N.M. Admin. Code § 13.10.2.7

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.2.7 - DEFINITIONS

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.

N.M. Admin. Code § 13.10.2.7

3/1/96; Recompiled 11/30/01