0001| HOUSE BILL 359
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0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997
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0003| INTRODUCED BY
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0004| MICHAEL M. OLGUIN
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0005|
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0006|
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0007|
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0008| FOR THE HEALTH CARE REFORM COMMITTEE
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0009|
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0010| AN ACT
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0011| RELATING TO HEALTH INSURANCE; PRESERVING ADJUSTED COMMUNITY
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0012| RATING FOR INDIVIDUAL AND GROUP PLANS.
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0013|
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0014| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0015| Section 1. Section 59A-18-13.1 NMSA 1978 (being Laws
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0016| 1994, Chapter 75, Section 26) is amended to read:
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0017| "59A-18-13.1. ADJUSTED COMMUNITY RATING.--
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0018| A. [Until July 1, 1998] Every insurer, fraternal
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0019| benefit society, health maintenance organization or nonprofit
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0020| health care plan that provides primary health insurance or
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0021| health care coverage insuring or covering major medical
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0022| expenses shall, in determining the initial year's premium
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0023| charged for an individual, use only the rating factors of age,
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0024| gender, geographic area of the place of employment and smoking
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0025| practices. In determining the initial and any subsequent
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0001| year's rate, the difference in rates in any one age group that
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0002| may be charged on the basis of a person's gender shall not
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0003| exceed another person's rates in the age group by more than
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0004| twenty percent of the lower rate, and no person's rate shall
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0005| exceed the rate of any other person with similar family
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0006| composition by more than two hundred fifty percent of the lower
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0007| rate, except that the rates for children under the age of
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0008| nineteen may be lower than the bottom rates in the two hundred
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0009| fifty percent band. The rating factor restrictions shall not
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0010| prohibit an insurer, society, organization or plan from
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0011| offering rates that differ depending upon family composition.
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0012| [B. Effective July 1, 1998, every insurer,
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fraternal benefit society, health maintenance organization or
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nonprofit health care plan that provides primary health
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insurance or health care coverage insuring or covering major
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medical expenses shall charge the same premium for the same
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coverage to each New Mexico resident, regardless of a person's
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individual circumstances for medical risk, job risk or gender.
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The only rating factor that may be used is whether a person is
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under or over the age of nineteen.
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C.] B. The superintendent shall adopt
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0022| regulations to implement the provisions of this section."
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0023| Section 2. Section 59A-23B-6 NMSA 1978 (being Laws 1991,
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0024| Chapter 111, Section 6, as amended) is amended to read:
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0025| "59A-23B-6. FORMS AND RATES--APPROVAL OF THE SUPERINTENDENT
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0001| OF INSURANCE--ADJUSTED COMMUNITY RATING.--
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0002| A. All policy or plan forms, including applications,
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0003| enrollment forms, policies, plans, certificates, evidences of
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0004| coverage, riders, amendments, endorsements and disclosure forms,
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0005| shall be submitted to the department of insurance for approval
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0006| prior to use.
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0007| B. No policy or plan may be issued in the state
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0008| unless the rates have first been filed with and approved by the
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0009| superintendent of insurance. This subsection shall not apply to
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0010| policies or plans subject to the Small Group Rate and
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0011| Renewability Act.
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0012| C. [Until July 1, 1998] In determining the initial
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0013| year's premium or rate charged for coverage under a policy or
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0014| plan, the only rating factors that may be used are age, gender,
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0015| geographic area of the place of employment and smoking practices.
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0016| [Until July 1, 1998] In determining the initial and any
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0017| subsequent year's rate, the difference in rates in any one age
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0018| group that may be charged on the basis of a person's gender shall
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0019| not exceed another person's rates in the age group by more than
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0020| twenty percent of the lower rate, and no person's rate shall
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0021| exceed the rate of any other person with similar family
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0022| composition by more than two hundred fifty percent of the lower
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0023| rate, except that the rates for children under the age of
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0024| nineteen may be lower than the bottom rates in the two hundred
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0025| fifty percent band. The rating factor restrictions shall not
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0001| prohibit an insurer, society, organization or plan from offering
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0002| rates that differ depending upon family composition.
