2021 New Mexico Statutes
Chapter 59A - Insurance Code
Article 23E - Health Insurance Portability
Section 59A-23E-14 - Health insurance issuers; guaranteed availability of coverage.
A. Except as provided in Subsections B through F of this section, a health insurance issuer that offers health insurance coverage in the individual or group markets shall renew or continue that coverage in force at the option of the plan sponsor or the individual.
B. A health insurance issuer may refuse to renew or may discontinue health insurance coverage offered pursuant to Subsection A of this section if:
(1) the plan sponsor or individual has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the issuer has not received timely premium payments;
(2) the plan sponsor or individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of a material fact under the terms of the coverage;
(3) the issuer is ceasing to offer coverage in the market in accordance with Subsection C of this section; or
(4) in the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, there is no longer any enrollee in connection with that plan who lives, resides or works in the service area of the issuer or the area for which the issuer is authorized to do business and the issuer would deny enrollment with respect to the network plan pursuant to Paragraph (1) of Subsection C of Section 59A-23E-13 NMSA 1978.
C. A health insurance issuer may discontinue offering a particular type of individual or group health insurance coverage offered in the group or individual markets only if:
(1) the issuer provides notice to each plan sponsor or individual provided coverage of this type in the market and to the participants and beneficiaries covered under the coverage of the discontinuation at least ninety days prior to the date of the discontinuation;
(2) the issuer offers to a plan sponsor or individual provided coverage of this type in the market the option to purchase any other health insurance plan coverage currently being offered by the issuer in that market; and
(3) in exercising the option to discontinue coverage of this type and in offering the option of coverage pursuant to Paragraph (2) of this subsection, the issuer acts uniformly without regard to the claims experience of those sponsors or individuals or any health status related factors relating to any participants or beneficiaries who may become eligible for that coverage.
D. If a health insurance issuer elects to discontinue offering all health insurance coverage in the individual or group markets, coverage may be discontinued only if:
(1) the issuer provides notice to the superintendent and to each plan sponsor or to the individual and participants and beneficiaries covered under that coverage of the discontinuation at least one hundred eighty days prior to the date of discontinuation; and
(2) all health insurance issued or delivered for issuance in the state in the market is discontinued and coverage is not renewed.
E. After discontinuation pursuant to Subsection D of this section, the health insurance issuer shall not provide for the issuance of any health insurance coverage in the market involved during the five-year period beginning on the date of the discontinuation of the last health insurance coverage not renewed.
F. At the time of coverage renewal pursuant to Subsection A of this section, a health insurance issuer may modify the coverage for a policy form offered to a group or individual if the modification is effective on a uniform basis among all groups or individuals, as applicable, with that policy form.
History: Laws 1997, ch. 243, § 14; 1998, ch. 41, § 18; 2019, ch. 259, § 13.
ANNOTATIONSThe 2019 amendment, effective June 14, 2019, removed the failure of a plan sponsor to comply with a material plan provision as a reason for a health insurance issuer to refuse to renew or to discontinue health insurance coverage, and provided that any changes to coverage provisions under a given plan must be on a uniform basis among all groups or individuals; in the section heading, deleted "renewability of coverage for employers in the small or large group market; requirement and exceptions to requirement" and added "availability of coverage"; in Subsection B, deleted Paragraph B(3) and redesignated former Paragraphs B(4) and B(5) as Paragraphs B(3) and B(4), respectively, and deleted former Paragraph B(6); in Subsection D, Paragraph D(1), after "plan sponsor", deleted "and to participants and beneficiaries covered under the plan" and added "or to the individual and participants and beneficiaries covered under that coverage"; in Subsection F, deleted Paragraphs F(1) and F(2) and added "or individual if the modification is effective on a uniform basis among all groups or individuals, as applicable, with that policy form"; and deleted Subsection G.
The 1998 amendment, effective March 6, 1998, inserted "Health insurance issuers" near the beginning and "small or large" near the middle in the section heading, substituted "refuse to renew or may " for "nonrenew or discontinue" near the beginning of Subsection B, and substituted "59A-23E-13 NMSA 1978" for "13 of the Health Insurance Portability Act" near the end of Paragraphs B(3) and (5).
