0001| SENATE BILL 1015 | 0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997 | 0003| INTRODUCED BY | 0004| JOSEPH J. CARRARO | 0005| | 0006| | 0007| | 0008| | 0009| | 0010| AN ACT | 0011| RELATING TO INSURANCE; PROHIBITING DISCRIMINATION AGAINST | 0012| INSUREDS AND DEPENDENTS BASED ON DISABILITY; PROVIDING FOR | 0013| CONTINUATION OF COVERAGE AFTER LIMITING AGE FOR DISABLED | 0014| DEPENDENTS. | 0015| | 0016| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO: | 0017| Section 1. Section 59A-16-12.1 NMSA 1978 (being Laws | 0018| 1991, Chapter 111, Section 12) is amended to read: | 0019| "59A-16-12.1. DISCRIMINATION ON THE BASIS OF | 0020| DETERIORATION IN HEALTH OR DISABILITY--CONVERSION POLICY | 0021| EQUIVALENCY.-- | 0022| A. No insurer shall cancel, non-renew or change | 0023| the premiums, benefits or conditions of ~~[an individual]~~ a | 0024| health insurance policy or health maintenance organization | 0025| contract as to ~~[one]~~ any insured or dependent solely | 0001| because of a deterioration in the health of that insured or | 0002| dependent occurring after the issuance or delivery of the | 0003| policy or contract or because of the insured's or any | 0004| dependent's disability. | 0005| B. No insurer shall decline to issue a group | 0006| health insurance policy solely on the basis that an otherwise | 0007| qualified group includes persons who are disabled. | 0008| ~~[B.]~~ C. No conversion of a group health | 0009| insurance policy that provides hospital, surgical and medical | 0010| expense benefits shall be made to a conversion policy that has | 0011| not been approved and found by the superintendent to provide | 0012| benefits and conditions closely approximating the coverage of | 0013| the policy from which conversion is exercised." | 0014| Section 2. Section 59A-22-33 NMSA 1978 (being Laws 1984, | 0015| Chapter 127, Section 455) is amended to read: | 0016| "59A-22-33. HANDICAPPED CHILDREN--COVERAGE CONTINUED.--An | 0017| individual or group hospital or medical expense insurance | 0018| policy delivered or issued for delivery in this state which | 0019| provides that coverage of a dependent child of an insured, or | 0020| of an employee or other member of the covered group, shall | 0021| terminate upon attainment of the limiting age for dependent | 0022| children specified in the policy shall also provide, in sub- | 0023| | 0024| stance, that attainment of the limiting age shall not operate | 0025| to terminate the coverage of a child while the child is, and | 0001| continues to be both incapable of self-sustaining employment, | 0002| by reason of mental retardation, ~~[or]~~ physical handicap or | 0003| disability, and chiefly dependent upon the policyholder for | 0004| support and maintenance. However, proof of the incapacity and | 0005| dependency of the child must be furnished to the insurer by the | 0006| insured employee or member within thirty-one ~~[(31)]~~ days of | 0007| the child's attainment of the limiting age and subsequently, as | 0008| may be required by the insurer, but not more frequently than | 0009| annually after the two-year period following the child's | 0010| attainment of the limiting age." | 0011| Section 3. A new Section 59A-22-41 NMSA 1978 is enacted | 0012| to read: | 0013| "59A-22-41. [NEW MATERIAL] COVERAGE OF DEVELOPMENTAL | 0014| DISABILITY THERAPEUTIC SERVICES.