N.M. Admin. Code § 13.10.17.2

Current through Register Vol. 35, No. 24, December 23, 2024

Section 13.10.17.2 - SCOPE

A.Applicability. This rule applies to all health care insurers that provide, offer or administer health benefits plans, including health benefits plans:

(1) with a point-of-service option that allows subscribers to obtain health care services out-of-network;

(2) provided by an entity that purchases or is authorized to purchase health care benefits pursuant to the New Mexico Health Care Purchasing Act (Sections 13-7-1 through 13-7-11 NMSA 1978); and

(3) utilizing a preferred provider network, as defined under Section 59A-22A-3 NMSA 1978.

B.Exemptions. This rule does not apply to policies or certificates that provide coverage for:

(1) only short-term travel, accident-only, specified disease or other limited benefits; or

(2) credit, disability income, hospital indemnity, long-term care insurance, limited scope vision care, limited scope dental or any other limited supplemental benefit; or

(3) self-funded plans that are subject to the Employee Retirement Income Security Act of 1974 (ERISA).

C.Conflicts. For purpose of this rule, if any provision in this rule conflicts with any provision in 13.10.13 NMAC, Managed Health Care or 13.10.16 NMAC, Provider Grievances, the provisions in this rule shall apply.

N.M. Admin. Code § 13.10.17.2

Adopted by New Mexico Register, Volume XXVII, Issue 23, December 15, 2016, eff. 1/1/2017, Amended by New Mexico Register, Volume XXXV, Issue 22, November 19, 2024, eff. 11/19/2024