New Mexico § 59A-22A-3 Definitions

New Mexico Statutes

§ 59A-22A-3 — Definitions

New Mexico § 59A-22A-3

Ch. 59AInsurance Code

Art. 22APreferred Provider Arrangements

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Bluebook

N.M. Stat. Ann. § 59A-22A-3 (2026).

Text

As used in the Preferred Provider Arrangements Law: A. "covered person" means any person on whose behalf the health care insurer is obligated to pay for or to provide health benefit services; B. "covered services" means health care services which the health care insurer is obligated to pay for or to provide under a health benefit plan; C. "emergency care" means health care procedures, treatments or services delivered to a covered person after the sudden onset of what reasonably appears to be a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could be reasonably expected by a reasonable layperson to result in jeopardy to a person's health, serious impairment of bodily functions, serious dysfunc

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As used in the Preferred Provider Arrangements Law: A. "covered person" means any person on whose behalf the health care insurer is obligated to pay for or to provide health benefit services; B. "covered services" means health care services which the health care insurer is obligated to pay for or to provide under a health benefit plan; C. "emergency care" means health care procedures, treatments or services delivered to a covered person after the sudden onset of what reasonably appears to be a medical condition that manifests itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could be reasonably expected by a reasonable layperson to result in jeopardy to a person's health, serious impairment of bodily functions, serious dysfunction of a bodily organ or part or disfigurement to a person; D. "health benefit plan" means the health insurance policy or subscriber agreement between the covered person or the policyholder and the health care insurer that defines the covered services and benefit levels available; E. "health care insurer" means any person who provides health insurance in this state. For the purposes of the Small Group Rate and Renewability Act [Chapter 59A, Article 23C NMSA 1978], "carrier" or "insurer" includes a licensed insurance company, a licensed fraternal benefit society, a prepaid hospital or medical service plan, a health maintenance organization, a nonprofit health care organization, a multiple employer welfare arrangement or any other person providing a plan of health insurance subject to state insurance regulation; F. "health care provider" means providers of health care services licensed as required in this state; G. "health care services" means services rendered or products sold by a health care provider within the scope of the provider's license. The term includes hospital, medical, surgical, dental, vision and pharmaceutical services or products; H. "preferred provider" means a health care provider or group of providers who have contracted with a health care insurer to provide specified covered services to a covered person; and I. "preferred provider arrangement" means a contract between or on behalf of the health care insurer and a preferred provider that complies with all the requirements of the Preferred Provider Arrangements Law.