New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 32 - COVERAGE FOR CONTRACEPTION
Section 13.10.32.10 - COVERAGE FOR CONTRACEPTION WHERE A PRESCRIPTION IS NOT REQUIRED
Universal Citation: 13 NM Admin Code 13.10.32.10
Current through Register Vol. 35, No. 6, March 26, 2024
A. If a prescription is not required for the purchase of a contraceptive, an insurer shall not charge a member for a purchase at an in-network pharmacy, and shall provide a process for the member to obtain reimbursement for an out-of-network purchase.
B. An insurer's website and evidence of coverage handbook shall clearly explain the process a covered person shall use to submit a claim for reimbursement for the purchase of non-prescription contraception drugs or devices. The reimbursement process is subject to these requirements:
(1) An insurer
shall allow a covered person at least 90 days from the date of purchase to
submit a request for reimbursement.
(2) An insurer shall reimburse a covered
person within 30 days of receipt of a timely and complete reimbursement request
submitted electronically, by email, or by fax, and within 45 days of receipt of
a timely and complete reimbursement request submitted by U.S. mail.
(a) A reimbursement request that is
transmitted electronically, via email, or fax, pursuant to the insurer's
instructions, is deemed received by the insurer on the date of receipt, unless
the covered person receives notice of a transmission error.
(b) A request for reimbursement is complete
if it contains the covered person's name and address, their plan identification
number, and a paid receipt explicitly delineating the purchased services or
supplies.
(c) An insurer may
require a covered person to use a specific claim form for a reimbursement
request.
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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