New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 17 - GRIEVANCE PROCEDURES
Section 13.10.17.2 - SCOPE
Universal Citation: 13 NM Admin Code 13.10.17.2
Current through Register Vol. 35, No. 18, September 24, 2024
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, vision care 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.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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