A. A group health plan, other than a small group health plan or a blanket health insurance policy or contract that is delivered, issued for delivery or renewed in this state shall provide coverage for eligible insureds to receive a heart artery calcium scan.

Terms Used In New Mexico Statutes 59A-23-7.16

  • Contract: A legal written agreement that becomes binding when signed.

B. Coverage provided pursuant to this section shall:

(1)     be limited to the provision of a heart artery calcium scan to an eligible insured to be used as a clinical management tool;

(2)     be provided every five years if an eligible insured has previously received a heart artery calcium score of zero; and

(3)     not be required for future heart artery calcium scans if an eligible insured receives a heart artery calcium score greater than zero.

C. At its discretion or as required by law, an insurer may offer or refuse coverage for further cardiac testing or procedures for eligible insureds based upon the results of a heart artery calcium scan.

D. The provisions of this section do not apply to short-term travel, accident-only or limited or specified-disease policies, plans or certificates of health insurance.

E. As used in this section:

(1)     “eligible insured” means an insured who:

(a) is a person between the ages of forty-five and sixty-five; and

(b) has an intermediate risk of developing coronary heart disease as determined by a health care provider based upon a score calculated from an evidence- based algorithm widely used in the medical community to assess a person’s ten-year cardiovascular disease risk, including a score calculated using a pooled cohort equation;

(2)     “health care provider” means a physician, physician assistant, nurse practitioner or other health care professional authorized to furnish health care services within the scope of the professional’s license; and

(3)     “heart artery calcium scan” means a computed tomography scan measuring coronary artery calcium for atherosclerosis and abnormal artery structure and function.