0001| SENATE BILL 199
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0002| 42ND LEGISLATURE - STATE OF NEW MEXICO - SECOND SESSION,
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0003| 1996
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0004| INTRODUCED BY
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0005| JANICE D. PASTER
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0006|
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0007|
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0008|
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0009| FOR THE HEALTH CARE TASK FORCE
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0010|
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0011| AN ACT
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0012| RELATING TO INSURANCE; AMENDING AND ENACTING CERTAIN PROVISIONS
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0013| OF THE HEALTH INSURANCE ALLIANCE ACT; AMENDING AND ENACTING
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0014| SECTIONS OF THE NMSA 1978; REPEALING A SECTION OF LAWS 1994;
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0015| DECLARING AN EMERGENCY.
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0016|
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0017| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0018| Section 1. Section 59A-54-12 NMSA 1978 (being Laws 1987,
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0019| Chapter 154, Section 12, as amended) is amended to read:
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0020| "59A-54-12. ELIGIBILITY--POLICY PROVISIONS.--
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0021| A. A person is eligible for a pool policy only if on
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0022| the effective date of coverage or renewal of coverage the person
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0023| is a New Mexico resident and:
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0024| (1) is not eligible as an insured or covered
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0025| dependent for any health plan that provides coverage for
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0001| comprehensive major medical or comprehensive physician and
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0002| hospital services;
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0003| (2) is only eligible for a health plan that is
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0004| offered at a rate higher than that available from the pool;
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0005| (3) has been rejected for coverage for
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0006| comprehensive major medical or comprehensive physician and
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0007| hospital services; or
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0008| (4) is only eligible for a health plan with a
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0009| rider, waiver or restrictive provision for that particular
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0010| individual based on a specific condition.
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0011| B. Coverage under a pool policy is in excess of and
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0012| shall not duplicate coverage under any other form of health
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0013| insurance.
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0014| C. A pool policy shall provide that coverage of a
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0015| dependent unmarried person terminates when the person becomes
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0016| nineteen years of age or, if the person is enrolled full time in
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0017| an accredited educational institution, when he becomes twenty-five years of age. The policy shall also provide in substance
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0018| that attainment of the limiting age does not operate to
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0019| terminate coverage when the person is and continues to be:
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0020| (1) incapable of self-sustaining employment by
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0021| reason of mental retardation or physical handicap; and
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0022| (2) primarily dependent for support and
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0023| maintenance upon the person in whose name the contract is
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0024| issued.
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0025| Proof of incapacity and dependency shall be furnished to
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0001| the insurer within one hundred twenty days of attainment of the
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0002| limiting age and subsequently as required by the insurer but not
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0003| more frequently than annually after the two-year period
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0004| following attainment of the limiting age.
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0005| D. A pool policy that provides coverage for a family
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0006| member of the person in whose name the contract is issued shall,
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0007| as to the coverage of the family member or the individual in
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0008| whose name the contract was issued, provide that the health
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0009| insurance benefits applicable for children are payable with
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0010| respect to a newly born child of the family member or the person
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0011| in whose name the contract is issued from the moment of coverage
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0012| of injury or illness, including the necessary care and treatment
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0013| of medically diagnosed congenital defects and birth
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0014| abnormalities. If payment of a specific premium is required to
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0015| provide coverage for the child, the contract may require that
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0016| notification of the birth of a child and payment of the required
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0017| premium shall be furnished to the carrier within thirty-one days
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0018| after the date of birth in order to have the coverage continued
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0019| beyond the thirty-one day period.
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0020| E. A pool policy may contain provisions under which
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0021| coverage is excluded during a six-month period following the
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0022| effective date of coverage as to a given individual for pre-existing conditions, as long as either of the following exists:
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0023| (1) the condition has manifested itself within
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0024| a period of six months before the effective date of coverage in
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0025| such a manner as would cause an ordinarily prudent person to
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0001| seek diagnoses or treatment; or
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0002| (2) medical advice or treatment was recommended
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0003| or received within a period of six months before the effective
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0004| date of coverage.
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0005| F. The pre-existing condition exclusions described
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0006| in Subsection E of this section shall be waived to the extent to
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0007| which similar exclusions have been satisfied under any prior
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0008| health insurance coverage [which] that was involuntarily
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0009| terminated, if the application for pool coverage is made not
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0010| later than thirty-one days following the involuntary
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0011| termination. In that case, coverage in the pool shall be
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0012| effective from the date on which the prior coverage was
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0013| terminated. This subsection does not prohibit pre-existing
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0014| conditions coverage in a pool policy that is more favorable to
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0015| the insured than that specified in this subsection.
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0016| G. An individual is not eligible for coverage by the
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0017| pool if:
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0018| (1) he is, at the time of application, eligible
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0019| for medicare or medicaid, which would provide coverage for
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0020| amounts in excess of limited policies such as dread disease,
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0021| cancer policies or hospital indemnity policies;
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0022| (2) he has terminated coverage by the pool
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0023| within the past twelve months; or
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0024| (3) he is an inmate of a public institution or
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0025| is eligible for public programs for which medical care is
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0001| provided.
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0002| H. Any person whose health insurance coverage from a
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0003| qualified state health policy with similar coverage is
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0004| terminated because of nonresidency in another state may apply
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0005| for coverage under the pool. If the coverage is applied for
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0006| within thirty-one days after that termination and if premiums
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0007| are paid for the entire coverage period, the effective date of
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0008| the coverage shall be the date of termination of the previous
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0009| coverage.
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0010| I. A person otherwise eligible and having coverage
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0011| pursuant to the provisions of the Comprehensive Health Insurance
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0012| Pool Act shall not become ineligible because that person becomes
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0013| eligible for coverage pursuant to the provisions of the Health
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0014| Insurance Alliance Act."
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0015| Section 2. Section 59A-56-2 NMSA 1978 (being Laws 1994,
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0016| Chapter 75, Section 2) is amended to read:
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0017| "59A-56-2. PURPOSE.--The purpose of the Health Insurance
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0018| Alliance Act is to provide increased access to voluntary health
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0019| insurance coverage in New Mexico [The initial purpose is to
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0020| improve access to health insurance coverage for small employers
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0021| on a voluntary basis]. An additional purpose of the Health
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0022| Insurance Alliance Act is to provide for the development of [a
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0023| plan] plans for [expanded] health insurance coverage [to
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0024| include uninsured children, other employer groups] for
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0025| children, small employers and individuals."
