## Facts

- New Mexico enacted the Life Insurance Guaranty Act to protect policyholders from losses caused by insurer insolvency by requiring “member insurers” to fund the system through assessments.
- The New Mexico Life Insurance Guaranty Association sought a declaratory judgment that New Mexico Blue Cross–Blue Shield and two nonprofit HMOs were engaged in “health insurance” and therefore were “member insurers” subject to assessment.
- The defendant entities were nonprofit membership corporations authorized and regulated under the Nonprofit Health Care Plan Act to provide services and/or make health care expense payments to subscribers on a service-benefit or expense-payment basis.
- The case was tried on a stipulated record; the dispute centered on statutory interpretation, including whether the plans wrote “insurance” to which the Guaranty Act applied.
- The district court held the plans did not write covered “insurance,” were not “member insurers,” and were not assessable; the Association appealed.

## Issues

1. Whether nonprofit health care plans organized under the Nonprofit Health Care Plan Act are engaged in “health insurance” within the meaning of the Life Insurance Guaranty Act.
2. Whether such plans qualify as “member insurers” subject to Guaranty Act assessments when the Guaranty Act does not expressly include them.

## Decision

- The New Mexico Supreme Court affirmed.
- The court held the defendant nonprofit health care plans were not engaged in the kind of “insurance” to which the Life Insurance Guaranty Act applies.
- Because the plans were not “member insurers,” they were not liable for assessments by the Association.

## Legal Principles

- Statutory coverage of a guaranty-assessment scheme depends on legislative text and context; courts will not extend coverage to entities not clearly included.
- Where the legislature creates and regulates nonprofit health care plans under a separate statutory framework, their treatment as insurers for some purposes does not automatically make them insurers for all purposes.
- Selective legislative incorporation of nonprofit health care plans into certain insurance statutes, coupled with omission from the Life Insurance Guaranty Act, supports an inference that the omission was intentional.
- Absent a clear statutory basis that an entity writes “insurance to which the Act applies,” the entity cannot be deemed a “member insurer” subject to guaranty assessments.

## Conclusion

The court concluded that nonprofit health care plans regulated under a separate act were not brought within the Life Insurance Guaranty Act’s definition of covered insurance or “member insurer,” and therefore could not be assessed by the guaranty association without explicit legislative inclusion.


N.M. Life Ins. Guar. Ass’n v. Moore, 93 N.M. 47, 596 P.2d 260 (N.M. 1979)