2019 New Mexico Statutes
Chapter 59A - Insurance Code
Article 23 - Group and Blanket Health Insurance Contracts
Section 59A-23-6 - Alcohol dependency coverage.
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 behavioral health services division of the human services department 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; or
(3) meets at least the minimum standards adopted by the behavioral health services division for treatment of alcoholism in regional treatment centers.
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 18 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 office of superintendent 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 that such endorsements or riders are approved by the office of superintendent of insurance as being in compliance with this section and applicable provisions of the Insurance Code.
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.
History: 1978 Comp., § 59-18-24, enacted by Laws 1983, ch. 64, § 1; 1978 Comp., § 59-18-24, recompiled as 59A-23-6 by Laws 1987, ch. 259, § 32; 2007, ch. 325, § 12; 2013, ch. 74, § 27.
ANNOTATIONSCross references. — For Title 18 of the federal Social Security Act, see 42 U.S.C. §§ 1395 to 1395vv.
The 2013 amendment, effective March 29, 2013, required the superintendent of insurance to approve group health insurance policy forms; in Paragraph (2) of Subsection B, after "joint commission", deleted "on accreditation of hospitals"; and in Subsection C, in the second sentence, after "policy forms approved by the", added "office of superintendent of", after "insurance", deleted "division of the public regulation commission", and after "riders are approved by the", added "office of superintendent of", and after "insurance", deleted "division".
The 2007 amendment, effective June 15, 2007, changed "health and environment department" to "human services department"; changed "substance abuse bureau" to "behavioral health services division"; and changed "department of insurance" to "insurance division of the public regulation commission".
