2020 New Mexico Statutes
Chapter 59A - Insurance Code
Article 23F - New Mexico Health Insurance Exchange
Section 59A-23F-2 - Definitions.

Universal Citation: NM Stat § 59A-23F-2 (2020)

As used in the New Mexico Health Insurance Exchange Act:

A. "board" means the board of directors of the exchange;

B. "bronze plan" means a level of coverage that is designed to provide benefits that are actuarially equivalent to sixty percent of the full actuarial value of the benefits provided under a health benefit plan or the allowable value for a bronze plan as defined by federal regulation;

C. "enrollee" means:

(1) a qualified individual or qualified employee enrolled in a qualified health plan;

(2) the dependent of a qualified employee enrolled in a qualified health plan through the small business health options program;

(3) a person who is enrolled in a qualified health plan through the small business health options program, consistent with applicable law and the terms of the group health plan; or

(4) a business owner enrolled in a qualified health plan through the small business health options program, provided that at least one employee of the business owner enrolls in a qualified health plan through the small business health options program, or the dependent of a business owner enrolled in a qualified health plan through the small business health options program;

D. "exchange" means the New Mexico health insurance exchange, composed of an exchange for the individual market and a small business health options program or "SHOP" exchange under a single governance and administrative structure;

E. "gold plan" means a level of coverage that is designed to provide benefits that are actuarially equivalent to eighty percent of the full actuarial value of the benefits provided under a health benefit plan or the allowable value for a gold plan as defined by federal regulation;

F. "health benefit plan" means an individual or group policy or agreement entered into, offered or issued by a health insurance carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services;

G. "health insurance issuer" means an insurance company, insurance service or insurance organization, including a health maintenance organization, that is licensed to engage in the business of insurance in the state;

H. "insurance producer" means a person required to be licensed in this state to sell, solicit or negotiate insurance;

I. "Native American" means:

(1) an individual who is a member of any federally recognized Indian nation, tribe or pueblo or who is an Alaska native; or

(2) an individual who has been deemed eligible for services and programs provided to Native Americans by the United States public health service or the bureau of Indian affairs;

J. "navigator" means a person that, in a manner culturally and linguistically appropriate to the state's diverse populations, conducts public education, distributes tax credit and qualified health plan enrollment information, facilitates enrollment in qualified health plans or provides referrals to consumer assistance or ombudsman services. "Navigator" does not mean a health insurance issuer or a person that receives any consideration, directly or indirectly, from any health insurance issuer in connection with the enrollment of a qualified individual in a qualified health plan; provided that an insurance producer may be a navigator if the insurance producer receives no consideration, directly or indirectly, from any health insurance issuer in connection with the enrollment of a qualified individual or qualified employer in a qualified health plan, an approved health plan or any other health coverage;

K. "qualified employee" means an employee or former employee of a qualified employer who has been offered health insurance coverage by that qualified employer through the small business health options program for the employee or former employee and, if the qualified employer offers dependent coverage through the small business health options program, for the employee or former employee's dependents;

L. "qualified employer" means a small employer that elects to make, at a minimum, all of the employer's full-time employees eligible for one or more qualified health plans in the small group market offered through a small business health options program;

M. "qualified health plan" means a health plan that has in effect a certification from the superintendent that it meets the standards set forth in applicable federal and state law and regulations and rules as well as any additional requirements established by the board;

N. "qualified individual" means an individual who has been determined eligible to enroll through the exchange in a qualified health plan in the individual market;

O. "silver plan" means a level of coverage that is designed to provide benefits that are actuarially equivalent to seventy percent of the full actuarial value of the benefits provided under a health benefit plan or the allowable value for a silver plan as defined by federal regulation;

P. "small business health options program" means a program operated by the exchange through which a qualified employer can provide its employees and their dependents with access to one or more qualified health plans; and

Q. "superintendent" means the superintendent of insurance.

History: Laws 2013, ch. 54, § 2; 2020, ch. 35, § 2.

ANNOTATIONS

The 2020 amendment, effective May 20, 2020, defined "bronze plan", "enrollee", "gold plan", "health benefit plan", "insurance producer", "qualified employee", "qualified employer", "qualified health plan", "qualified individual", "silver plan", and "small business health options program" and removed certain definitions as used in the New Mexico Health Insurance Exchange Act; deleted former Subsection A, which defined "agent", and redesignated former Subsection B as Subsection A; deleted former Subsection C, which defined "broker", and added new Subsections B and C; added new Subsections E and F and redesignated former Subsection E as Subsection G; added a new Subsection H and redesignated former Subsections F and G as Subsections I and J, respectively; in Subsection J, after "provided that", deleted "a broker or an agent" and added "an insurance producer", and after "may be a navigator if the", deleted "broker or the agent" and added "insurance producer"; and added new Subsections K through P and redesignated the succeeding subsection accordingly.

Severability. — Laws 2013, ch. 54, § 16 provided that if any part or application of Laws 2013, ch. 54, §§ 1 through 15 are held invalid, the remainder or its application to other situations or persons shall not be affected.

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