HB0066GUS

HOUSE HEALTH, GOVERNMENT AND INDIAN

AFFAIRS COMMITTEE SUBSTITUTE FOR

HOUSE BILL 66

51st legislature - STATE OF NEW MEXICO - first session, 2013

AN ACT

RELATING TO HEALTH COVERAGE; ENACTING NEW SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO ESTABLISH HEALTH CARE COVERAGE IDENTIFICATION CARD REQUIREMENTS.

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

SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

"[NEW MATERIAL] IDENTIFICATION CARDS--REQUIREMENTS--TIMELY ISSUANCE AND RENEWAL.--

A. A group health plan offering coverage pursuant to this section shall issue an identification card to the primary insured. The group health plan may also issue identification cards to individuals covered under the primary insured's coverage. The identification card shall contain the following information in a readily identifiable format on the face of the card and via electronic coding associated with the card:

(1) the name of the third-party administrator of the group health plan;

(2) the name of the holder of the group health plan;

(3) the name of the insured;

(4) an indication that the group health plan is self-insured;

(5) the identification number of the insured;

(6) the group health plan or contract number;

(7) the date upon which the insured's coverage became effective;

(8) the name of the primary care provider for each insured where selection of a primary care provider is required;

(9) a telephone number or electronic address at which authorization or admission certification may be obtained, if authorization or admission certification is required; and

(10) in-network cost-sharing information, including amounts applicable to primary care provider visits, specialist visits, emergency room visits and hospital stays.

B. A group health plan shall provide each primary insured a new identification card issued pursuant to this section according to the following schedule:

(1) within thirty days of a group health plan's effective date;

(2) within thirty days of the date that the group health plan receives the enrollment information of the primary insured, after the primary insured initially becomes eligible for coverage under an existing group health plan; and

(3) no later than thirty days after the group health plan receives notice of a change in any information that an identification card is required to contain pursuant to Subsection A of this section.

C. A group health plan that has provided an identification card to a primary insured before January 1, 2014 shall replace that card upon renewal of the group health plan with an identification card that complies with the provisions of this section.

D. The provisions of this section shall not apply to group health coverage intended to supplement major medical group-type coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy.

E. As used in this section:

(1) "identification card" means a group health plan identification card; and

(2) "primary care provider" means a health care practitioner acting within the scope of the health care practitioner's license who provides the first level of basic or general health care for a person's health needs, including diagnostic and treatment services, initiates referrals to other health care practitioners and maintains the continuity of care when appropriate."

SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

"[NEW MATERIAL] IDENTIFICATION CARDS--REQUIREMENTS--TIMELY ISSUANCE AND RENEWAL.--

A. An insurer or administrator that delivers, issues for delivery or renews an individual health insurance policy, health care plan or certificate of health insurance in this state shall issue an identification card to the primary insured. The insurer or administrator may also issue identification cards to individuals covered under the primary insured's coverage. The identification card shall contain the following information in a readily identifiable format on the face of the card and via electronic coding associated with the card:

(1) the name of the administrator or insurer issuing the health insurance policy, health care plan or certificate of health insurance;

(2) the name of the holder of the health insurance policy, health care plan or certificate of health insurance;

(3) the name of the insured;

(4) an indication of whether the policy, plan or certificate is insured or self-insured;

(5) the insured's identification number;

(6) the policy, plan or certificate number;

(7) the date upon which the insured's coverage became effective;

(8) the name of the primary care provider for each insured where selection of a primary care provider is required;

(9) a telephone number or electronic address at which authorization or admission certification may be obtained, if authorization or admission certification is required; and

(10) in-network cost-sharing information, including amounts applicable to primary care provider visits, specialist visits, emergency room visits and hospital stays.

B. An insurer or administrator shall provide each primary insured a new identification card issued pursuant to this section according to the following schedule:

(1) within thirty days of a health insurance policy's, health care plan's or certificate of health insurance's effective date;

(2) within thirty days of the date that the insurer or administrator receives the enrollment information of the primary insured, after the primary insured initially becomes eligible for coverage under an existing health insurance policy, health care plan or certificate of health insurance; and

(3) no later than thirty days after the insurer or administrator receives notice of a change in any information that an identification card is required to contain pursuant to Subsection A of this section.

C. An individual health insurance policy, health care plan or certificate of health insurance that has provided an identification card to a primary insured before January 1, 2014 shall replace that card upon renewal of the policy, plan or certificate with an identification card that complies with the provisions of this section.

D. Each insurer and administrator of an individual health insurance policy, health care plan or certificate of health insurance in the state shall make an informational filing of the identification card form with the superintendent. The filing shall contain the form of the identification card with all information required pursuant to this section. All variants of the form shall be identified.

E. The provisions of this section shall not apply to individual health insurance policies, plans or certificates intended to supplement major medical group-type coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy, plan or certificate.

F. As used in this section:

(1) "identification card" means a health insurance policy, health care plan or certificate of health insurance identification card; and

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

"[NEW MATERIAL] IDENTIFICATION CARDS--REQUIREMENTS--TIMELY ISSUANCE AND RENEWAL.--

A. An insurer or administrator that delivers, issues for delivery or renews a group or blanket health insurance policy, health care plan or certificate of health insurance in this state shall issue an identification card to the primary insured. The insurer or administrator may also issue identification cards to individuals covered under the primary insured's coverage. The identification card shall contain the following information in a readily identifiable format on the face of the card and via electronic coding associated with the card:

(1) the name of the administrator of or the insurer issuing the health insurance policy, health care plan or certificate of health insurance;

(2) the name of the holder of the health insurance policy, health care plan or certificate of health insurance;

(3) the name of the insured;

(4) an indication of whether the policy, plan or certificate is insured or self-insured;

(5) the identification number of the insured;

(6) the group or blanket number, if applicable;

(7) the policy, plan or certificate number, if applicable;

(8) the date upon which the insured's coverage became effective;

(9) the name of the primary care provider for each insured where selection of a primary care provider is required;

(10) a telephone number or electronic address at which authorization or admission certification may be obtained, if authorization or admission certification is required; and

(11) in-network cost-sharing information, including amounts applicable to primary care provider visits, specialist visits, emergency room visits and hospital stays.

