New Mexico § 59A-16-21.4 Unfair trade practices on the basis of disability

New Mexico Statutes

§ 59A-16-21.4 — Unfair trade practices on the basis of disability

New Mexico § 59A-16-21.4

Ch. 59AInsurance Code

Art. 16Trade Practices and Frauds

This text of New Mexico § 59A-16-21.4 (Unfair trade practices on the basis of disability) is published on Counsel Stack Legal Research, covering New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.M. Stat. Ann. § 59A-16-21.4 (2026).

Text

prohibited. 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

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prohibited. 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.