A. The health insurance policy issued by the pool shall pay for medically necessary eligible health care services rendered or furnished for the diagnoses or treatment of illness or injury that exceed the deductible and coinsurance amounts applicable under Section 59A-54-14 NMSA 1978 and are not otherwise limited or excluded. Eligible expenses are the charges for the health care services and items for which benefits are extended under the pool policy. The coverage to be issued by the pool and its schedule of benefits, exclusions and other limitations shall be established by the board and shall, at a minimum, reflect the levels of health insurance coverage generally available in New Mexico for small group policies; provided that a health insurance policy issued by the pool shall not include a lifetime maximum benefit. The superintendent shall approve the benefit package developed by the board to ensure its compliance with the Medical Insurance Pool Act. The benefit package shall include therapy services and hearing aids.
B. The Medical Insurance Pool Act shall not be construed to prohibit the pool from issuing additional types of health insurance policies with different types of benefits that, in the opinion of the board, may be of benefit to the citizens of New Mexico.
C. The board may design and employ cost containment measures and requirements, including preadmission certification and concurrent inpatient review, for the purpose of making the pool more cost effective.
History: 1978 Comp., § 59A-54-13, enacted by Laws 1987, ch. 154, § 13; 1991, ch. 200, § 10; 2001, ch. 352, § 8; 2008, ch. 88, § 3.
The 2008 amendment, effective May 14, 2008, in Subsection A, provided that a health insurance policy issued by the pool shall not include a lifetime maximum benefit.
The 2001 amendment, effective June 15, 2001, substituted "Medical Insurance Pool Act" for "Comprehensive Health Insurance Pool Act" in Subsections A and B; and inserted "and" preceding "its schedule of benefits" in Subsection A.
The 1991 amendment, effective June 14, 1991, in Subsection A, substituted "59A-54-14 NMSA 1978" for "14 of the Comprehensive Health Insurance Pool Act" in the first sentence, substituted "generally available in New Mexico for small group policies" for "of the top five insurers in the state" at the end of the third sentence and made minor stylistic changes.
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