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New Mexico Statutes Chapter 59A. Insurance Code § 59A-47-53. Diagnostic and supplemental breast examinations

Current as of May 06, 2021 | Updated by FindLaw Staff

A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state that provides coverage for diagnostic and supplemental breast examinations shall not impose cost sharing for diagnostic and supplemental breast examinations.

B. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law.

C. As used in this section:

(1) “cost sharing” means a deductible, coinsurance, copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense;

(2) “diagnostic breast examination” means a medically necessary and clinically appropriate examination of the breast using diagnostic mammography, breast magnetic resonance imaging or breast ultrasound that evaluates an abnormality:

(a) seen or suspected from a screening examination for breast cancer; or

(b) detected by another means of examination; and

(3) “supplemental breast examination” means a medically necessary and clinically appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is:

(a) used to screen for breast cancer when there is no abnormality seen or suspected; and

(b) based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer.

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Cite this article: FindLaw.com - New Mexico Statutes Chapter 59A. Insurance Code § 59A-47-53. Diagnostic and supplemental breast examinations - last updated May 06, 2021 | https://codes.findlaw.com/nm/chapter-59a-insurance-code/nm-st-sect-59a-47-53/

Read this complete New Mexico Statutes Chapter 59A. Insurance Code § 59A-47-53. Diagnostic and supplemental breast examinations on Westlaw

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