N.M. Admin. Code § 13.10.7.14

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

Section 13.10.7.14 - PROTECTION OF ENROLLEES

Each HMO shall adopt at least one of the following arrangements to protect its enrollees from incurring liability for payment of any fees which are the legal obligation of the HMO:

A. a contractual arrangement with any provider regularly used by the enrollees of the HMO prohibiting the provider from holding any enrollee liable for payment of any fees which are the legal obligation of the HMO;

B. a stand-by reinsurance agreement or membership in a guaranty association that is acceptable to the superintendent;

C. adequate financial reserves acceptable to the superintendent; or

D. other arrangements acceptable to the superintendent to protect enrollees.

N.M. Admin. Code § 13.10.7.14

6/1/98; Recompiled 11/30/01