2006 New Mexico Statutes - Section 59A-56-8 — Approved health plan.

59A-56-8. Approved health plan.

A.     An approved health plan shall conform to the alliance's approved health plan design criteria.  The board may allow more than one plan design for approved health plans.  A member may provide one approved health plan for each plan design approved by the board.  

B.     The board shall designate plan designs for approved health plans.  The board may designate plan designs for an approved health plan that provides catastrophic coverage or other benefit plan designs.  

C.     Each approved health plan shall offer a premium that is no greater than the average of the standard rate index for plans with the same characteristics.  

D.     Any member that provides or offers to renew a group health insurance contract providing health insurance benefits to employees of the state, a county, a municipality or a school district for which public funds are contributed shall offer at least one approved health plan to small employers and eligible individuals; provided, however, if a member does not offer anywhere in the United States a plan that meets substantially the design criteria of an approved health plan, the member shall not be required to offer an approved health plan.  

E.     If a plan design approved by the board is not offered by any member already offering an approved health plan, but a member offers a substantially similar plan design outside the alliance, the board may require the member to offer that plan design as an approved health plan through the alliance.  

F.     A member required to offer, and offering, an approved health plan pursuant to the requirement of Subsection D of this section shall continue to offer that plan for five consecutive years after the date the member was last required to offer the plan.  A member offering an approved health plan but not required to offer it pursuant to the cited subsection may withdraw the plan but shall continue to offer it for five consecutive years after the date notice of future withdrawal is given to the board unless: 

(1)     the member substitutes another approved health plan for the plan withdrawn; or 

(2)     the board allows the plan to be withdrawn because it imposes a serious hardship upon the member.  

G.     No member shall be required to offer an approved health plan if the member notifies the superintendent in writing that it will no longer offer health insurance, life insurance or annuities in the state, except for renewal of existing contracts, provided that: 

(1)     the member does not offer or provide health insurance, life insurance or annuities for a period of five years from the date of notification to the superintendent to any person in the state who is not covered by the member through a health insurance policy in effect on the date of the notification; and 

(2)     with respect to health or life insurance policies or annuities in effect on the date of notification to the superintendent, the member continues to comply with all applicable laws and regulations governing the provision of insurance in this state, including the payment of applicable taxes, fees and assessments.