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0001| Section 3. Section 59A-56-3 NMSA 1978 (being Laws 1994,
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0002| Chapter 75, Section 3) is amended to read:
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0003| "59A-56-3. DEFINITIONS.--As used in the Health Insurance
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0004| Alliance Act:
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0005| A. "alliance" means the New Mexico health insurance
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0006| alliance;
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0007| B. "approved health plan" means any arrangement for
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0008| the provision of health insurance offered through and approved
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0009| by the alliance [by which insureds have access to health
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0010| insurance];
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0011| C. "board" means the board of directors of the
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0012| alliance;
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0013| D. "child" means a dependent unmarried individual
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0014| who is less than nineteen years of age or an unmarried
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0015| individual who is enrolled full time in an accredited
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0016| educational institution until the individual becomes twenty-five
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0017| years of age;
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0018| E. "department" means the department of insurance;
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0019| [D.] F. "director" means an individual who
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0020| serves on the board;
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0021| [E.] G. "earned premiums" means premiums paid or
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0022| due during [the] a calendar year for coverage under an
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0023| approved health plan less any unearned premiums at the end of
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0024| that calendar year plus any unearned premiums from the end of
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0025| the [previous] immediately preceding calendar year;
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0001| [F.] H. "eligible expenses" [are] means the
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0002| allowable charges for a health care service [and items for
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0003| which benefits are extended] covered under an approved health
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0004| plan;
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0005| I. "gross earned premiums" means premiums paid or
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0006| due during a calender year for all health insurance written in
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0007| the state less any unearned premiums at the end of that calendar
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0008| year plus any unearned premiums from the end of the immediately
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0009| preceding calendar year;
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0010| [G.] J. "health care service" means a service or
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0011| product furnished an individual [or incidental to the
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0012| furnishing of the service or product] for the purpose of
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0013| preventing, alleviating, curing or healing human illness or
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0014| injury and includes services and products incidental to
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0015| furnishing the described services or products;
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0016| [H.] K. "health insurance" means "health"
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0017| insurance as defined in Section 59A-7-3 NMSA 1978; any hospital
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0018| and medical expense-incurred policy, including medicare
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0019| supplement insurance; nonprofit health care [service] plan
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0020| service contract; health maintenance organization subscriber
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0021| contract; short-term, accident, fixed indemnity, specified
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0022| disease policy, long-term care or disability income
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0023| insurance contracts and limited health benefit or credit
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0024| health insurance; coverage for health care services under
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0025| uninsured arrangements of group or group-type contracts,
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0001| including employer self-insured, cost-plus or other benefits
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0002| methodologies not involving insurance or not subject to New
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0003| Mexico premium taxes; coverage for health care services under
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0004| group-type contracts that are not available to the general
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0005| public and can be obtained only because of connection with a
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0006| particular organization or group; or coverage by medicare or
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0007| other governmental [benefits; or "health insurance" as defined
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0008| by Section 59A-7-3 NMSA 1978] programs providing health care
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0009| services; but "health insurance" does not include insurance
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0010| [arising out of] issued pursuant to provisions of the
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0011| Workers' Compensation Act or similar law, automobile medical
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0012| payment insurance or [insurance under] provisions by which
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0013| benefits are payable with or without regard to fault [and]
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0014| that [is] are required by law to be contained in any
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0015| liability insurance policy;
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0016| [I.] L. "health maintenance organization" means
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0017| a health maintenance organization as defined by Subsection M of
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0018| Section 59A-46-2 NMSA 1978;
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0019| [J.] M. "incurred claims" means claims paid
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0020| during a calendar year plus claims incurred in the calendar year
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0021| and paid prior to April 1 of the succeeding year, less claims
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0022| incurred previous to the current calendar year and paid prior to
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0023| April 1 of the current year;
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0024| [K.] N. "insured" means a small employer or its
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0025| employee and an individual covered by an approved health plan,
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0001| [or an individual] a former employee of a small employer who
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0002| is covered by an approved health plan through conversion or an
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0003| individual covered by an approved health plan that allows
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0004| individual enrollment;
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0005| [L.] O. "medicare" means coverage under both
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0006| Parts A and B of Title 18 of the federal Social Security Act;
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0007| [M.] P. "member" means [an insurance company
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0008| authorized to transact health insurance business in this state,
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0009| a nonprofit health care plan, a health maintenance organization
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0010| or self-insurers not subject to federal preemption, but does not
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0011| include an insurance company that is licensed under the Prepaid
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0012| Dental Plan Law or a company that is solely engaged in the sale
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0013| of dental insurance and is licensed under a provision of the
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0014| Insurance Code] a member of the alliance;
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0015| Q. "nonprofit health care plan" means a "health
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0016| care plan" as defined in Subsection K of Section 59A-47-3 NMSA
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0017| 1978;
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0018| R. "premiums" means the premiums received for
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0019| coverage under an approved health plan during a calendar year;
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0020| [N.] S. "small employer" means a person that is
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0021| a resident of this state, has employees at least fifty percent
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0022| of whom are residents of this state, is actively engaged in
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0023| business and that on at least fifty percent of its working days
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0024| during the preceding calendar year employed no [less] fewer
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0025| than two and no more than fifty eligible employees; provided
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0001| that: (1) in determining the number of eligible
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0002| employees, the spouse or dependent of an employee may, at the
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0003| employer's discretion, be counted as a separate employee; and
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0004| (2) companies that are [affiliated companies
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0005| or that are] eligible to file a combined tax return or a
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0006| consolidated tax return for purposes of state income taxation
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0007| shall be considered one employer; [and
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0008| O.] T. "superintendent" means the superintendent
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0009| of insurance;
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0010| U. "total premiums" means the total premiums for
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0011| business written in the state received during a calendar year;
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0012| and
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0013| V. "unearned premiums" means the portion of a
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0014| premium previously paid for which the coverage period is in the
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0015| future."
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0016| Section 4. Section 59A-56-4 NMSA 1978 (being Laws 1994,
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0017| Chapter 75, Section 4) is amended to read:
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0018| "59A-56-4. ALLIANCE CREATED--BOARD CREATED.--
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0019| A. The "New Mexico health insurance alliance" is
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0020| created as a nonprofit [independent] public corporation for
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0021| the purpose of providing increased access to health insurance in
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0022| the state. All insurance companies authorized to transact
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0023| health insurance business in this state, nonprofit health care
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0024| plans, health maintenance organizations and self-insurers not
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0025| subject to federal preemption shall organize and be members of
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0001| the alliance as a condition of their authority to offer health
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0002| insurance in this state, except for an insurance company that
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0003| is licensed under the Prepaid Dental Plan Law or a company that
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0004| is solely engaged in the sale of dental insurance and is
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0005| licensed under a provision of the Insurance Code. The alliance
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0006| [shall] is not [be considered] a governmental agency for
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0007| any purpose.
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0008| B. The [board of directors of the New Mexico health
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0009| insurance] alliance [is created] shall be governed by a
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0010| board of directors constituted pursuant to the provisions of
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0011| this section. The board is a governmental entity for purposes
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0012| of the Tort Claims Act, but the board shall not be considered a
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0013| governmental entity for any other purpose.
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0014| C. The superintendent shall, within sixty days after
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0015| [the effective date of the Health Insurance Alliance Act]
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0016| March 4, 1994, give notice to all members of the time and
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0017| place for the initial organizational meeting of the alliance.
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0018| Each member shall be entitled to one vote in person or by proxy
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0019| at the organizational meeting.
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0020| D. The alliance shall operate subject to the
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0021| supervision and approval of the board. The board shall consist
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0022| of:
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0023| (1) five directors, [appointed] elected by
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0024| the members, who shall be officers or employees of members and
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0025| shall consist of one representative of a nonprofit health care
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0001| plan, two representatives of health maintenance organizations
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0002| and two representatives of other types of members;
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0003| (2) five directors, appointed by the governor,
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0004| who shall be officers, general partners or proprietors of
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0005| small employers [and] who, after the term of the initial
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0006| appointments, are covered by approved health plans;
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0007| (3) four directors appointed by the governor,
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0008| who shall be employees of small employers, and who, after the
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0009| term of the initial appointments, are employees of small
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0010| employers covered by approved health plans; and
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0011| (4) the superintendent or his designee, [The
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0012| superintendent] who shall be a nonvoting member except when
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0013| his vote is necessary to break a tie.
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0014| E. The superintendent shall serve as chair of the
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0015| board unless he declines, in which event he shall appoint the
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0016| chair.
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0017| F. The directors [appointed] elected by the
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0018| members shall be [appointed] elected for initial terms of
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0019| three years or less, staggered so that the term of at least one
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0020| director [shall expire] expires on June 30 of each year.
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0021| The directors appointed by the governor shall be appointed for
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0022| initial terms of three years or less, staggered so that the term
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0023| of at least one director [shall expire] expires on June 30
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0024| of each year. Following the initial terms, directors shall be
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0025| elected or appointed for terms of three years. [If the
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0001| members fail to make the initial appointments within sixty days
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0002| following the first organizational meeting, the superintendent
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0003| shall make those appointments.] A director whose term has
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0004| expired shall continue to serve until his successor is elected
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0005| or appointed.
