2019 New Mexico Statutes
Chapter 59A - Insurance Code
Article 23 - Group and Blanket Health Insurance Contracts
Section 59A-23-3 - Group health insurance.
A. Group health insurance is that form of health insurance covering groups of persons, with or without their dependents, and issued upon the following basis:
(1) under a policy issued to an employer, who shall be deemed the policyholder, insuring at least one employee of such employer for the benefit of persons other than the employer. The term "employees", as used in this section, includes the officers, managers and employees of the employer, the partners, if the employer is a partnership, the officers, managers and employees of subsidiary or affiliated corporations of a corporation employer, and the individual proprietors, partners and employees of individuals and firms the business of which is controlled by the insured employer through stock ownership, contract or otherwise. The term "employer", as used in this section, includes any municipal or governmental corporation, unit, agency or department thereof and the proper officers, as such, or any unincorporated municipality or department thereof, as well as private individuals, partnerships and corporations. A small employer shall also be subject to the Small Group Rate and Renewability Act [Chapter 59A, Article 23C NMSA 1978]. A "small employer" means any person, firm, corporation, partnership or association actively engaged in business who, on at least fifty percent of its working days during the preceding year, employed no more than fifty eligible employees. In determining the number of eligible employees, companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state taxation shall be considered one employer;
(2) under a policy issued to an association, including a labor union and an agricultural association, which shall have a constitution and bylaws and which has been organized and is maintained in good faith for purposes other than that of obtaining insurance, insuring at least twenty-five members of the association for the benefit of persons other than the association or its officers or trustees, as such;
(3) under a policy issued to a cooperative; or
(4) under a policy issued to any other substantially similar group that, in the discretion of the superintendent, may be subject to the issuance of a group sickness and accident policy or contract.
B. Each policy, as provided by this section, shall contain in substance the following provisions:
(1) a provision that the policy, the application of the policyholder, if such application or copy thereof is attached to such policy, and the individual applications, if any, submitted in connection with such policy by the employees or members, shall constitute the entire contract between the parties, and that all statements, in the absence of fraud, made by any applicant or applicants shall be deemed representations and not warranties, and that no such statement shall void the insurance or reduce benefits thereunder unless contained in a written application for such insurance;
(2) a provision that the insurer will furnish to the policyholder, for delivery to each employee or member of the insured group, an individual certificate setting forth in summary form a statement of the essential features of the insurance coverage of such employee or member and to whom benefits thereunder are payable. If dependents are included in the coverage, only one certificate need be issued for each family unit; and
(3) a provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy.
C. For purposes of this section only, the directors of a corporation shall be deemed to be employees of the corporation.
D. For the purposes of this section, "cooperative" means a private health insurance cooperative established pursuant to Section 2 [59A-23-11 NMSA 1978] of this 2011 act.
History: Laws 1984, ch. 127, § 462; 1991, ch. 153, § 10; 1993, ch. 126, § 5; 1994, ch. 75, § 28; 2011, ch. 34, § 1.
ANNOTATIONSThe 2011 amendment, effective June 17, 2011, provided that policies issued to a cooperative are group health insurance policies and added Subsection D to define "cooperative".
The 1994 amendment, effective January 1, 1995, substituted "fifty" for "twenty-five" in the next-to-last sentence in Paragraph A(1).
The 1993 amendment, effective June 18, 1993, added Subsection C.
The 1991 amendment, effective June 14, 1991, in Subsection A, added the last three sentences in Paragraph (1) and made minor stylistic changes in Paragraphs (1) and (2).
