44TH LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 1999
RELATING TO INSURANCE; MANDATING INSURANCE COVERAGE FOR BONE DENSITOMETRY; AMENDING AND ENACTING SECTIONS OF THE NEW MEXICO INSURANCE CODE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. A new Section 59A-22-42 NMSA 1978 is enacted to read:
"59A-22-42. [NEW MATERIAL] COVERAGE FOR BONE DENSITOMETRY.--
A. Each individual and group health insurance policy, nonprofit health care plan policy, health maintenance organization contract and certificate of insurance delivered or issued for delivery in this state shall provide coverage for bone densitometry, including single and dual photon absorptiometry and dual x-ray absorptiometry. Benefits shall be payable at a minimum as follows:
(1) for a woman with decreasing estrogen levels who is not using estrogen replacement therapy, two bone density tests in her lifetime under coverage by each insurer; provided that if other clinical indications of rapid bone loss occur, the lifetime limit shall not apply; and
(2) for all other persons diagnosed as having clinical indications of rapid bone loss, tests as prescribed by a health care provider.
B. Coverage pursuant to this section may be subject to deductibles and coinsurance provisions consistent with those applicable to other benefits under the same policy, contract or certificate.
C. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies."
Section 2. Section 59A-23-4 NMSA 1978 (being Laws 1984, Chapter 127, Section 463, as amended by Laws 1997, Chapter 7, Section 2 and by Laws 1997, Chapter 249, Section 2 and by Laws 1997, Chapter 250, Section 2 and also by Laws 1997, Chapter 255, Section 2) is amended to read:
"59A-23-4. OTHER PROVISIONS APPLICABLE.--
A. No blanket or group health insurance policy or contract shall contain any provision relative to notice or proof of loss or the time for paying benefits or the time within which suit may be brought upon the policy that in the superintendent's opinion is less favorable to the insured than would be permitted in the required or optional provisions for individual health insurance policies as set forth in Chapter 59A, Article 22 NMSA 1978.
B. The following provisions of Chapter 59A, Article 22 NMSA 1978 shall also apply as to Chapter 59A, Article 23 NMSA 1978 and blanket and group health insurance contracts:
(1) Section 59A-22-1 NMSA 1978, except Subsection C of that section; and
(2) Section 59A-22-32 NMSA 1978.
C. The following provisions of Chapter 59A, Article 22 NMSA 1978 shall also apply as to group health insurance contracts:
(1) Section 59A-22-33 NMSA 1978;
(2) Section 59A-22-34 NMSA 1978;
(3) Section 59A-22-34.1 NMSA 1978;
(4) Section 59A-22-35 NMSA 1978;
(5) Section 59A-22-36 NMSA 1978;
(6) Section 59A-22-39 NMSA 1978;
(7) Section 59A-22-34.3 NMSA 1978;
(8) Section 59A-22-39.1 NMSA 1978;
[(7)] (9) Section 59A-22-40 NMSA 1978; [and
(8)] (10) Section 59A-22-41 NMSA 1978; and
(11) Section 59A-22-42 NMSA 1978."