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0006| G. Whenever a vacancy on the board occurs, the
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0007| electing or appointing authority of [that director] the
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0008| director's position that is vacant shall fill the vacancy by
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0009| electing or appointing an individual to serve the balance of
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0010| the unexpired term; provided, when a vacancy occurs in one of
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0011| the director's positions elected by the members, the
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0012| superintendent is authorized to appoint a temporary replacement
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0013| director until the next scheduled election of directors elected
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0014| by the members is held. The individual elected or appointed
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0015| to fill a vacancy shall meet the requirements for initial
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0016| election or appointment to that position.
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0017| H. Directors may be reimbursed by the alliance as
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0018| provided in the Per Diem and Mileage Act in the same manner and
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0019| amounts as nonsalaried public officers, but shall receive no
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0020| other compensation, perquisite or allowance from the
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0021| alliance."
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0022| Section 5. Section 59A-56-5 NMSA 1978 (being Laws 1994,
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0023| Chapter 75, Section 5) is amended to read:
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0024| "59A-56-5. PLAN OF OPERATION.--
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0025| A. The board shall submit a plan of operation to the
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0001| superintendent and any amendments to the plan necessary or
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0002| suitable to assure the fair, reasonable and equitable
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0003| administration of the alliance.
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0004| B. The superintendent shall, after notice and
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0005| hearing, approve the plan of operation if it is determined to
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0006| assure the fair, reasonable and equitable administration of the
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0007| alliance. The plan of operation shall become effective upon
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0008| written approval of the superintendent consistent with the date
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0009| on which health insurance coverage through the alliance pursuant
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0010| to the provisions of the Health Insurance Alliance Act is made
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0011| available. [If the board fails to submit a plan of operation
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0012| within one hundred eighty days after the appointment of the
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0013| board, the superintendent shall, after notice and hearing, adopt
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0014| and promulgate a plan of operation.] A plan of operation
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0015| adopted by the superintendent shall continue in force until
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0016| modified by him or superseded by a subsequent plan of operation
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0017| submitted by the board and approved by the superintendent.
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0018| C. The plan of operation shall:
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0019| (1) establish procedures for the handling and
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0020| accounting of assets of the alliance;
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0021| (2) establish regular times and places for
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0022| meetings of the board;
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0023| (3) establish procedures for records to be kept
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0024| of all financial transactions and for annual fiscal reporting to
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0025| the superintendent;
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0001| (4) establish the amount of and the method for
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0002| collecting assessments pursuant to Section [11 of the Health
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0003| Insurance Alliance Act] 59A-56-11 NMSA 1978;
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0004| (5) establish a program to publicize the
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0005| existence of the alliance, the approved health plans, the
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0006| eligibility requirements and procedures for enrollment in an
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0007| approved health plan and to maintain public awareness of the
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0008| alliance;
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0009| (6) establish penalties for [noncollection]
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0010| nonpayment of assessments [from] by members;
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0011| (7) establish procedures for alternative
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0012| dispute resolution of disputes between members and insureds; and
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0013| (8) contain additional provisions necessary and
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0014| proper for the execution of the powers and duties of the
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0015| alliance."
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0016| Section 6. Section 59A-56-6 NMSA 1978 (being Laws 1994,
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0017| Chapter 75, Section 6) is amended to read:
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0018| "59A-56-6. BOARD--POWERS AND DUTIES.--
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0019| A. The board shall have the general powers and
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0020| authority granted to insurance companies licensed to transact
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0021| health insurance business under the laws of this state.
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0022| B. The board:
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0023| (1) may enter into contracts to carry out the
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0024| provisions of the Health Insurance Alliance Act, including, with
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0025| the approval of the superintendent, contracting with similar
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0001| alliances of other states for the joint performance of common
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0002| administrative functions or with persons or other organizations
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0003| for the performance of administrative functions;
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0004| (2) may sue and be sued;
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0005| (3) may conduct periodic audits of the members
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0006| to assure the general accuracy of the financial data submitted
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0007| to the alliance;
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0008| (4) shall establish maximum rate schedules,
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0009| allowable rate adjustments, administrative allowances,
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0010| reinsurance premiums and agent referral, [and] servicing
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0011| fees [and any other actuarial functions appropriate to the
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0012| operation of the alliance, but within the limits established]
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0013| or commissions subject to applicable provisions in the
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0014| Insurance Code. In determining the initial year's rate for
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0015| health insurance, the only rating factors that may be used are
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0016| age, gender, geographic area of the place of employment and
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0017| smoking practices. In any year's rate, the difference in rates
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0018| in any one age group that may be charged on the basis of a
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0019| person's gender shall not exceed another person's rates in the
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0020| age group by more than twenty percent of the lower rate, and no
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0021| person's rate shall exceed the rate of any other person with
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0022| similar family composition by more than two hundred fifty
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0023| percent of the lower rate, except that the rates for children
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0024| under the age of nineteen may be lower than the bottom rates in
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0025| the two hundred fifty percent band. The rating factor
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0001| restrictions shall not prohibit a member from offering rates
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0002| that differ depending upon family composition;
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0003| (5) may direct a member to issue policies or
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0004| certificates of coverage of health insurance in accordance with
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0005| the requirements of the Health Insurance Alliance Act;
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0006| (6) shall establish procedures for alternative
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0007| dispute resolution of disputes between members and insureds;
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0008| (7) shall cause the alliance to have an annual
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0009| audit of its operations by an independent certified public
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0010| accountant;
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0011| (8) shall conduct all board meetings as if it
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0012| were [an agency] subject to the provisions of the Open
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0013| Meetings Act;
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0014| (9) shall draft one or more sample health
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0015| insurance policies that are the prototype documents for the
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0016| members;
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0017| (10) shall determine the design criteria to be
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0018| met for an approved health plan;
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0019| (11) shall review each proposed approved health
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0020| plan to determine if it meets the alliance designed criteria
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0021| and, if it does meet the criteria, approve the plan [provided
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0022| that], but the board shall not permit more than one approved
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0023| health plan per member for each set of plan design criteria;
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0024| (12) shall review annually each approved health
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0025| plan to determine if it still qualifies as an approved health
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0001| plan based on the alliance designed criteria and, if the plan is
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0002| no longer approved, arrange for the transfer of the insureds
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0003| covered under the formerly approved plan to an approved health
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0004| plan;
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0005| (13) may terminate an approved health plan not
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0006| operating as required by the board;
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0007| (14) shall terminate an approved health plan if
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0008| timely claim payments are not made pursuant to the plan; and
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0009| (15) shall engage in significant marketing
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0010| activities, including a program of media advertising, to inform
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0011| small employers and eligible individuals of the existence of
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0012| the alliance, its purpose and the health insurance available or
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0013| potentially available through the alliance.
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0014| C. The alliance is subject to and responsible for
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0015| examination by the superintendent. No later than March 1 of
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0016| each year, the board shall submit to the superintendent an
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0017| audited financial report for the preceding calendar year in a
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0018| form approved by the superintendent."
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0019| Section 7. Section 59A-56-8 NMSA 1978 (being Laws 1994,
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0020| Chapter 75, Section 8) is amended to read:
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0021| "59A-56-8. APPROVED HEALTH PLAN [OR SERVICE].--
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0022| A. An approved health plan shall conform to the
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0023| alliance's approved health plan design criteria. The board may
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0024| allow more than one plan design for approved health plans. A
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0025| member may provide one approved health plan for each plan design
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0001| approved by the board.
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0002| B. The board shall designate plan designs for
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0003| standard approved health plans. The board may designate plan
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0004| designs for an approved health plan that provides catastrophic
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0005| coverage or other benefit plan designs.
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0006| [B. The] C. Each approved health plan shall
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0007| offer a premium that is no greater than [fifteen] ten
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0008| percent over and no less than [fifteen] ten percent under
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0009| the average of the standard rate index for plans with the same
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0010| characteristics.