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0003| [D. Effective July 1, 1998, each policy or plan
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covered by the Minimum Healthcare Protection Act shall charge the
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same premium for the same coverage to each New Mexico resident,
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regardless of a person's individual circumstances for medical
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risk, job risk or gender. The only rating factor that may be
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used is whether a person is under or over the age of nineteen.
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E.] D. The superintendent of insurance shall adopt
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0010| regulations to implement the provisions of this section."
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0011| Section 3. Section 59A-23C-5.1 NMSA 1978 (being Laws 1994,
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0012| Chapter 75, Section 33) is amended to read:
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0013| "59A-23C-5.1. ADJUSTED COMMUNITY RATING.--
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0014| A. [Until July 1, 1998] A health benefit plan that
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0015| is offered by a carrier to a small employer shall be offered
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0016| without regard to the health status of any individual in the
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0017| group, except as provided in the Small Group Rate and
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0018| Renewability Act. The only rating factors that may be used to
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0019| determine the initial year's premium charged a group, subject to
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0020| the maximum rate variation provided in this section for all
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0021| rating factors, are the group members':
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0022| (1) age;
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0023| (2) gender;
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0024| (3) geographic area of the place of employment;
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0025| or
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0001| (4) smoking practices.
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0002| B. [Until July 1, 1998] In determining the initial
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0003| and any subsequent year's rate, the difference in rates in any
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0004| one age group that may be charged on the basis of a person's
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0005| gender shall not exceed another person's rates in the age group
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0006| by more than twenty percent of the lower rate, and no person's
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0007| rate shall exceed the rate of any other person with similar
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0008| family composition by more than two hundred fifty percent of the
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0009| lower rate, except that the rates for children under the age of
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0010| nineteen may be lower than the bottom rates in the two hundred
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0011| fifty percent band. The rating factor restrictions shall not
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0012| prohibit a carrier from offering rates that differ depending upon
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0013| family composition.
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0014| [C. Effective July 1, 1998, a health benefit plan
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that is offered by a carrier to a small employer shall charge the
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same premium for the same coverage to each New Mexico resident,
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regardless of a person's individual circumstances for medical
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risk, job risk or gender. The only rating factor that may be
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used is whether a person is under or over the age of nineteen.
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D.] C. The superintendent shall adopt regulations
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0021| to implement the provisions of this section."
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0022| Section 4. EFFECTIVE DATE.--The effective date of the
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0023| provisions of this act is July 1, 1997.
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0024| State of New Mexico
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0025| House of Representatives
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0001|
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0002| FORTY-THIRD LEGISLATURE
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0003| FIRST SESSION, 1997
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0004|
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0005|
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0006| February 21, 1997
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0007|
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0008|
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0009| Mr. Speaker:
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0010|
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0011| Your BUSINESS AND INDUSTRY COMMITTEE, to whom has
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0012| been referred
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0013|
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0014| HOUSE BILL 359
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0015|
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0016| has had it under consideration and reports same with
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0017| recommendation that it DO PASS, and thence referred to the
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0018| APPROPRIATIONS AND FINANCE COMMITTEE.
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0019|
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0020| Respectfully submitted,
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0021|
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0022|
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0023|
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0024|
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0025| Fred Luna, Chairman
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0001|
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0002|
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0003| Adopted Not Adopted
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0004|
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0005| (Chief Clerk) (Chief Clerk)
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0006|
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0007| Date
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0008|
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0009| The roll call vote was 8 For 0 Against
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0010| Yes: 8
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0011| Excused: Getty, Gubbels, Hobbs, Rodella, Varela
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0012| Absent: None
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0013|
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0014|
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0015| G:\BILLTEXT\BILLW_97\H0359 State of New Mexico
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0016| House of Representatives
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0017|
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0018| FORTY-THIRD LEGISLATURE
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0019| FIRST SESSION, 1997
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0020|
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0021|
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0022| February 25, 1997
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0023|
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0024|
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0025| Mr. Speaker:
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0001|
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0002| Your APPROPRIATIONS AND FINANCE COMMITTEE, to
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0003| whom has been referred
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0004|
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0005| HOUSE BILL 359
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0006|
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0007| has had it under consideration and reports same with
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0008| recommendation that it DO PASS, amended as follows:
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0009|
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0010| 1. On page 1, line 25, after "practices" insert "except that
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0011| for individual policies the rating factor of the individual's place
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0012| of residence may be used instead of the geographic area of the
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0013| individual's place of employment".
