N.M. Stat. § 59A-12A-2
Definitions.
As used in Chapter 59A, Article 12A NMSA 1978:
A. unless otherwise specified in that article, all definitions of the Insurance Code
apply;
B. "administrator" or "third party administrator" or "TPA" means a business entity
that receives any form of administrative or service fee, consideration, payment,
premium, reimbursement or compensation for performing or providing any service,
function or duty, or activity respecting insurance or alternatives to insurance in any
administrative or management capacity, including but not limited to claims or expense
review, underwriting, administration and management under a contract or other
agreement to be performed in this state or with respect to risks located or partially
located in this state or on behalf of persons in this state for any:
(1)
plan;
(2)
insurance carrier; or
(3)
person that self insures;
C. "administrator" does not include:
(1)
an employer on behalf of its employees or the employees of one or more
subsidiaries or affiliated corporations of that employer as long as only the functions of a
group policyholder are performed;
(2)
a union on behalf of its members as long as only the functions of a group
policyholder are performed;
(3)
an insurance company or a corporation that owns more than fifty percent
of an insurance company licensed in this state or a health maintenance organization,
nonprofit health care plan or a dental plan that is licensed in this state;
(4)
an insurance producer licensed in this state acting on behalf of an
admitted insurance carrier by whom the insurance producer is appointed and only within
the scope of the insurance producer's license as an insurance producer as defined in
the article of the Insurance Code under which the insurance producer is licensed;
(5)
a creditor on behalf of its debtors with respect to insurance covering its
debtors as long as only the functions of a group policyholder or creditor are performed;
(6)
a trust and its trustees, agents and employees acting under the trust,
established in conformity with 29 U.S.C. Sec. 186;
(7)
a trust exempt from taxations under Section 501(a) of the Internal
Revenue Code of 1986, and its trustees and employees acting under the trust, or a
custodian and its agents and employees acting pursuant to a custodian account that
meets the requirements of Section 401(f) of the Internal Revenue Code of 1986;
(8)
a bank that is subject to supervision or examination by federal or state
regulatory authorities as long as the bank is only performing the function for which it is
licensed;
(9)
a company that advances and collects any premium or charge from its
credit card holders who have authorized it to do so, provided the company does not
adjust or settle claims and acts only in its debtor-creditor relationship with its credit card
holders;
(10)
a person who adjusts or settles claims in the normal course of practice or
employment as an attorney at law who does not collect any charge or premium in
connection with life or health coverage or annuities;
(11)
an adjuster licensed by the superintendent, when engaged in the
performance of duties as an adjuster;
(12)
any joint fund, risk management pool or self-insurance pool composed of
political subdivisions of this state that participate in such funds or pools through
interlocal agreements, and any administrative agency established under the interlocal
agreement to administer the fund or pool;
(13)
a person providing technical, advisory or consulting services who does not
make management or discretionary decisions on behalf of an insurance carrier, plan or
person that self-insures;
(14)
a full-time salaried employee of an insurance carrier to the extent that the
functions performed are only for that insurance carrier or any affiliated carrier;
(15)
attorneys in fact for a Lloyd's or reciprocal exchange as authorized
respectively in Chapter 38 or 39 NMSA 1978, while acting as attorney in fact for such
Lloyd's or reciprocal exchange;
(16)
a certified public accountant, attorney at law or actuary when performing
duties or undertaking responsibilities within the authority and scope of that particular
profession;
(17)
an association and any subsidiary, affiliated or related corporations of that
association. For the purposes of this subsection, "association" means a bona fide trade
or professional association which has been in existence for not less than five years and
which enters into agreements to pool its liabilities for workers compensation benefits,
pursuant to the Group Self-Insurance Act [Chapter 52, Article 6 NMSA 1978]; or
(18)
a home owner warranty corporation provided by a trade association that
has been in business in New Mexico for at least five years;
D. "alternatives to insurance" means an agreement to indemnify against loss, risk,
damage, liability or other contingency relating to property or persons, whether or not
such agreement is deemed to be insurance under applicable law or where persons self
insure;
E. "bank" means a bank, savings and loan association, credit union or other
financial institution authorized by law to accept and maintain deposits;
F. "business entity" means a corporation, organization, government or
governmental subdivision or agency, business trust, estate trust, partnership,
association or any other legal entity; and
G. "plan" means any employer-employee, multiple employer-employee, group,
member or other employee benefit or welfare program, medical, accident, sickness,
injury, indemnity, death or health benefit program contracting to provide indemnification
or expense reimbursement in this state to persons domiciled in this state or for risks
located or partially located in this state for any type of the following coverages,
expenses or benefits: medical, surgical, orthopedic, chiropractic, physical therapy,
speech pathology, audiology, professional mental health, dental, hospital, workers'
compensation or optometric plan or programs, hospital care or benefit or benefits in the
event of sickness, accident, disability, death or unemployment, or prepaid legal
services.
- Cross-references to the US Code
- 29:186