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0011| [C.] D. Any member that [submits a bid for]
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0012| provides or offers to [provide or renews] renew a group
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0013| health insurance contract providing health insurance benefits to
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0014| employees of the state, a county, a municipality or a school
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0015| district for which public funds are contributed shall offer at
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0016| least one approved health plan to small employers; provided,
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0017| however, if a member does not offer anywhere in the United
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0018| States a plan that meets substantially the design criteria of an
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0019| approved health plan, the member shall not be required to offer
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0020| an approved health plan.
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0021| E. If a plan design approved by the board is not
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0022| offered by any member already offering an approved health plan,
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0023| but a member offers a substantially similar plan design outside
|
0024| the alliance, the board may require the member to offer that
|
0025| plan design as an approved health plan through the alliance.
|
0001| F. An approved health plan shall be offered for at
|
0002| least five consecutive years following the date last required in
|
0003| accordance with Subsection D of this section or after notifying
|
0004| the board of its future withdrawal if not required in accordance
|
0005| with Subsection D of this section unless:
|
0006| (1) the member substitutes another approved
|
0007| health plan for the plan withdrawn; or
|
0008| (2) the board allows the plan to be withdrawn
|
0009| because it imposes a serious hardship upon the member.
|
0010| G. No member shall be required to offer an approved
|
0011| health plan if the member notifies the superintendent in writing
|
0012| that it will no longer offer health insurance, life insurance or
|
0013| annuities in the state, except for renewal of existing
|
0014| contracts, provided that:
|
0015| (1) the member does not offer or provide health
|
0016| insurance, life insurance or annuities for a period of five
|
0017| years from the date of notification to the superintendent to any
|
0018| person in the state who is not covered by the member through a
|
0019| health insurance policy in effect on the date of the
|
0020| notification; and
|
0021| (2) with respect to health or life insurance
|
0022| policies or annuities in effect on the date of notification to
|
0023| the superintendent, the member continues to comply with all
|
0024| applicable laws and regulations governing the provision of
|
0025| insurance in this state, including the payment of applicable
|
0001| taxes, fees and assessments."
|
0002| Section 8. Section 59A-56-9 NMSA 1978 (being Laws 1994,
|
0003| Chapter 75, Section 9) is amended to read:
|
0004| "59A-56-9. REINSURANCE.--
|
0005| A. [Any] A member offering an approved health
|
0006| plan [to small employers] shall be reinsured for certain
|
0007| losses by the alliance. Within six months following the end of
|
0008| each calendar year in which the member offering the approved
|
0009| health plan paid more in incurred claims [than], plus the
|
0010| member's reinsurance premium pursuant to Subsection B of this
|
0011| section, than eighty-five percent of earned premiums received
|
0012| by the member [received in gross earned premiums] on all
|
0013| approved health plans issued by the member, [combined] the
|
0014| member shall receive from the alliance the excess amount for
|
0015| the calendar year by which the incurred claims and reinsurance
|
0016| premium exceeded eighty-five percent of the [gross] earned
|
0017| premiums received by the alliance or its administrator.
|
0018| B. The alliance shall withhold from all premiums
|
0019| that it receives a reinsurance premium as established by the
|
0020| board. The reinsurance premium shall not exceed five percent of
|
0021| premiums paid [by insured groups] in [their] the first
|
0022| year of coverage and shall not exceed ten percent of [such]
|
0023| premiums for renewal years. In determining the reinsurance
|
0024| premium for a particular calendar year, the board shall set the
|
0025| reinsurance premium at a rate that will recover the total
|
0001| reinsurance loss for the preceding year over a reasonable number
|
0002| of years in accordance with sound actuarial principles."
|
0003| Section 9. Section 59A-56-10 NMSA 1978 (being Laws 1994,
|
0004| Chapter 75, Section 10) is amended to read:
|
0005| "59A-56-10. ADMINISTRATION.--The alliance shall deduct
|
0006| from premiums collected for approved health plans an
|
0007| administrative charge as set by the board. The administrative
|
0008| charge shall be determined before the beginning of each calendar
|
0009| year. The maximum administrative charge the alliance may charge
|
0010| is ten percent of [gross] premiums [from a small employer]
|
0011| in the first year and five percent of [gross] premiums in
|
0012| renewal years."
|
0013| Section 10. Section 59A-56-11 NMSA 1978 (being Laws 1994,
|
0014| Chapter 75, Section 11) is amended to read:
|
0015| "59A-56-11. ASSESSMENTS.--
|
0016| A. After the completion of each calendar year, the
|
0017| alliance shall assess all its members for the [total] net
|
0018| reinsurance loss in the previous calendar year and for the net
|
0019| administrative loss that occurred in the previous calendar year,
|
0020| taking into account investment income for the period and other
|
0021| appropriate gains and losses using the following definitions:
|
0022| (1) net reinsurance losses shall be the
|
0023| [reinsurance incurred claims against the alliance for the
|
0024| previous calendar year reduced by the reinsurance earned]
|
0025| amount determined for the previous calendar year in accordance
|
0001| with Subsection A of Section 59A-56-9 NMSA 1978 for all members
|
0002| offering an approved health plan reduced by reinsurance
|
0003| premiums charged by the alliance in the previous calendar
|
0004| year; and
|
0005| (2) net administrative losses shall be the
|
0006| administrative expenses incurred by the alliance in the previous
|
0007| calendar year and projected for the current calendar year less
|
0008| the sum of administrative allowances [earned] received by
|
0009| the alliance and any legislative appropriation for the period,
|
0010| but, in the event of an administrative gain, net administrative
|
0011| losses for the purpose of assessments shall be considered zero,
|
0012| and the gain shall be carried forward to the administrative fund
|
0013| for the next calendar year as an additional allowance.
|
0014| B. The assessment for each member shall be
|
0015| determined by multiplying the total losses of the alliance's
|
0016| operation, as defined in Subsection A of this section, by a
|
0017| fraction, the numerator of which [equals] is an amount equal
|
0018| to that member's total [premium] premiums, or [its] the
|
0019| equivalent, exclusive of premiums received by the member for an
|
0020| approved health plan for health insurance written in the state
|
0021| during the preceding calendar year and the denominator of which
|
0022| equals the total premiums of all health insurance [premiums]
|
0023| written in the state during the preceding calendar year
|
0024| exclusive of premiums for approved health plans; provided that
|
0025| [premium income] total premiums shall not include payments
|
0001| by the secretary of human services pursuant to a contract issued
|
0002| under Section 1876 of the federal Social Security Act, [and
|
0003| shall not include premium income] total premiums exempted by
|
0004| the federal Employee Retirement Income Security Act of 1974 or
|
0005| [other] federal government programs.
|
0006| C. If assessments exceed actual reinsurance losses
|
0007| and administrative losses of the alliance, the excess shall be
|
0008| held at interest by the board to offset future losses.
|
0009| D. To enable the board to properly determine the net
|
0010| reinsurance amount and its responsibility for reinsurance to
|
0011| each member:
|
0012| (1) by April 15 of each year, each member
|
0013| offering an approved health plan shall submit a listing of all
|
0014| incurred claims [or health charges of each approved health plan
|
0015| for the previous year, including all claims or health charges
|
0016| incurred in the previous year and paid prior to April 1 of the
|
0017| current year. From this amount shall be subtracted and
|
0018| identified by list all incurred claims or health charges of each
|
0019| approved health plan paid in the previous year's months of
|
0020| January, February and March incurred prior to] for the
|
0021| previous year; and
|
0022| (2) by April 15 of each year, each member shall
|
0023| submit a report that includes the total [amount of all] earned
|
0024| premiums received during the prior year less [any earned
|
0025| premium] the total earned premiums exempted by federal
|
0001| government programs.
|
0002| E. The alliance shall notify [members] each
|
0003| member of the amount of [the] its assessment due by May 15
|
0004| of each year. The assessment shall be paid by the member by
|
0005| June 15 of each year.
