U.S. Federal and State Cases, Codes, and Articles
Select a tab to search United States Cases, Codes, or Articles
U.S. Federal and State Cases, Codes, and Articles
Select a tab to search United States Cases, Codes, or Articles
Search for cases
Indicates required field
Search by keyword or citation
Indicates required field
Search blogs, article pages, and cases and codes
Indicates required field
Current as of May 06, 2021 | Updated by FindLaw Staff
A. Any of the following practices with respect to a health benefits plan are defined as unfair and deceptive practices and are prohibited:
(1) canceling or changing the premiums, benefits or conditions of a health benefits plan on the basis of an insured's actual or perceived disability;
(2) denying a prosthetic or orthotic benefit for an individual with limb loss or absence that would otherwise be covered for a non-disabled person seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity;
(3) failure to apply the most recent version of treatment and fit criteria developed by the professional association with the most relevant clinical specialty when performing a utilization review for a request for coverage of prosthetic or orthotic benefits; and
(4) failure to apply medical necessity review standards developed by the professional association with the most relevant clinical specialty when conducting utilization management review or processing appeals regarding benefit denial.
B. For purposes of this section, “health benefits plan” means a policy or agreement entered into, offered or issued by a health insurance carrier to provide, deliver, arrange for, pay for or reimburse the costs of health care services; provided that “health benefits plan” does not include the following:
(1) an accident-only policy;
(2) a credit-only policy;
(3) a long- or short-term care or disability income policy;
(4) a specified disease policy;
(5) coverage provided pursuant to Title 18 of the federal Social Security Act, as amended;
(6) coverage provided pursuant to Title 19 of the federal Social Security Act and the Public Assistance Act;
(7) a federal TRICARE policy, including a federal civilian health and medical program of the uniformed services supplement;
(8) a fixed or hospital indemnity policy;
(9) a dental-only policy;
(10) a vision-only policy;
(11) a workers' compensation policy;
(12) an automobile medical payment policy; or
(13) any other policy specified in rules of the superintendent.
Cite this article: FindLaw.com - New Mexico Statutes Chapter 59A. Insurance Code § 59A-16-21.4. Unfair trade practices on the basis of disability prohibited - last updated May 06, 2021 | https://codes.findlaw.com/nm/chapter-59a-insurance-code/nm-st-sect-59a-16-21-4/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw's Learn About the Law.
Get help with your legal needs
FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.
Search our directory by legal issue
Enter information in one or both fields (Required)