-- | 0015| A. Each individual and group health insurance | 0016| policy, health maintenance organization contract, nonprofit | 0017| health care plan policy and certificate of health insurance | 0018| delivered or issued for delivery in this state shall provide | 0019| coverage for medically necessary therapeutic services for | 0020| treatment of developmental disabilities, without limitation as | 0021| to the number or duration of such services. | 0022| B. Coverage for therapeutic services pursuant to | 0023| this section may be subject to deductibles consistent with | 0024| those on other benefits under the same policy, contract or | 0025| certificate. | 0001| C. The provisions of this section do not apply to | 0002| short-term travel, accident-only or limited or disease-specific | 0003| policies. | 0004| D. As used in this section, "developmental | 0005| disabilities" means: | 0006| (1) a severe chronic disability of a person | 0007| that: | 0008| (a) is attributable to a mental or | 0009| physical impairment, including the result from trauma to the | 0010| brain, or combination or mental and physical impairments; | 0011| (b) is manifested before the person | 0012| reaches the age of twenty-two years; | 0013| (c) is expected to continue | 0014| indefinitely; | 0015| (d) results in substantial functional | 0016| limitations in three or more of the following areas of major | 0017| life activities: 1) self-care; 2) receptive and expressive | 0018| language; 3) learning; 4) mobility; 5) self-direction; 6) | 0019| capacity for independent living; and 7) economic self- | 0020| sufficiency; and | 0021| (e) reflects the person's need for a | 0022| combination and sequence of special, interdisciplinary or | 0023| generic care treatment or other support and services that are | 0024| of life-long or extended duration and are individually planned | 0025| and coordinated; or | 0001| (2) are children, from birth through two years | 0002| of age, who are at risk for or have developmental delays as | 0003| defined by the department of health and are children eligible | 0004| for early intervention services." | 0005| Section 4. Section 59A-23-4 NMSA 1978 (being Laws 1984, | 0006| Chapter 127, Section 463, as amended) is amended to read: | 0007| "59A-23-4. OTHER PROVISIONS APPLICABLE.-- | 0008| A. No blanket or group health insurance policy or | 0009| contract shall contain any provision relative to notice or | 0010| proof of loss or the time for paying benefits or the time | 0011| within which suit may be brought upon the policy that in the | 0012| superintendent's opinion is less favorable to the insured than | 0013| would be permitted in the required or optional provisions for | 0014| individual health insurance policies as set forth in Chapter | 0015| 59A, Article 22 NMSA 1978. | 0016| B. The following provisions of Chapter 59A, Article | 0017| 22 NMSA 1978 shall also apply as to Chapter 59A, Article 23 | 0018| NMSA 1978 and blanket and group health insurance contracts: | 0019| (1) Section 59A-22-1 NMSA 1978, except | 0020| Subsection C thereof; and | 0021| (2) Section 59A-22-32 NMSA 1978. | 0022| C. The following provisions of Chapter 59A, Article | 0023| 22 NMSA 1978 shall also apply as to group health insurance | 0024| contracts: | 0025| (1) Section 59A-22-33 NMSA 1978; | 0001| (2) Section 59A-22-34 NMSA 1978; | 0002| (3) Section 59A-22-34.1 NMSA 1978; | 0003| (4) Section 59A-22-35 NMSA 1978; | 0004| (5) Section 59A-22-36 NMSA 1978; | 0005| (6) Section 59A-22-39 NMSA 1978; ~~[and]~~ | 0006| (7) Section 59A-22-40 NMSA 1978; and | 0007| (8) Section 59A-22-41 NMSA 1978." | 0008| Section 5. Section 59A-46-30 NMSA 1978 (being Laws 1993, | 0009| Chapter 266, Section 29) is amended to read: | 0010| "59A-46-30. STATUTORY CONSTRUCTION AND RELATIONSHIP TO | 0011| OTHER LAWS.-- | 0012| A. The provisions of the Insurance Code other than | 0013| Chapter 59A, Article 46 NMSA 1978 shall not apply to health | 0014| maintenance organizations except as expressly provided in the | 0015| Insurance Code and that article. To the extent reasonable and | 0016| not inconsistent with the provisions of that article, the | 0017| following articles and provisions of the Insurance Code shall | 0018| also apply to health maintenance organizations and their | 0019| promoters, sponsors, directors, officers, employees, agents, | 0020| solicitors and other representatives ~~[and]~~. For the