|
0006| F. The proportion of participation of each member in
|
0007| the alliance shall be determined annually by the board, based on
|
0008| annual statements filed by each member and other reports deemed
|
0009| necessary by the board. Any deficit incurred by the alliance
|
0010| shall be recouped by assessments apportioned among the members
|
0011| pursuant to the formula provided in Subsection B of this
|
0012| section; provided that the assessment paid for any member shall
|
0013| be allowed as a credit on the future premium tax return for
|
0014| that member, with the credit limited to fifty percent of the
|
0015| premium tax due the first year the assessment is imposed; forty
|
0016| percent the second year; and thirty percent the third and all
|
0017| subsequent years.
|
0018| G. The board may [abate or] defer, in whole or in
|
0019| part, the payment of an assessment of a member if, in the
|
0020| opinion of the board, after approval of the superintendent,
|
0021| payment of the assessment would endanger the ability of the
|
0022| member to fulfill its contractual obligations. In the event
|
0023| payment of an assessment against a member is [abated or]
|
0024| deferred, the amount [by which such assessment is abated or]
|
0025| deferred may be assessed against the other members in a manner
|
0001| consistent with the basis for assessments set forth in
|
0002| Subsection A of this section. [The member receiving the
|
0003| abatement or deferment shall remain liable to the alliance for
|
0004| the deficiency for four years including interest at the
|
0005| prevailing rate as determined by regulation of the
|
0006| superintendent. The board may sue to recover the abatement or
|
0007| deferment plus interest and costs.] The member receiving the
|
0008| deferment shall pay the assessment in full plus interest at the
|
0009| prevailing rate as determined by regulation of the
|
0010| superintendent within four years from the date payment is
|
0011| deferred. After four years but within five years of the date of
|
0012| the deferment, the board may sue to recover the amount of the
|
0013| deferred payment plus interest and costs. Board actions to
|
0014| recover deferred payments brought after five years of the date
|
0015| of deferment are barred. Any amount received shall be deducted
|
0016| from future assessments or reimbursed pro rata to the members
|
0017| paying the deferred assessment.
|
0018| H. In addition to the assessments provided in this
|
0019| section for reinsurance and administrative losses, the board may
|
0020| impose on all members annually an assessment not to exceed two
|
0021| hundred dollars ($200) for the board to hire consultants and
|
0022| plan and develop alliance programs. This additional
|
0023| assessment shall be allowed as a credit on the next premium tax
|
0024| due for the member."
|
0025| Section 11. Section 59A-56-13 NMSA 1978 (being Laws 1994,
|
0001| Chapter 75, Section 13) is amended to read:
|
0002| "59A-56-13. ALLIANCE ADMINISTRATOR.--
|
0003| A. The board may select an alliance administrator
|
0004| through a competitive request for proposal process. The board
|
0005| shall evaluate proposals based on criteria established by the
|
0006| board that shall include:
|
0007| (1) proven ability to [handle accident and]
|
0008| administer health insurance programs;
|
0009| (2) an estimate of total charges for
|
0010| administering the alliance for the proposed contract period;
|
0011| and
|
0012| (3) ability to administer the alliance in a
|
0013| cost-efficient manner.
|
0014| B. The alliance administrator contract shall be for
|
0015| a period up to four years, subject to annual renegotiation of
|
0016| the fees and services, and shall provide for cancellation of the
|
0017| contract for cause, termination of the alliance by the
|
0018| legislature or the combining of the alliance with a governmental
|
0019| body.
|
0020| C. At least one year prior to the expiration of
|
0021| [each four-year period of service by the] an alliance
|
0022| administrator contract, the board [shall] may invite all
|
0023| interested parties, including the current administrator, to
|
0024| submit [bids] proposals to serve as alliance administrator
|
0025| for [up to] a succeeding [four-year] contract period.
|
0001| Selection of the administrator for a succeeding contract
|
0002| period shall be made at least six months prior to the expiration
|
0003| of the current contract.
|
0004| D. The alliance administrator shall:
|
0005| (1) take applications for an approved health
|
0006| plan from small employers or a referring agent;
|
0007| (2) establish a premium billing procedure for
|
0008| collection of premiums from insureds. Billings shall be made on
|
0009| a periodic basis, not less than monthly, as determined by the
|
0010| board;
|
0011| (3) pay the member that offers an approved
|
0012| health plan the net premium due after deduction of reinsurance
|
0013| and administrative allowances;
|
0014| (4) provide the member with any changes in the
|
0015| status of insureds;
|
0016| (5) perform all necessary functions to assure
|
0017| that each member is providing timely payment of benefits to
|
0018| individuals covered under an approved health plan, including:
|
0019| (a) making information available to
|
0020| insureds relating to the proper manner of submitting a claim for
|
0021| benefits to the member offering the approved health plan and
|
0022| distributing forms on which submissions shall be made; and
|
0023| (b) making information available on
|
0024| approved health plan benefits and rates to insureds;
|
0025| (6) submit regular reports to the board
|
0001| regarding the operation of the alliance, the frequency, content
|
0002| and form of which shall be determined by the board;
|
0003| (7) following the close of each fiscal year,
|
0004| determine [net written] premiums of members, the expense of
|
0005| administration and the paid and incurred [losses] health care
|
0006| service charges for the year and report this information to the
|
0007| board and the superintendent on a form prescribed by the
|
0008| superintendent; and
|
0009| (8) establish the premiums for reinsurance and
|
0010| the administrative charges, subject to approval of the board."
|
0011| Section 12. Section 59A-56-14 NMSA 1978 (being Laws 1994,
|
0012| Chapter 75, Section 14) is amended to read:
|
0013| "59A-56-14. ELIGIBILITY--GUARANTEED ISSUE--PLAN
|
0014| PROVISIONS.--
|
0015| A. A small employer is eligible for an approved
|
0016| health plan if on the effective date of coverage or renewal:
|
0017| (1) at least fifty percent of its eligible
|
0018| employees not otherwise insured elect to be covered under the
|
0019| approved health plan; [and]
|
0020| (2) the small employer has not terminated
|
0021| coverage with an approved health plan within three years of the
|
0022| date of application for coverage except to change to another
|
0023| approved health plan; and
|
0024| (3) the small employer does not offer other
|
0025| general group health insurance coverage to its employees. For
|
0001| the purposes of this paragraph, general group health insurance
|
0002| coverage excludes coverage providing only a specific limited
|
0003| form of health insurance such as accident or disability income
|
0004| insurance coverage or a specific health care service such as
|
0005| dental care.
|
0006| B. An approved health plan shall provide [that
|
0007| coverage of a dependent unmarried individual terminates when the
|
0008| individual becomes nineteen years of age or, if the individual
|
0009| is enrolled full time in an accredited educational institution,
|
0010| when the individual becomes twenty-five years of age] coverage
|
0011| for a child. The policy shall also provide in substance that
|
0012| attainment of the limiting age by an unmarried dependent
|
0013| individual does not operate to terminate coverage when the
|
0014| individual continues to be incapable of self-sustaining
|
0015| employment by reason of [mental retardation] developmental
|
0016| disability or physical handicap and the individual is primarily
|
0017| dependent for support and maintenance upon the employee. Proof
|
0018| of incapacity and dependency shall be furnished to the alliance
|
0019| and the member that offered the approved health plan within one
|
0020| hundred twenty days of attainment of the limiting age. The
|
0021| board may require subsequent proof annually after a two-year
|
0022| period following attainment of the limiting age.
|
0023| C. An approved health plan shall provide that the
|
0024| health insurance benefits applicable for eligible dependents are
|
0025| payable with respect to a newly born child of the family member
|
0001| or the individual in whose name the contract is issued from the
|
0002| moment of birth, including the necessary care and treatment of
|
0003| medically diagnosed congenital defects and birth abnormalities.