Section 3. Section 59A-46-30 NMSA 1978 (being Laws 1993, Chapter 266, Section 29, as amended) is amended to read:
"59A-46-30. STATUTORY CONSTRUCTION AND RELATIONSHIP TO OTHER LAWS.--
A. The provisions of the Insurance Code other than Chapter 59A, Article 46 NMSA 1978 shall not apply to health maintenance organizations except as expressly provided in the Insurance Code and that article. To the extent reasonable and not inconsistent with the provisions of that article, the following articles and provisions of the Insurance Code shall also apply to health maintenance organizations and their promoters, sponsors, directors, officers, employees, agents, solicitors and other representatives. For the purposes of such applicability, a health maintenance organization may therein be referred to as an "insurer":
(1) Chapter 59A, Article 1 NMSA 1978;
(2) Chapter 59A, Article 2 NMSA 1978;
[(3) Chapter 59A, Article 3 NMSA 1978;
(4)] (3) Chapter 59A, Article 4 NMSA 1978;
[(5)] (4) Subsection C of Section 59A-5-22
NMSA 1978;
[(6)] (5) Sections 59A-6-2 through 59A-6-4
and 59A-6-6 NMSA 1978;
[(7)] (6) Chapter 59A, Article 8 NMSA 1978;
[(8)] (7) Chapter 59A, Article 10 NMSA 1978;
[(9)] (8) Section 59A-12-22 NMSA 1978;
[(10)] (9) Chapter 59A, Article 16 NMSA 1978;
[(11)] (10) Chapter 59A, Article 18 NMSA
1978;
[(12)] (11) Chapter 59A, Article 19 NMSA
1978;
[(13)] (12) Section 59A-22-14 NMSA 1978;
[(14)] (13) Chapter 59A, Article 23B NMSA
1978;
[(15)] (14) Sections 59A-34-9 through
59A-34-13, 59A-34-17, 59A-34-23, 59A-34-36 and 59A-34-37 NMSA
1978;
[(16)] (15) Chapter 59A, Article 37 NMSA
1978; [and]
[(17)] (16) the Patient Protection Act; and
(17) Section 59A-22-42 NMSA 1978.
B. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed as violating any provision of law relating to solicitation or advertising by health professionals, but health professionals shall be individually subject to the laws, rules, regulations and ethical provisions governing their individual professions.
C. Any health maintenance organization authorized under the provisions of the Health Maintenance Organization Law shall not be deemed to be practicing medicine and shall be exempt from the provisions of laws relating to the practice of medicine."
Section 4. Section 59A-47-33 NMSA 1978 (being Laws 1984, Chapter 127, Section 879.32, as amended) is amended to read:
"59A-47-33. OTHER PROVISIONS APPLICABLE.--The provisions of the Insurance Code other than Chapter 59A, Article 47 NMSA 1978 shall not apply to health care plans except as expressly provided in the Insurance Code and that article. To the extent reasonable and not inconsistent with the provisions of that article, the following articles and provisions of the Insurance Code shall also apply to health care plans, their promoters, sponsors, directors, officers, employees, agents, solicitors and other representatives; and, for the purposes of such applicability, a health care plan may therein be referred to as an "insurer":
A. Chapter 59A, Article 1 NMSA 1978;
B. Chapter 59A, Article 2 NMSA 1978;
C. Chapter 59A, Article 4 NMSA 1978;
D. Subsection C of Section 59A-5-22 NMSA 1978;
E. Sections 59A-6-2 through 59A-6-4 and
59A-6-6 NMSA 1978;
F. Section 59A-7-11 NMSA 1978;
G. Chapter 59A, Article 8 NMSA 1978;
H. Chapter 59A, Article 10 NMSA 1978;
I. Section 59A-12-22 NMSA 1978;
J. Chapter 59A, Article 16 NMSA 1978;
K. Chapter 59A, Article 18 NMSA 1978;
L. Chapter 59A, Article 19 NMSA 1978;
M. Subsections B through E of Section
59A-22-5 NMSA 1978;
N. Section 59A-22-14 NMSA 1978;
O. Section 59A-22-34.1 NMSA 1978;
P. Section 59A-22-39 NMSA 1978;
Q. Section 59A-22-40 NMSA 1978;
R. Section 59A-22-41 NMSA 1978;
S. Section 59A-22-42 NMSA 1978;
[S.] T. Sections 59A-34-9 through 59A-34-13 and
59A-34-23 NMSA 1978;
[T.] U. Chapter 59A, Article 37 NMSA 1978, except
Section 59A-37-7 NMSA 1978;
[U.] V. Section 59A-46-15 NMSA 1978; and
[V.] W. the Patient Protection Act."
Section 5. EFFECTIVE DATE.--The effective date of the provisions of this act is July 1, 1999.