As used in Chapter 59A, Article 12A NMSA 1978:
A. unless otherwise specified in that article, all definitions of the Insurance Code apply;
B. "administrator" or "third party administrator" or "TPA" means a business entity that receives any form of administrative or service fee, consideration, payment, premium, reimbursement or compensation for performing or providing any service, function or duty, or activity respecting insurance or alternatives to insurance in any administrative or management capacity, including but not limited to claims or expense review, underwriting, administration and management under a contract or other agreement to be performed in this state or with respect to risks located or partially located in this state or on behalf of persons in this state for any:
(1) plan;
(2) insurance carrier; or
(3) person that self insures;
C. "administrator" does not include:
(1) an employer on behalf of its employees or the employees of one or more subsidiaries or affiliated corporations of that employer as long as only the functions of a group policyholder are performed;
(2) a union on behalf of its members as long as only the functions of a group policyholder are performed;
(3) an insurance company or a corporation that owns more than fifty percent of an insurance company licensed in this state or a health maintenance organization, nonprofit health care plan or a dental plan that is licensed in this state;
(4) an insurance producer licensed in this state acting on behalf of an admitted insurance carrier by whom the insurance producer is appointed and only within the scope of the insurance producer's license as an insurance producer as defined in the article of the Insurance Code under which the insurance producer is licensed;
(5) a creditor on behalf of its debtors with respect to insurance covering its debtors as long as only the functions of a group policyholder or creditor are performed;
(6) a trust and its trustees, agents and employees acting under the trust, established in conformity with 29 U.S.C. Sec. 186;
(7) a trust exempt from taxations under Section 501(a) of the Internal Revenue Code of 1986, and its trustees and employees acting under the trust, or a custodian and its agents and employees acting pursuant to a custodian account that meets the requirements of Section 401(f) of the Internal Revenue Code of 1986;
(8) a bank that is subject to supervision or examination by federal or state regulatory authorities as long as the bank is only performing the function for which it is licensed;
(9) a company that advances and collects any premium or charge from its credit card holders who have authorized it to do so, provided the company does not adjust or settle claims and acts only in its debtor-creditor relationship with its credit card holders;
(10) a person who adjusts or settles claims in the normal course of practice or employment as an attorney at law who does not collect any charge or premium in connection with life or health coverage or annuities;
(11) an adjuster licensed by the superintendent, when engaged in the performance of duties as an adjuster;
(12) any joint fund, risk management pool or self-insurance pool composed of political subdivisions of this state that participate in such funds or pools through interlocal agreements, and any administrative agency established under the interlocal agreement to administer the fund or pool;
(13) a person providing technical, advisory or consulting services who does not make management or discretionary decisions on behalf of an insurance carrier, plan or person that self-insures;
(14) a full-time salaried employee of an insurance carrier to the extent that the functions performed are only for that insurance carrier or any affiliated carrier;
(15) attorneys in fact for a Lloyd's or reciprocal exchange as authorized respectively in Chapter 38 or 39 NMSA 1978, while acting as attorney in fact for such Lloyd's or reciprocal exchange;
(16) a certified public accountant, attorney at law or actuary when performing duties or undertaking responsibilities within the authority and scope of that particular profession;
(17) an association and any subsidiary, affiliated or related corporations of that association. For the purposes of this subsection, "association" means a bona fide trade or professional association which has been in existence for not less than five years and which enters into agreements to pool its liabilities for workers compensation benefits, pursuant to the Group Self-Insurance Act [Chapter 52, Article 6 NMSA 1978]; or
(18) a home owner warranty corporation provided by a trade association that has been in business in New Mexico for at least five years;
D. "alternatives to insurance" means an agreement to indemnify against loss, risk, damage, liability or other contingency relating to property or persons, whether or not such agreement is deemed to be insurance under applicable law or where persons self insure;
E. "bank" means a bank, savings and loan association, credit union or other financial institution authorized by law to accept and maintain deposits;
F. "business entity" means a corporation, organization, government or governmental subdivision or agency, business trust, estate trust, partnership, association or any other legal entity; and
G. "plan" means any employer-employee, multiple employer-employee, group, member or other employee benefit or welfare program, medical, accident, sickness, injury, indemnity, death or health benefit program contracting to provide indemnification or expense reimbursement in this state to persons domiciled in this state or for risks located or partially located in this state for any type of the following coverages, expenses or benefits: medical, surgical, orthopedic, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, workers' compensation or optometric plan or programs, hospital care or benefit or benefits in the event of sickness, accident, disability, death or unemployment, or prepaid legal services.
History: 1978 Comp., § 59A-12A-2, enacted by Laws 1989, ch. 374, § 2; 2016, ch. 89, § 49.
ANNOTATIONSCross references. — For the Insurance Code, see 59A-1-1 NMSA 1978 and notes thereto.
For Sections 501(a) and 401(f) of the Internal Revenue Code of 1986, see 26 U.S.C. §§ 501(a) and 401(f), respectively.
The 2016 amendment, effective July 1, 2017, revised the definition of "third party administrator", added the definition of "business entity" as used in the Insurance Code, and replaced "agent" with "insurance producer" throughout the section; in Subsection B, in the introductory paragraph, after "'TPA' means a", deleted "person who" and added "business entity"; in Subsection C, Paragraph (3), after "corporation", deleted "which" and added "that", in Paragraph (4), after "carrier by whom", deleted "he" and added "the insurance producer", after "scope of", deleted "his" and added "insurance producer's", and after "Code under which", deleted "he" and added "the insurance producer is", in Paragraphs (10) and (11) deleted "his", in Paragraph (13), deleted "any" and added "a", and after "does not make", deleted "any", in Paragraph (14), deleted "any" and added "a", in Paragraph (18), after "in New Mexico for", deleted "a" and added "at"; in Subsection D, after "means", deleted "any" and added "an"; and in Subsection F, deleted "'person' includes", and added "'business entity' means".
Severability. — Laws 2016, ch. 89, § 71 provided that if any part or application of Laws 2016, ch. 89 is held invalid, the remainder or its application to other situations or persons shall not be affected.