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0014|
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0015| 2. On page 2, line 7, after "nineteen" insert "or children
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0016| aged nineteen to twenty-five who are full-time students".
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0017|
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0018| 3. On page 3, line 15, after "practices" insert "except that
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0019| for individual policies the rating factor of the individual's place
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0020| of residence may be used instead of the geographic area of the
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0021| individual's place of employment".
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0022|
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0023| 4. On page 3, line 23, after "nineteen" insert "or children
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0024| aged nineteen to twenty-five who are full-time students".
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0025|
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0001| 5. On page 4, line 22, strike "age" and insert in lieu
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0002| thereof "ages".
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0003|
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0004| 6. On page 4, strike line 23 in its entirety.
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0005|
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0006| 7. Renumber the succeeding paragraphs accordingly.
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0007|
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0008| 8. On page 4, line 24, strike "area" and insert in lieu
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0009| thereof "areas" and strike "place" and insert in lieu thereof
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0010| "places".
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0011|
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0012| 9. On page 5, line 9, after "nineteen" insert "or children
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0013| aged nineteen to twenty-five who are full-time students".
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0014|
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0015| Respectfully submitted,
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0016|
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0017|
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0018|
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0019|
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0020|
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0021| Max Coll, Chairman
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0022|
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0023|
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0024| Adopted Not Adopted
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0025|
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0001| (Chief Clerk) (Chief Clerk)
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0002|
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0003| Date
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0004|
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0005| The roll call vote was 10 For 3 Against
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0006| Yes: 10
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0007| No: Bird, Buffett, Pearce
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0008| Excused: Heaton, Marquardt, Varela, Watchman
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0009| Absent: None
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0010|
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0011|
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0012| .117628.1
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0013| G:\BILLTEXT\BILLW_97\H0359
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0014| FORTY-THIRD LEGISLATURE
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0015| FIRST SESSION
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0016|
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0017|
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0018| February 28, 1997
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0019|
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0020|
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0021| HOUSE FLOOR AMENDMENT number ___1___ to HOUSE BILL 359, as amended
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0022|
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0023| Amendment sponsored by Representative M. Michael Olguin
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0024|
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0025|
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0001| 1. Strike House Appropriations and Finance Committee Amendments 6
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0002| and 7.
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0003|
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0004|
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0005|
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0006|
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0007|
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0008|
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0009|
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0010|
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0011|
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0012|
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0013| ___________________________
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0014| M. Michael Olguin
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0015|
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0016|
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0017|
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0018| Adopted ___________________ Not Adopted ___________________________
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0019| (Chief Clerk) (Chief Clerk)
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0020|
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0021|
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0022| Date ________________
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0023|
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0024| FORTY-THIRD LEGISLATURE
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0025| FIRST SESSION, 1997
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0001|
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0002|
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0003| March 12, 1997
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0004|
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0005| Mr. President:
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0006|
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0007| Your CORPORATIONS & TRANSPORTATION COMMITTEE, to whom
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0008| has been referred
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0009|
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0010| HOUSE BILL 359, as amended
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0011|
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0012| has had it under consideration and reports same with recommendation
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0013| that it DO PASS.
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0014|
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0015| Respectfully submitted,
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0016|
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0017|
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0018|
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0019| __________________________________
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0020| Roman M. Maes, III, Chairman
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0021|
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0022|
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0023|
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0024| Adopted_______________________ Not Adopted_______________________
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0025| (Chief Clerk) (Chief Clerk)
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0001|
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0002|
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0003|
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0004| Date ________________________
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0005|
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0006|
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0007| The roll call vote was 7 For 0 Against
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0008| Yes: 7
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0009| No: 0
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0010| Excused: Fidel, Griego, Howes
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0011| Absent: None
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0012|
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0013|
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0014| H0359CT1
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