|
0004| If payment of a specific premium is required to provide coverage
|
0005| for the child, the contract may require that notification of the
|
0006| birth of a child and payment of the required premium shall be
|
0007| furnished to the member within thirty-one days after the date of
|
0008| birth in order to have the coverage from birth. An approved
|
0009| health plan shall provide that the health insurance benefits
|
0010| applicable for eligible dependents are payable for an adopted
|
0011| child in accordance with the provisions of Section 59A-22-34.1
|
0012| NMSA 1978.
|
0013| D. Except as provided in Subsections E, [and] G
|
0014| and H of this section, an approved health plan may contain
|
0015| provisions under which coverage is excluded during a six-month
|
0016| period following the effective date of coverage of an individual
|
0017| for preexisting conditions, as long as either of the following
|
0018| exists:
|
0019| (1) the condition has manifested itself within
|
0020| a period of six months before the effective date of coverage in
|
0021| such a manner as would cause an ordinarily prudent person to
|
0022| seek diagnosis or treatment; or
|
0023| (2) medical advice or treatment was recommended
|
0024| or received within a period of six months before the effective
|
0025| date of coverage.
|
0001| E. The preexisting condition exclusions described in
|
0002| Subsection D of this section shall be waived to the extent to
|
0003| which similar exclusions have been satisfied under any prior
|
0004| health insurance coverage if the application for health
|
0005| insurance through the alliance is made not later than thirty-one
|
0006| days following the termination of the prior coverage. In that
|
0007| case, coverage through the alliance shall be effective from the
|
0008| date on which the prior coverage was terminated. This
|
0009| subsection does not prohibit preexisting conditions coverage in
|
0010| an approved health plan that is more favorable to the
|
0011| [insured] covered individual than that specified in this
|
0012| subsection.
|
0013| F. An individual is not eligible for coverage by the
|
0014| alliance if he:
|
0015| (1) [he] is [at the time of application]
|
0016| eligible for medicare; provided, however, if an individual has
|
0017| health insurance coverage from an employer whose group includes
|
0018| twenty or more individuals, an individual eligible for medicare
|
0019| who continues to be employed may choose to be covered through an
|
0020| approved health plan;
|
0021| (2) [he] has voluntarily terminated health
|
0022| insurance issued through the alliance within the past twelve
|
0023| months unless it was due to a change in employment; or
|
0024| (3) [he] is an inmate of a public institution
|
0025| [or is eligible for public programs, other than state-funded
|
0001| programs, for which medical care is provided].
|
0002| G. The alliance shall provide for an open enrollment
|
0003| period of sixty days from the initial offering of an approved
|
0004| health plan. Individuals enrolled during the open enrollment
|
0005| period shall not be subject to the preexisting conditions
|
0006| limitation.
|
0007| H. If an insured covered by an approved health plan
|
0008| switches to another approved health plan that provides increased
|
0009| or additional benefits such as lower deductible or co-payment
|
0010| requirements, the member offering the approved health plan with
|
0011| increased or additional benefits may require the six-month
|
0012| period for preexisting conditions provided in Subsection D of
|
0013| this section to be satisfied prior to receipt of the additional
|
0014| benefits.
|
0015| I. An approved health plan shall provide for a
|
0016| thirty-day reinstatement period from the end of a grace period
|
0017| provided by the approved health plan, requiring payments of all
|
0018| back premiums plus a penalty of five percent of the annualized
|
0019| premium. Any claims incurred between the date through which
|
0020| premiums have been paid and the date of reinstatement are not
|
0021| covered unless covered by the conditions of the approved health
|
0022| plan."
|
0023| Section 13. Section 59A-56-17 NMSA 1978 (being Laws 1994,
|
0024| Chapter 75, Section 17) is amended to read:
|
0025| "59A-56-17. BENEFITS.--
|
0001| A. An approved health plan [issued through the
|
0002| alliance] shall pay for [or provide] medically necessary
|
0003| eligible expenses that exceed the deductible, co-payment and co-insurance amounts applicable under the provisions of Section
|
0004| [18 of the Health Insurance Alliance Act] 59A-56-18 NMSA
|
0005| 1978 and are not otherwise limited or excluded. The Health
|
0006| Insurance Alliance Act does not prohibit the board from
|
0007| approving additional types of health plan designs with similar
|
0008| cost-benefit structures or other types of health plan designs.
|
0009| An approved health plan for small employers shall, at a
|
0010| minimum, reflect the levels of health insurance coverage
|
0011| generally available in New Mexico for small employer group
|
0012| policies, but an approved health plan for small employers may
|
0013| also offer health plan designs that are not generally available
|
0014| in New Mexico for small employer group policies.
|
0015| B. The board may design and require an approved
|
0016| health plan to contain cost-containment measures and
|
0017| requirements, including managed care, pre-admission
|
0018| certification, [and] concurrent inpatient review and the use
|
0019| of fee schedules for health care providers, including the
|
0020| diagnosis-related grouping system and the resource-based
|
0021| relative value system."
|
0022| Section 14. Section 59A-56-18 NMSA 1978 (being Laws 1994,
|
0023| Chapter 75, Section 18) is amended to read:
|
0024| "59A-56-18. DEDUCTIBLES--CO-INSURANCE--MAXIMUM OUT-OF-POCKET PAYMENTS.--
|
0025| A. Subject to the limitations provided in Subsection
|
0001| C of this section, an approved health plan offered through the
|
0002| alliance may impose a deductible on a per-person calendar year
|
0003| basis. [A deductible plan of five hundred dollars ($500) shall
|
0004| initially be offered.] Approved health plans offered by
|
0005| health maintenance [organization plans] organizations shall
|
0006| provide equivalent cost-benefit structures. The board may
|
0007| authorize deductibles in other amounts and equivalent cost-benefit structures. [The deductible shall be applied to the
|
0008| first five hundred dollars ($500) or any other amount determined
|
0009| as deductible by the board of eligible expenses incurred by the
|
0010| covered individual.]
|
0011| B. Subject to the limitations provided in Subsection
|
0012| C of this section, a mandatory co-insurance requirement
|
0013| [shall] for an approved health plan may be imposed [at an
|
0014| average not to exceed thirty percent] as a percentage of
|
0015| eligible expenses in excess of [the mandatory] a deductible.
|
0016| Health maintenance organizations shall impose equivalent cost-benefit structures.
|
0017| C. The maximum aggregate out-of-pocket payments for
|
0018| eligible expenses [or health care services] by the covered
|
0019| individual shall be determined by the board."
|
0020| Section 15. Section 59A-56-19 NMSA 1978 (being Laws 1994,
|
0021| Chapter 75, Section 19) is amended to read:
|
0022| "59A-56-19. DEPENDENT FAMILY MEMBER REQUIRED COVERAGE--SMALL EMPLOYER RESPONSIBILITY.--
|
0023| A. A small employer [may] shall collect or make
|
0024| a payroll deduction from the compensation of an employee for the
|
0025| portion of the approved health plan cost the employee is
|
0001| responsible for paying. The small employer may contribute to
|
0002| the cost of that plan on behalf of the employee.
|
0003| B. A small employer shall make available to
|
0004| dependent family members of an employee covered by an approved
|
0005| health plan the same approved health plan. The small employer
|
0006| may contribute to the cost of [group] family coverage.
|
0007| C. All premiums collected, deducted from the
|
0008| compensation of employees or paid on their behalf by the small
|
0009| employer shall be promptly remitted to the alliance."
|
0010| Section 16. Section 59A-56-20 NMSA 1978 (being Laws 1994,
|
0011| Chapter 75, Section 20) is amended to read:
|
0012| "59A-56-20. RENEWABILITY.--
|
0013| A. An approved health plan shall contain provisions
|
0014| under which the member offering the plan is obligated to renew
|
0015| the health insurance if premiums are paid until the day the plan
|
0016| is replaced by another plan or the small employer terminates
|
0017| coverage. An individual covered by health insurance under an
|
0018| approved health plan may retain coverage until he [first]
|
0019| becomes eligible for medicare as the primary coverage, except
|
0020| that in a family policy [the age of the younger family member
|
0021| shall be used to continue the coverage and as the basis for
|
0022| eligibility] coverage under an approved health plan shall
|
0023| continue for any person in the family who is not eligible for
|
0024| medicare.
