N.M. Stat. § 59A-23F-2
Definitions.
As used in the New Mexico Health Insurance Exchange Act:
A. "board" means the board of directors of the exchange;
B. "bronze plan" means a level of coverage that is designed to provide benefits that
are actuarially equivalent to sixty percent of the full actuarial value of the benefits
provided under a health benefit plan or the allowable value for a bronze plan as defined
by federal regulation;
C. "enrollee" means:
(1)
a qualified individual or qualified employee enrolled in a qualified health
plan;
(2)
the dependent of a qualified employee enrolled in a qualified health plan
through the small business health options program;
(3)
a person who is enrolled in a qualified health plan through the small
business health options program, consistent with applicable law and the terms of the
group health plan; or
(4)
a business owner enrolled in a qualified health plan through the small
business health options program, provided that at least one employee of the business
owner enrolls in a qualified health plan through the small business health options
program, or the dependent of a business owner enrolled in a qualified health plan
through the small business health options program;
D. "exchange" means the New Mexico health insurance exchange, composed of an
exchange for the individual market and a small business health options program or
"SHOP" exchange under a single governance and administrative structure;
E. "gold plan" means a level of coverage that is designed to provide benefits that
are actuarially equivalent to eighty percent of the full actuarial value of the benefits
provided under a health benefit plan or the allowable value for a gold plan as defined by
federal regulation;
F. "health benefit plan" means an individual or group policy or agreement entered
into, offered or issued by a health insurance carrier to provide, deliver, arrange for, pay
for or reimburse any of the costs of health care services;
G. "health insurance issuer" means an insurance company, insurance service or
insurance organization, including a health maintenance organization, that is licensed to
engage in the business of insurance in the state;
H. "insurance producer" means a person required to be licensed in this state to sell,
solicit or negotiate insurance;
I. "Native American" means:
(1)
an individual who is a member of any federally recognized Indian nation,
tribe or pueblo or who is an Alaska native; or
(2)
an individual who has been deemed eligible for services and programs
provided to Native Americans by the United States public health service or the bureau
of Indian affairs;
J. "navigator" means a person that, in a manner culturally and linguistically
appropriate to the state's diverse populations, conducts public education, distributes tax
credit and qualified health plan enrollment information, facilitates enrollment in qualified
health plans or provides referrals to consumer assistance or ombudsman services.
"Navigator" does not mean a health insurance issuer or a person that receives any
consideration, directly or indirectly, from any health insurance issuer in connection with
the enrollment of a qualified individual in a qualified health plan; provided that an
insurance producer may be a navigator if the insurance producer receives no
consideration, directly or indirectly, from any health insurance issuer in connection with
the enrollment of a qualified individual or qualified employer in a qualified health plan,
an approved health plan or any other health coverage;
K. "qualified employee" means an employee or former employee of a qualified
employer who has been offered health insurance coverage by that qualified employer
through the small business health options program for the employee or former
employee and, if the qualified employer offers dependent coverage through the small
business health options program, for the employee or former employee's dependents;
L. "qualified employer" means a small employer that elects to make, at a minimum,
all of the employer's full-time employees eligible for one or more qualified health plans in
the small group market offered through a small business health options program;
M. "qualified health plan" means a health plan that has in effect a certification from
the superintendent that it meets the standards set forth in applicable federal and state
law and regulations and rules as well as any additional requirements established by the
board;
N. "qualified individual" means an individual who has been determined eligible to
enroll through the exchange in a qualified health plan in the individual market;
O. "silver plan" means a level of coverage that is designed to provide benefits that
are actuarially equivalent to seventy percent of the full actuarial value of the benefits
provided under a health benefit plan or the allowable value for a silver plan as defined
by federal regulation;
P. "small business health options program" means a program operated by the
exchange through which a qualified employer can provide its employees and their
dependents with access to one or more qualified health plans; and
Q. "superintendent" means the superintendent of insurance.