New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY
Section 13.10.2.7 - DEFINITIONS
Universal Citation: 13 NM Admin Code 13.10.2.7
Current through Register Vol. 35, No. 18, September 24, 2024
A. As used in this rule, the following terms have the meanings given in the cited section of the New Mexico Statutes Annotated 1978:
(1)
Approved health plans, Section 59A-56-3(B) NMSA 1978;
(2) Fraternal benefit society, Section
59A-44-1 NMSA 1978;
(3) Health
insurance alliance, Section 59A-56-3(A) NMSA 1978;
(4) Health maintenance organization, Section
59A-46-2(M) NMSA 1978;
(5) Insurer,
Section 59A-1-8 NMSA 1978;
(6)
Insurance Code, Section 59A-1-1 NMSA 1978;
(7) Superintendent, Section 59A-1-12 NMSA
1978;
(8) Health facility, Section
50-23-3(E) NMSA 1978.
B. As used in this rule, the following terms have the meanings given here:
(1) "Attending physician" means the attending
obstetrician, pediatrician or other physician attending the mother or newly
born child.
(2) "Inpatient" means a
patient admitted for treatment to a health facility.
(3) "Maternity benefits" means coverage for
prenatal, intrapartum, perinatal or postpartum care.
(4) "Medically necessary" means that the
patient's health, in the opinion of the attending physician, would be adversely
affected by lack of appropriate treatment.
(5) "New Mexico comprehensive health
insurance pool" means an entity organized pursuant to Section 59A-54-4(A) NMSA
1978.
(6) "Nonprofit health care
plan" means a health care plan organized pursuant to Section 59A-47-4 NMSA
1978.
(7) "Pool policy" means a
health insurance policy delivered or issued for delivery in this state pursuant
to the Comprehensive Health Insurance Pool Act, Article 54 NMSA 1978.
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