2006 New Mexico Statutes - Section 59A-56-6 — Board; powers and duties.

59A-56-6. Board; powers and duties.

A.     The board shall have the general powers and authority granted to insurance companies licensed to transact health insurance business under the laws of this state.   

B.     The board:   

(1)     may enter into contracts to carry out the provisions of the Health Insurance Alliance Act [Chapter 59A, Article 56 NMSA 1978], including, with the approval of the superintendent, contracting with similar alliances of other states for the joint performance of common administrative functions or with persons or other organizations for the performance of administrative functions;   

(2)     may sue and be sued;   

(3)     may conduct periodic audits of the members to assure the general accuracy of the financial data submitted to the alliance;   

(4)     shall establish maximum rate schedules, allowable rate adjustments, administrative allowances, reinsurance premiums and agent referral, servicing fees or commissions subject to applicable provisions in the Insurance Code. In determining the initial year's rate for health insurance, the only rating factors that may be used are age, gender, geographic area of the place of employment and smoking practices. In any year's rate, the difference in rates in any one age group that may be charged on the basis of a person's gender shall not exceed another person's rates in the age group by more than twenty percent of the lower rate, and no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under the age of nineteen may be lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit a member from offering rates that differ depending upon family composition;   

(5)     may direct a member to issue policies or certificates of coverage of health insurance in accordance with the requirements of the Health Insurance Alliance Act;   

(6)     shall establish procedures for alternative dispute resolution of disputes between members and insureds;   

(7)     shall cause the alliance to have an annual audit of its operations by an independent certified public accountant;   

(8)     shall conduct all board meetings as if it were subject to the provisions of the Open Meetings Act [Chapter 10, Article 15 NMSA 1978];   

(9)     shall draft one or more sample health insurance policies that are the prototype documents for the members;   

(10)     shall determine the design criteria to be met for an approved health plan;   

(11)     shall review each proposed approved health plan to determine if it meets the alliance designed criteria and, if it does meet the criteria, approve the plan; provided that the board shall not permit more than one approved health plan per member for each set of plan design criteria;   

(12)     shall review annually each approved health plan to determine if it still qualifies as an approved health plan based on the alliance designed criteria and, if the plan is no longer approved, arrange for the transfer of the insureds covered under the formerly approved plan to an approved health plan;   

(13)     may terminate an approved health plan not operating as required by the board;   

(14)     shall terminate an approved health plan if timely claim payments are not made pursuant to the plan; and   

(15)     shall engage in significant marketing activities, including a program of media advertising, to inform small employers and eligible individuals of the existence of the alliance, its purpose and the health insurance available or potentially available through the alliance.   

C.     The alliance is subject to and responsible for examination by the superintendent. No later than March 1 of each year, the board shall submit to the superintendent an audited financial report for the preceding calendar year in a form approved by the superintendent.