B. An insurer or administrator shall provide each primary insured a new identification card issued pursuant to this section according to the following schedule:

(1) within thirty days of a health insurance policy, health care plan or certificate of health insurance becoming effective;

C. An insurer or administrator that has provided an identification card to a primary insured before January 1, 2014 shall replace that card upon renewal of the policy, plan or certificate with an identification card that complies with the provisions of this section.

D. Each insurer and administrator of a group or blanket health insurance policy, health care plan or certificate of health insurance in the state shall make an informational filing of the identification card form with the superintendent. The filing shall contain the form of the identification card with all information required pursuant to this section. All variants of the form shall be identified.

E. The provisions of this section shall not apply to a group or blanket policy, plan or contract intended to supplement major medical coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy.

F. As used in this section:

(1) "identification card" means a health insurance policy, health care plan or certificate of health insurance identification card; and

SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

"[NEW MATERIAL] IDENTIFICATION CARDS--REQUIREMENTS--TIMELY ISSUANCE AND RENEWAL.--

A. A carrier that delivers, issues for delivery or renews an individual or group health maintenance organization contract in this state shall issue an identification card to the primary enrollee. The carrier may also issue identification cards to individuals covered under the primary enrollee's coverage. The identification card shall contain the following information in a readily identifiable format on the face of the card and via electronic coding associated with the card:

(1) the name of the carrier issuing the health maintenance organization contract;

(2) the name of the holder of the health maintenance organization contract;

(3) the name of the enrollee;

(4) an indication of whether the health maintenance organization contract is insured or self-insured;

(5) the identification number of the enrollee;

(6) the contract number, if applicable;

(7) the group number, if applicable;

(8) the date upon which the enrollee's coverage became effective;

(9) the name of the primary care provider for each enrollee where selection of a primary care provider is required;

(10) a telephone number or electronic address at which authorization or admission certification may be obtained, if authorization or admission certification is required; and

(11) in-network cost-sharing information, including amounts applicable to primary care provider visits, specialist visits, emergency room visits and hospital stays.

B. A carrier shall provide each primary enrollee a new identification card issued pursuant to this section according to the following schedule:

(1) within thirty days of a health maintenance organization contract's effective date;

(2) within thirty days of the date that the carrier receives the enrollment information of the primary enrollee, after the primary enrollee initially becomes eligible for coverage under an existing health maintenance organization contract; and

(3) no later than thirty days after the carrier receives notice of a change in any information that an identification card is required to contain pursuant to Subsection A of this section.

C. A carrier that has provided an identification card to a primary enrollee before January 1, 2014 shall replace that card upon renewal of the health maintenance organization contract with an identification card that complies with the provisions of this section.

D. Each carrier issuing an identification card pursuant to this section shall make an informational filing of the identification card form with the superintendent. The filing shall contain the form of the identification card with all information required pursuant to this section. All variants of the form shall be identified.

E. The provisions of this section shall not apply to an individual or group health maintenance organization contract intended to supplement major medical coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance contract.

F. As used in this section:

(1) "identification card" means a health maintenance organization identification card; and

SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

"[NEW MATERIAL] IDENTIFICATION CARDS--REQUIREMENTS--TIMELY ISSUANCE AND RENEWAL.--

A. An individual or group health care plan shall issue an identification card to the primary subscriber. The health care plan may also issue identification cards to individuals covered under the primary subscriber's coverage. The identification card shall contain the following information in a readily identifiable format on the face of the card and via electronic coding associated with the card:

(1) the name of the issuer or administrator of the health care plan;

(2) the name of the holder of the health care plan;

(3) the name of the subscriber;

(4) an indication of whether the health care plan is insured or self-insured;

(5) the identification number of the subscriber;

(6) the health care plan or contract number, if applicable;

(7) the group number, if applicable;

(8) the date upon which the subscriber's coverage became effective;

(9) the name of the primary care provider for each subscriber where selection of a primary care provider is required;

(10) a telephone number or electronic address at which authorization or admission certification may be obtained, if authorization or admission certification is required; and

(11) in-network cost-sharing information, including amounts applicable to primary care provider visits, specialist visits, emergency room visits and hospital stays.

B. A health care plan shall provide each primary subscriber a new identification card issued pursuant to this section according to the following schedule:

(1) within thirty days of a health care plan's effective date;

(2) within thirty days of the date that the health care plan receives the enrollment information of the primary subscriber, after the primary subscriber initially becomes eligible for coverage under an existing health care plan; and

(3) no later than thirty days after the health care plan receives notice of a change in any information that an identification card is required to contain pursuant to Subsection A of this section.

C. A health care plan that has provided an identification card to a primary subscriber before January 1, 2014 shall replace that card upon renewal of the health care plan with an identification card that complies with the provisions of this section.

D. Each health care plan issuing an identification card pursuant to this section shall make an informational filing of the identification card form with the superintendent. The filing shall contain the form of the identification card with all information required pursuant to this section. All variants of the form shall be identified.

E. The provisions of this section shall not apply to an individual or group health care plan intended to supplement major medical coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance health care plan.

F. As used in this section:

(1) "identification card" means a health care plan identification card; and

SECTION 6. EFFECTIVE DATE.--The effective date of the provisions of this act is January 1, 2014.

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