N.M. Admin. Code § 13.19.3.7

Current through Register Vol. 35, No. 21, November 5, 2024

Section 13.19.3.7 - DEFINITIONS

A."Agent" has the definition ascribed thereto in Section 59A-12-2A NMSA 1978 of the New Mexico Insurance Code.

B."Arrangement" means a fund, trust, plan, program or other mechanism by which a person provides, or attempts to provide, health care benefits to individuals.

C."Authorized insurer" has the definition ascribed thereto in Section 59A-1-8B NMSA 1978. For purposes of this rule, nonprofit health care plans holding a valid and subsisting certificate of authority, issued by the superintendent under Article 47 of the Insurance Code, and health maintenance organizations holding a valid and subsisting certificate of authority, issued by the superintendent under Article 46 of the Insurance Code, shall also be defined as authorized insurers.

D."Collectively bargained arrangement" means an arrangement which provides or represents that it is providing health care benefits or coverage under or pursuant to one or more collective bargaining agreements.

E."Employee leasing arrangement" means an arrangement, under contract or otherwise, whereby one business or other entity leases all or a significant number of its workers from another business or entity.

F."Employee welfare benefit plan" means any plan, fund or program which was heretofore or is hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan, fund or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical or hospital care or benefits, or benefits in the event of sickness, accident, disability, death or unemployment.

G."Fully insured by an authorized insurer" means that, for all of the health care coverage provided or offered by or through an arrangement:

(1) an authorized insurer is directly obligated by contract to provide all of the coverage to or under the arrangement;

(2) the authorized insurer assumes all of the risk for payment of all covered services or benefits; and

(3) the liability of the authorized insurer for payment of the covered services or benefits is directly to the individual employee, member or dependent receiving the health care services.

H."Insurance administrator" has the definition ascribed thereto in Section 59A-12A-2B NMSA 1978 of the New Mexico Insurance Code.

I."Insurance consultant" has the definition ascribed thereto in Section 59A-11A-1NMSA 1978 of the New Mexico Insurance Code.

J."Multiple employer welfare arrangement" has the meaning given in Section 59A-1-8.1 NMSA 1978 of the New Mexico Insurance Code.

K."Reportable MEWA" means a person or entity that provides health care benefits or coverage to the employees of two or more employers. Reportable MEWA does not include:

(1) an authorized insurer;

(2) an arrangement which is fully insured by an authorized insurer;

(3) a collectively bargained arrangement;

(4) an employee welfare benefit plan established or maintained by a rural electric cooperative or a rural telephone cooperative; or

(5) a multiple employer welfare arrangement that has satisfactorily demonstrated to the superintendent that it is subject to the jurisdiction of another agency of this state or the federal government in accordance with Section 59A-15-17 NMSA 1978 of the Health Care Benefits Jurisdiction Act.

L."Rural electric cooperative means":

(1) any organization which is exempt from tax under Section 501(a) of Title 26 of the United States Code and which is engaged primarily in providing electric service on a mutual or cooperative basis; or

(2) any organization described in Paragraph (4) or (6) of Section 501(c) of Title 26 of the United States Code which is exempt from tax under Section 501(a) of Title 26 and at least eighty percent (80%) of the members of which are organizations described in 13 NMAC 19.3.7.11.1 [now Paragraph (1) of Subsection K of 13.19.3.7 NMAC].

M."Rural telephone cooperative" means an organization described in Paragraph (4) or (6) of Section 501(c) of Title 26 of the United States Code which is exempt from tax under Section 501(a) of Title 26 and at least eighty percent (80%) of the members of which are organizations engaged primarily in providing telephone service to rural areas of the United States on a mutual, cooperative or other basis.

N.M. Admin. Code § 13.19.3.7

5/1/92; Recompiled 11/30/01