purposes | 0021| of such applicability, a health maintenance organization may | 0022| therein be referred to as an "insurer": | 0023| (1) Chapter 59A, Article 1 NMSA 1978; | 0024| (2) Chapter 59A, Article 2 NMSA 1978; | 0025| (3) Chapter 59A, Article 3 NMSA 1978; | 0001| (4) Chapter 59A, Article 4 NMSA 1978; | 0002| (5) Subsection C of Section 59A-5-22 NMSA | 0003| 1978; | 0004| (6) Sections 59A-6-2 through 59A-6-4 and | 0005| 59A-6-6 NMSA 1978; | 0006| (7) Chapter 59A, Article 8 NMSA 1978; | 0007| (8) Chapter 59A, Article 10 NMSA 1978; | 0008| (9) Section 59A-12-22 NMSA 1978; | 0009| (10) Chapter 59A, Article 16 NMSA 1978; | 0010| (11) Chapter 59A, Article 18 NMSA 1978; | 0011| (12) Chapter 59A, Article 19 NMSA 1978; | 0012| (13) Section 59A-22-33 NMSA 1978; | 0013| (14) Section 59A-22-41 NMSA 1978; | 0014| ~~[(13)]~~ (15) Chapter 59A, Article 23B NMSA | 0015| 1978; | 0016| ~~[(14)]~~ (16) Sections 59A-34-9 through | 0017| 59A-34-13, 59A-34-23, 59A-34-36 and 59A-34-37 NMSA 1978; and | 0018| ~~[(15)]~~ (17) Chapter 59A, Article 37 NMSA | 0019| 1978. | 0020| B. Solicitation of enrollees by a health | 0021| maintenance organization granted a certificate of authority, or | 0022| its representatives, shall not be construed as violating any | 0023| provision of law relating to solicitation or advertising by | 0024| health professionals, but health professionals shall be | 0025| individually subject to the laws, rules, regulations and | 0001| ethical provisions governing their individual professions. | 0002| C. Any health maintenance organization authorized | 0003| under the provisions of the Health Maintenance Organization Law | 0004| shall not be deemed to be practicing medicine and shall be | 0005| exempt from the provisions of laws relating to the practice of | 0006| medicine." | 0007| Section 6. Section 59A-47-33 NMSA 1978 (being Laws 1984, | 0008| Chapter 127, Section 879.32, as amended by Laws 1994, Chapter | 0009| 64, Section 10 and also by Laws 1994, Chapter 75, Section 34) | 0010| is amended to read: | 0011| "59A-47-33. OTHER PROVISIONS APPLICABLE.--The provisions | 0012| of the Insurance Code other than Chapter 59A, Article 47 NMSA | 0013| 1978 shall not apply to health care plans except as expressly | 0014| provided in the Insurance Code and that article. To the extent | 0015| reasonable and not inconsistent with the provisions of that | 0016| article, the following articles and provisions of the Insurance | 0017| Code shall also apply to health care plans, their promoters, | 0018| sponsors, directors, officers, employees, agents, solicitors | 0019| and other representatives; and, for the purposes of such | 0020| applicability, a health care plan may therein be referred to as | 0021| an "insurer": | 0022| A. Chapter 59A, Article 1 NMSA 1978; | 0023| B. Chapter 59A, Article 2 NMSA 1978; | 0024| C. Chapter 59A, Article 4 NMSA 1978; | 0025| D. Subsection C of Section 59A-5-22 NMSA 1978; | 0001| E. Sections 59A-6-2 through 59A-6-4 and | 0002| 59A-6-6 NMSA 1978; | 0003| F. Section 59A-7-11 NMSA 1978; | 0004| G. Chapter 59A, Article 8 NMSA 1978; | 0005| H. Chapter 59A, Article 10 NMSA 1978; | 0006| I. Section 59A-12-22 NMSA 1978; | 0007| J. Chapter 59A, Article 16 NMSA 1978; | 0008| K. Chapter 59A, Article 18 NMSA 1978; | 0009| L. Chapter 59A, Article 19 NMSA 1978; | 0010| M. Subsections B through E of Section | 0011| 59A-22-5 NMSA 1978; | 0012| N. Section 59A-22-33 NMSA 1978; | 0013| O. Section 59A-22-41 NMSA 1978; | 0014| ~~[N.]~~ P. Section 59A-22-34.1 NMSA 1978; | 0015| ~~[O.]~~ Q. Section 59A-22-39 NMSA 1978; | 0016| ~~[P.]~~ R. Section 59A-22-40 NMSA 1978; | 0017| ~~[Q.]~~ S. Sections 59A-34-9 through 59A-34-13 | 0018| ~~[NMSA 1978]~~ and ~~[Section]~~ 59A-34-23 NMSA 1978; | 0019| ~~[R.]~~ T. Chapter 59A, Article 37 NMSA 1978, | 0020| except Section 59A-37-7 NMSA 1978; and | 0021| ~~[S.]~~ U. Section 59A-46-15 NMSA 1978." | 0022| |