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New Mexico Mandated Benefits presented by Michael Batte

New Mexico Mandated Benefits presented by Michael Batte. Insure NM! Council November 22, 2004. Purposes of Mandates. Public policy Level playing field Response to marketplace. Variations of Mandates. Anti-discrimination of providers Children coverage Women’s coverage issues

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New Mexico Mandated Benefits presented by Michael Batte

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  1. New MexicoMandated Benefitspresented byMichael Batte Insure NM! Council November 22, 2004 Department of Insurance

  2. Purposes of Mandates • Public policy • Level playing field • Response to marketplace Department of Insurance

  3. Variations of Mandates • Anti-discrimination of providers • Children coverage • Women’s coverage issues • Special needs • Other Department of Insurance

  4. Anti-discrimination • Indemnity coverage – Freedom of Choice provisions • HMO’s – Provider discrimination prohibited Department of Insurance

  5. Children’s coverage • New born • Adopted • Domestic orders • Immunizations • Circumcision • Maximum age • Handicapped continuation Department of Insurance

  6. Women’s coverage issues • Mammograms • Mastectomy & lymph node dissection • Cytologic screening • Prescription contraceptives • Maternity transport • Alpha-fetoprotein IV screening test Department of Insurance

  7. Special conditions • Diabetes • Inborn errors of metabolism • Cancer clinical trials Department of Insurance

  8. Other • Home health care • Smoking cessation • TMJ • Alcohol dependence Department of Insurance

  9. Federal Mandates(Employer sponsored) • Maternity coverage • Mental health parity • Guaranteed issue – small employer Department of Insurance

  10. Cost of state mandates? • Industry trade associations – 15% to 25% • Our HMO’s – have estimated between 10% and 15% • My guess – closer to 3% than 15% • The answer can be determined Department of Insurance

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