2006 New Mexico Statutes - Section 59A-23-6 — Alcohol dependency coverage [; group health insurers]

59A-23-6. Alcohol dependency coverage [; group health insurers]

A.     Each insurer that delivers or issues for delivery in this state a group health insurance policy shall offer and make available benefits for the necessary care and treatment of alcohol dependency. Such benefits shall:   

(1)     be subject to annual deductibles and coinsurance consistent with those imposed on other benefits within the same policy;   

(2)     provide no less than thirty days necessary care and treatment in an alcohol dependency treatment center and thirty outpatient visits for alcohol dependency treatment; and   

(3)     be offered for benefit periods of no more than one year and may be limited to a lifetime maximum of no less than two benefit periods.   

Such offer of benefits shall be subject to the rights of the group health insurance holder to reject the coverage or to select any alternative level of benefits if that right is offered by or negotiated with that insurer.   

B.     For purposes of this section, "alcohol dependency treatment center" means a facility that provides a program for the treatment of alcohol dependency pursuant to a written treatment plan approved and monitored by a physician or meeting the quality standards of the substance abuse bureau of the behavioral health services division of the health and environment department [department of health] and which facility also:   

(1)     is affiliated with a hospital under a contractual agreement with an established system for patient referral;   

(2)     is accredited as such a facility by the joint commission on accreditation of hospitals; or   

(3)     meets at least minimum standards adopted by the substance abuse bureau [alcoholism bureau] pursuant to Section 43-3-4 NMSA 1978 [repealed] for treatment of alcoholism in regional treatment centers as defined in Section 43-3-3 NMSA 1978 [repealed].   

C.     This section applies to policies delivered or issued for delivery or renewed, extended or amended in this state on or after July 1, 1983 or upon expiration of a collective bargaining agreement applicable to a particular policyholder, whichever is later; provided that this section does not apply to blanket, short-term travel, accident-only, limited or specified disease, individual conversion policies or policies designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as medicare, or any other similar coverage under state or federal governmental plans. With respect to any policy forms approved by the department of insurance prior to the effective date of this section, an insurer is authorized to comply with this section by the use of endorsements or riders, provided such endorsements or riders are approved by the department of insurance as being in compliance with this section and applicable provisions of Chapter 59 NMSA 1978 [recompiled and repealed].   

D.     If an organization offering group health benefits to its members makes more than one health insurance policy or nonprofit health care plan available to its members on a member option basis, the organization shall not require alcohol dependency coverage from one health insurer or health care plan without requiring the same level of alcohol dependency coverage for all other health insurance policies or health care plans that the organization makes available to its members.   
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