N.M. Admin. Code § 8.302.3.18 - INSURER RESPONSIBILITIES
Individual, blanket, group accident or health policies or certificates of insurance, including employee retirement income security Act (ERISA) plans, delivered, issued or renewed in the state of New Mexico must not contain exclusions or clauses which deny or limit insurance benefits to eligible recipients because of their eligibility for medicaid benefits. See Subsection D of Section 59-18-31 NMSA 1978 (Repl. Pamp. 1992).
A.
Direct payments to HSD: All
individual, blanket, or group accident or health policies or certificate of
insurance, including ERISA plans, delivered, issued or renewed in the state of
New Mexico must require insurers to reimburse HSD for benefits paid on behalf
of eligible recipients in the following situations:
(1) HSD has paid or is paying
benefits;
(2) HSD pays medicaid
providers for the services in question; and
(3) insurers are notified that insured
individuals receive medicaid benefits and that the benefits must be paid
directly to HSD. HSD certifies to insurers at the time it files claims for
reimbursement that these individuals are eligible for medicaid; and
(4) when the claim was paid by a MCO, payment
may be made directly to the MCO. If the MCO fails to initiate recovery within
12 months following the original payment date, the payment must be made to
HSD.
B.
Direct
provider payments: Medicaid providers may be paid directly by insurers
for furnishing medical services to eligible recipients. Providers must inform
insurers that the recipients are eligible for medicaid benefits by providing
medicaid eligibility information on the recipient. See Subsection C of Section
59A-18-31 NMSA 1978 (Repl. Pamp.
1992).
C.
Level of insurance
required: The minimum standards of acceptable coverage, deductibles,
coinsurance, lifetime benefits, out-of-pocket expenses, co-payments, and plan
requirements are the minimum standards of health insurance policies and managed
care plans established for small businesses in New Mexico. See the New Mexico
Insurance Code.
Notes
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