|
0025| B. If an approved health plan ceases to exist, the
|
0001| alliance shall provide an alternate approved health plan.
|
0002| C. An approved health plan shall provide covered
|
0003| individuals the right to continue health insurance coverage
|
0004| through an approved health plan as individual health insurance
|
0005| provided by the same member upon the death of the employee or
|
0006| upon the divorce, annulment or dissolution of marriage or legal
|
0007| separation of the spouse from the employee or by termination of
|
0008| employment by electing to do so within a period of time
|
0009| specified in the health insurance, provided that the employee
|
0010| was covered under an approved health plan while employed for at
|
0011| least six consecutive months. The individual may be charged an
|
0012| additional administrative charge for the individual health
|
0013| insurance.
|
0014| D. The right to continue health insurance coverage
|
0015| provided in this section terminates if the covered individual
|
0016| resides outside the United States for more than six consecutive
|
0017| months."
|
0018| Section 17. Section 59A-56-21 NMSA 1978 (being Laws 1994,
|
0019| Chapter 75, Section 21) is amended to read:
|
0020| "59A-56-21. [RULES] REGULATIONS.--The superintendent
|
0021| shall:
|
0022| A. adopt [rules] regulations that provide for
|
0023| disclosure by members of the availability of health insurance
|
0024| from the alliance; and
|
0025| B. adopt [rules] regulations to carry out the
|
0001| provisions of the Health Insurance Alliance Act."
|
0002| Section 18. Section 59A-56-23 NMSA 1978 (being Laws 1994,
|
0003| Chapter 75, Section 23) is amended to read:
|
0004| "59A-56-23. RATES--STANDARD RISK RATE--EXPERIENCE RATING
|
0005| PROHIBITED.--
|
0006| A. The alliance shall determine a standard risk rate
|
0007| index by actuarially calculating the average index rates that
|
0008| the insurer has filed under the requirements of the Small Group
|
0009| Rate and Renewability Act with the benefits similar to the
|
0010| alliance's standard approved health plan. A standard risk rate
|
0011| based on age and other appropriate demographic characteristics
|
0012| may be used. No standard risk rate shall be more than
|
0013| [fifteen] ten percent higher or [fifteen] ten percent
|
0014| lower than the average index rate. In determining the standard
|
0015| risk rate, the alliance shall consider the benefits provided by
|
0016| the approved health plan.
|
0017| B. Experience rating is not allowed other than for
|
0018| reinsurance purposes.
|
0019| C. All rates and rate schedules shall be submitted
|
0020| to the superintendent for approval prior to use."
|
0021| Section 19. Section 59A-56-24 NMSA 1978 (being Laws 1994,
|
0022| Chapter 75, Section 24) is amended to read:
|
0023| "59A-56-24. BENEFIT PAYMENTS REDUCTION.--
|
0024| A. An approved health plan shall be the last payer
|
0025| of benefits whenever any other benefit is available. Benefits
|
0001| otherwise payable under the approved health plan shall be
|
0002| reduced by all amounts paid or payable through any other health
|
0003| insurance and by all hospital and medical expense benefits paid
|
0004| or payable under any workers' compensation coverage, automobile
|
0005| medical payment or liability insurance, whether provided on the
|
0006| basis of fault or no-fault, and by any hospital or medical
|
0007| benefits paid or payable under or provided pursuant to any state
|
0008| or federal [law] program, excluding medicaid.
|
0009| B. The administrator or the alliance shall have a
|
0010| cause of action against any person covered by an approved health
|
0011| plan for the recovery of the amount of benefits paid that are
|
0012| not for [covered] eligible expenses. Benefits due from the
|
0013| approved health plan may be reduced or refused as a set-off
|
0014| against any amount recoverable under this section."
|
0015| Section 20. A new section of the Health Insurance Alliance
|
0016| Act is enacted to read:
|
0017| "[NEW MATERIAL] HEALTH INSURANCE COVERAGE FOR CHILDREN.--
|
0018| A. The board may adopt a children's health insurance
|
0019| program that conforms to one or more prototypes established by
|
0020| the board.
|
0021| B. Members providing approved health plans in the
|
0022| alliance are eligible to bid to provide a children's health
|
0023| insurance plan. A children's health insurance plan is not
|
0024| considered a separate approved health plan within the meaning of
|
0025| the Health Insurance Alliance Act.
|
0001| C. If an employer offers a group health insurance
|
0002| plan for employees that includes coverage for children and if
|
0003| the employee chooses to provide coverage for eligible children
|
0004| through the children's health insurance program of the alliance
|
0005| instead of the employer's group health insurance plan, the
|
0006| employer shall pay as part of the premium for the children's
|
0007| health insurance plan the contribution that the employer would
|
0008| have paid to provide coverage to the child through the
|
0009| employer's group health insurance plan.
|
0010| D. The board shall provide an addendum to the plan
|
0011| of operation for the superintendent's approval to assure the
|
0012| fair, reasonable and equitable administration of the children's
|
0013| health insurance program.
|
0014| E. All policy forms written to conform to the
|
0015| prototype of the children's health insurance plans shall be
|
0016| filed and approved by the superintendent before they are
|
0017| issued."
|
0018| Section 21. A new section of the Health Insurance Alliance
|
0019| Act is enacted to read:
|
0020| "[NEW MATERIAL] EXEMPTION.--The alliance is exempt from
|
0021| payment of all fees and taxes levied by this state or any of its
|
0022| political subdivisions."
|
0023| Section 22. TEMPORARY PROVISION--REPORT.--The department
|
0024| of insurance and the New Mexico health insurance alliance shall
|
0025| prepare and publish a report to the legislature by October 1,
|
0001| 1996 on the alliance programs and recommendations to facilitate
|
0002| participation in the alliance programs.
|
0003| Section 23. REPEAL.--Laws 1994, Chapter 75, Section 35 is
|
0004| repealed.
|
0005| Section 24. EMERGENCY.--It is necessary for the public
|
0006| peace, health and safety that this act take effect immediately.
|
0007|
|
0008|
|
0009|
|
0010| FORTY-SECOND LEGISLATURE
|
0011| SECOND SESSION, 1996
|
0012|
|
0013|
|
0014| JANUARY 24, 1996
|
0015|
|
0016| Mr. President:
|
0017|
|
0018| Your COMMITTEES' COMMITTEE, to whom has been referred
|
0019|
|
0020| SENATE BILL 199
|
0021|
|
0022| has had it under consideration and finds same to be GERMANE, PURSUANT
|
0023| TO CONSTITUTIONAL PROVISIONS, and thence referred to the
|
0024| CORPORATIONS AND TRANSPORTATION COMMITTEE.
|
0025|
|
0001| Respectfully submitted,
|
0002|
|
0003|
|
0004|
|
0005|
|
0006| __________________________________
|
0007| SENATOR MANNY M. ARAGON, Chairman
|
0008|
|
0009|
|
0010|
|
0011| Adopted_______________________ Not Adopted_______________________
|
0012| (Chief Clerk) (Chief Clerk)
|
0013|
|
0014|
|
0015| Date ________________________
|
0016|
|
0017|
|
0018|
|
0019| S0199CC1
|
0020|
|
0021| FORTY-SECOND LEGISLATURE SB 199/a
|
0022| SECOND SESSION, 1996
|
0023|
|
0024|
|
0025| January 30, 1996
|
0001|
|
0002| Mr. President:
|
0003|
|
0004| Your CORPORATIONS & TRANSPORTATION COMMITTEE, to whom
|
0005| has been referred
|
0006|
|
0007| SENATE BILL 199
|
0008|
|
0009| has had it under consideration and reports same with recommendation that
|
0010| it DO PASS, amended as follows:
|
0011|
|
0012| 1. On page 39, strike lines 10 through 25 in their entirety and
|
0013| on page 40, strike lines 1 through 17 in their entirety.
