2017 New Mexico Statutes
Chapter 59A - Insurance Code
Article 22A - Preferred Provider Arrangements
Section 59A-22A-5 - Health benefit plans.
59A-22A-5. Health benefit plans.
A. Health care insurers may issue health benefit plans which provide for incentives for covered persons to use the health care services of preferred providers. Such policies or subscriber agreement shall contain at least the following provisions:
(1) a provision that if a covered person receives emergency care for services specified in the preferred provider arrangement and cannot reasonably reach a preferred provider that emergency care rendered during the course of the emergency will be reimbursed as though the covered person had been treated by a preferred provider; and
(2) a provision which clearly identifies the differentials in benefit levels for health care services of preferred providers and benefit levels for health care services of non-preferred providers.
B. If a health benefit plan provides differences in benefit levels payable to preferred providers compared to other providers, such differences shall not unfairly deny payment for covered services and shall be no greater than necessary to provide a reasonable incentive for covered persons to use the preferred provider.
History: 1978 Comp., 59A-22A-5, enacted by Laws 1993, ch. 320, 63.
