N.M. Stat. § 59A-23E-16
Exclusions, limitations and exceptions for certain
group health plans and group health insurance.
A. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and
59A-23E-18 NMSA 1978 do not apply to any group retiree health plan and health
insurance coverage offered in connection with a group retiree health plan if, on the first
day of the plan year, the plan has fewer than two employees who are current
employees.
B. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and
59A-23E-18 NMSA 1978 shall not apply with respect to a group health plan or group
retiree health plan that is a nonfederal governmental plan if the plan sponsor makes an
election under the provisions of this subsection in conformity with regulations of the
federal secretary of health and human services. The period of an election for exclusion
made pursuant to this subsection is for a single specified plan year or, in the case of a
plan provided pursuant to a collective bargaining agreement, for the term of the
agreement. The plan for which an election is made shall provide under the terms of the
election for:
(1)
notice to enrollees on an annual basis and at the time of enrollment of the
facts and consequences of the election; and
(2)
certification and disclosure of creditable coverage under the plan with
respect to enrollees in accordance with Section 59A-23E-7 NMSA 1978 [repealed].
C. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and
59A-23E-18 NMSA 1978 do not apply to a group health plan and group health
insurance coverage offered in connection with a group health plan in relation to its
provision of excepted benefits described in Paragraph (9) of Subsection L of Section
59A-23E-2 NMSA 1978 if the benefits are:
(1)
provided under a separate policy, certificate or contract of insurance; or
(2)
otherwise not an integral part of the plan.
D. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and
59A-23E-18 NMSA 1978 do not apply to any group health plan and group health
insurance coverage offered in connection with a group health plan in relation to its
provision of excepted benefits described in Paragraph (10) of Subsection L of Section
59A-23E-2 NMSA 1978 if:
(1)
the benefits are provided under a separate policy, certificate or contract of
insurance;
(2)
there is no coordination between the provision of the benefits and any
exclusion of benefits under any group health plan maintained by the same plan sponsor;
and
(3)
the benefits are paid with respect to an event without regard to whether
benefits are provided with respect to that event under any group health plan maintained
by the same plan sponsor.
E. The requirements of Sections 59A-23E-3 through 59A-23E-15, 59A-23E-17 and
59A-23E-18 NMSA 1978 do not apply to any group health plan and group health
insurance coverage offered in connection with a group health plan in relation to its
provision of excepted benefits described in Paragraph (11) of Subsection L of Section
59A-23E-2 NMSA 1978 if the benefits are provided under a separate policy, certificate
or contract of insurance.