|
0014|
|
0015| 2. Renumber the succeeding sections accordingly.
|
0016|
|
0017| 3. On page 40, line 20, after "legislature" insert "and the
|
0018| governor".
|
0019|
|
0020| 4. On page 40, lines 20 and 21, strike the comma and "1996" and
|
0021| insert in lieu thereof "of each year, beginning on October 1, 1996".
|
0022|
|
0023| 5. On page 40, line 22, after the period insert the following new
|
0024| sentence to read:
|
0025|
|
0001| "The report shall include a director's report from members and insured
|
0002| representatives that reflects comments made by members and insureds
|
0003| regarding the alliance for each year the directors are required to
|
0004| report to the legislature and the governor.".
|
0005|
|
0006| 6. On page 40, between lines 24 and 25, insert the following new
|
0007| section to read:
|
0008|
|
0009| "Section 24. DELAYED REPEAL.--The Health Insurance Alliance Act is
|
0010| repealed June 30, 2003.".
|
0011|
|
0012| 7. Renumber the succeeding section accordingly,
|
0013|
|
0014|
|
0015|
|
0016|
|
0017|
|
0018|
|
0019|
|
0020|
|
0021|
|
0022| and thence referred to the FINANCE COMMITTEE.
|
0023|
|
0024| Respectfully submitted,
|
0025|
|
0001|
|
0002|
|
0003| __________________________________
|
0004| Roman M. Maes, III, Chairman
|
0005|
|
0006|
|
0007|
|
0008| Adopted_______________________ Not Adopted_______________________
|
0009| (Chief Clerk) (Chief Clerk)
|
0010|
|
0011|
|
0012| Date ________________________
|
0013|
|
0014|
|
0015| The roll call vote was 7 For 0 Against
|
0016| Yes: 7
|
0017| No: 0
|
0018| Excused: McKibben, Reagan
|
0019| Absent: 0
|
0020|
|
0021|
|
0022|
|
0023|
|
0024|
|
0025| S0199CT1 .111191.1
|
0001|
|
0002|
|
0003| FORTY-SECOND LEGISLATURE SB 199/a
|
0004| SECOND SESSION, 1996
|
0005|
|
0006|
|
0007| February 3, 1996
|
0008|
|
0009| Mr. President:
|
0010|
|
0011| Your FINANCE COMMITTEE, to whom has been referred
|
0012|
|
0013| SENATE BILL 199, as amended
|
0014|
|
0015| has had it under consideration and reports same with recommendation that
|
0016| it DO PASS, amended as follows:
|
0017|
|
0018| 1. Strike Senate Corporations and Transportation Committee
|
0019| Amendment 6.
|
0020|
|
0021| 2. On page 1, line 20, after the subsection designation "A."
|
0022| strike "A" and insert in lieu thereof "Except as provided in Subsection
|
0023| I of this section, a".
|
0024|
|
0025| 3. On page 5, strike lines 11 through 15 and insert in lieu
|
0001| thereof:
|
0002|
|
0003| "I. A person's eligibility for a policy issued under the
|
0004| Health Insurance Alliance Act shall not preclude a person from remaining
|
0005| on or choosing a pool policy; provided, a self-employed person who
|
0006| qualifies for an approved health plan under the Health Insurance
|
0007| Alliance Act by using a dependent as the second employee may choose a
|
0008| pool policy in lieu of the health plan under that act."".
|
0009|
|
0010| 4. On page 10, line 1, strike "and" and between lines 1 and 2,
|
0011| insert the following new paragraph:
|
0012|
|
0013| "(2) a self-employed person who qualifies as a small
|
0014| employer by using a spouse or dependent as a second employee, and one of
|
0015| the two is covered under a policy pursuant to the Comprehensive Health
|
0016| Insurance Pool Act, is a small employer for purposes of the Health
|
0017| Insurance Alliance Act; and".
|
0018|
|
0019| 5. Renumber the succeeding paragraph accordingly.
|
0020|
|
0021| 6. On page 40, strike lines 23 and 24 in their entirety.
|
0022|
|
0023| 7. On page 40, between lines 24 and 25, insert the following new
|
0024| section to read:
|
0025|
|
0001| "Section 23. Laws 1994, Chapter 75, Section 35 is amended to read:
|
0002|
|
0003| "Section 35. DELAYED REPEAL.--The Health Insurance Alliance Act is
|
0004| repealed June 30, [1998] 2003."".
|
0005|
|
0006|
|
0007|
|
0008| Respectfully submitted,
|
0009|
|
0010|
|
0011|
|
0012| __________________________________
|
0013| Ben D. Altamirano, Chairman
|
0014|
|
0015|
|
0016|
|
0017| Adopted_______________________ Not Adopted_______________________
|
0018| (Chief Clerk) (Chief Clerk)
|
0019|
|
0020|
|
0021| Date ________________________
|
0022|
|
0023|
|
0024| The roll call vote was 8 For 0 Against
|
0025| Yes: 8
|
0001| No: 0
|
0002| Excused: Donisthorpe, Duran, Ingle, Kidd, Kysar
|
0003| Absent: None
|
0004|
|
0005|
|
0006| S0199FC1 111639.1
|
0007|
|
0008| FORTY-SECOND LEGISLATURE
|
0009| SECOND SESSION
|
0010|
|
0011|
|
0012| February 5, 1996
|
0013|
|
0014|
|
0015| SENATE FLOOR AMENDMENT number _______ to SENATE BILL 199, as amended
|
0016|
|
0017| Amendment sponsored by Senator Janice D. Paster
|
0018|
|
0019|
|
0020| 1. Strike Senate Finance Committee Amendments 3, 4 and 5.
|
0021|
|
0022| 2. On page 5, strike lines 11 through 15 and insert in lieu
|
0023| thereof:
|
0024|
|
0025| "I. A person's eligibility for a policy issued under the
|
0001| Health Insurance Alliance Act shall not preclude a person from remaining
|
0002| on a pool policy, and a self-employed person who qualifies for an
|
0003| approved health plan under the Health Insurance Alliance Act by using a
|
0004| dependent as the second employee may choose a pool policy in lieu of the
|
0005| health plan under that act."".
|
0006|
|
0007|
|
0008|
|
0009|
|
0010|
|
0011|
|
0012| __________________________
|
0013| Janice D. Paster
|
0014|
|
0015|
|
0016|
|
0017| Adopted ___________________ Not Adopted _____________________
|
0018| (Chief Clerk) (Chief Clerk)
|
0019|
|
0020|
|
0021| Date _________________
|
0022| State of New Mexico
|
0023| House of Representatives
|
0024|
|
0025| FORTY-SECOND LEGISLATURE
|
0001| SECOND SESSION, 1996
|
0002|
|
0003|
|
0004| February 11, 1996
|
0005|
|
0006|
|
0007| Mr. Speaker:
|
0008|
|
0009| Your BUSINESS AND INDUSTRY COMMITTEE, to whom has been
|
0010| referred
|
0011|
|
0012| SENATE BILL 199, as amended
|
0013|
|
0014| has had it under consideration and reports same with
|
0015| recommendation that it DO PASS.
|
0016|
|
0017| Respectfully submitted,
|
0018|
|
0019|
|
0020|
|
0021|
|
0022| Fred Luna, Chairman
|
0023|
|
0024|
|
0025| Adopted Not Adopted
|
0001| (Chief Clerk) (Chief Clerk)
|
0002|
|
0003| Date
|
0004|
|
0005| The roll call vote was 9 For 0 Against
|
0006| Yes: 9
|
0007| Excused: None
|
0008| Absent: Gubbels, J.G.Taylor, Varela
|
0009|
|
0010|
|
0011|
|
0012| S0199BI1
|