preexisting condition. Upon renewal of that policy, an insured, at the sole discretion of the insured, may opt to continue the existing individual policy with the exclusion of payment for the preexisting condition.
D. A health insurer shall ensure that an insured's privacy and confidentiality are protected and made applicable to individual policies, similar to privacy requirements pursuant to the federal Health Insurance Portability and Accountability Act of 1996 for other policies.
E. For the purposes of this section:
(1) "coverage" does not include short-term, accident, fixed indemnity, specified disease policy or disability income, limited-benefit, credit, workers' compensation, automobile, medical or other insurance under which benefits are payable with or without regard to fault and that is required by law to be contained in any liability insurance policy;
(2) "health insurer" means a person duly authorized to transact the business of health insurance in the state pursuant to the Insurance Code but does not include a person that only issues a limited-benefit policy intended to supplement major medical coverage, including medicare supplement, long-term care, disability income, disease-specific, accident-only or hospital-indemnity-only insurance policies; and
(3) "preexisting condition" means a physical or mental condition for which medical advice, medication, diagnosis, care or treatment was recommended for or received by an applicant for health insurance within six months before the effective date of coverage, except that pregnancy is not considered a preexisting condition for federally defined individuals."
- 8 -