reglab/statecodes huggingface dataset:
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-5 - Debtor groups.

A policy of group life insurance may be issued to a creditor or its parent holding company or to a trustee or trustees or agent designated by two or more creditors, which creditor, holding company, affiliate, trustee, trustees or agent shall be deemed the policyholder, to insure debtors of the creditor, or creditors, subject to the following requirements:
A. the debtors eligible for insurance under the policy shall be all of the debtors of the creditor or creditors, or all of any class or classes thereof. The policy may provide that the term "debtors" shall include (1) borrowers of money or purchasers or lessees of goods, services, or property for which payment is arranged through a credit transaction; (2) the debtors of one or more subsidiary corporations; and (3) the debtors of one or more affiliated corporations, proprietorships, or partnerships if the business of the policyholder and of such affiliated corporations, proprietorships, or partnerships is under common control;
B. the premium for the policy shall be paid either from the creditor's funds, or from charges collected from the insured debtors, or from both. Except as provided in Subsection C, a policy on which no part of the premium is to be derived from funds contributed by insured debtors specifically for their insurance must insure all eligible debtors;
C. an insurer may exclude any debtors as to whom evidence of individual insurability is not satisfactory to the insurer;
D. the amount of the insurance on the life of any debtor shall at no time exceed the greater of the scheduled or actual amount of unpaid indebtedness to the creditor;
E. the insurance may be payable to the creditor or any successor to the right, title, and interest of the creditor. Such payment shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of such payment; and
F. notwithstanding the provisions of the above subsections, insurance on agricultural credit transaction commitments may be written up to the amount of the loan commitment on a nondecreasing or level term plan. Insurance on educational credit transaction commitments may be written up to the amount of the loan commitment less the amount of any repayments made on the loan.
History:
Laws 1984, ch. 127, § 403.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-6 - Labor union groups.

A policy of group life insurance may be issued to a labor union or similar organization, which shall be deemed the policyholder, to insure members of such union or organization for the benefit of persons other than the union or organization or any of its officials, representatives or agents, subject to the following requirements:
A. the members eligible for insurance under the policy shall be all of the members of the union or organization, or all of any class or classes thereof;
B. the premium for the policy shall be paid by the policyholder, either wholly from the union's or organization's funds, or from funds contributed by the insured members specifically for their insurance, or from both. Except as provided in Subsection C, a policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance must insure all eligible members, except those who reject such coverage in writing; and
C. an insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
History:
Laws 1984, ch. 127, § 404.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Group life insurance policy for benefit of union members, 17 A.L.R.2d 927.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-7 - Trustee groups.

A. A policy of group life insurance may be issued to a trust or to the trustee of a fund established by two or more employers, or by one or more labor unions or similar employee organizations, or by one or more employers and one or more labor unions or similar employee organizations, which trust or trustee shall be deemed the policyholder, to insure employees of the employers or members of the unions or organizations for the benefit of persons other than the employers or the unions or organizations, subject to the following requirements:
(1) the persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions or organizations, or all of any class or classes thereof. The policy may provide that the term "employees" shall include retired employees, the individual proprietor or partners if an employer is an individual proprietor or a partnership, and directors of a corporate employer. The policy may provide that the term "employees" shall include the trustees or their employees, or both, if their duties are principally connected with such trusteeship;
(2) the premium for the policy shall be paid from funds contributed by the employer or employers of the insured persons, or by the union or similar employee organizations, or by both, or from funds contributed by the insured persons or from both the insured persons and the employer or union or similar employee organization. Except as provided in Paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing; and
(3) an insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
B. No such policy or certificate of group life insurance may be renewed, delivered or issued for delivery in this state unless the superintendent has approved the issuance. The superintendent shall not grant his approval unless he finds that:
(1) the benefits of the policy are reasonable in relation to the premium charged; and
(2) the group to which the policy is issued is organized and operated in a fiscally sound manner.
C. The provisions of this section apply to the offering in this state of a policy issued in another state or its certificates.
History:
Laws 1984, ch. 127, § 405; 1991, ch. 125, § 27.
ANNOTATIONS
The 1991 amendment,
effective April 3, 1991, designated the formerly undesignated first paragraph as Subsection A and redesignated former Subsections A to C as Paragraphs (1) to (3) of Subsection A; in Subsection A, substituted "Paragraph (3) of this section" for "Subsection C" in the second sentence and made minor stylistic changes; and added Subsections B and C.
Severability.
— Laws 1991, ch. 125, § 30 provides for the severability of the act if any part or application thereof is held invalid.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-8 - Association groups.

A policy of group life insurance may be issued to any association organized in this state by any group of professional or business persons required to be licensed under the laws of the state in order to engage in such profession or business, or to any agricultural association organized under the laws of this state, and maintained in good faith for purposes other than that of obtaining insurance, insuring at least twenty-five (25) members of the association for the benefit of persons other than the association or its officers or trustees, as such. The association is deemed the policyholder.
History:
Laws 1984, ch. 127, § 406.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-9 - Discretionary groups.

A policy of group life insurance may be issued to any other group that, in the discretion of the superintendent, may be subject to the issuance of a group life insurance contract.
History:
Laws 1984, ch. 127, § 406a; 2013, ch. 74, § 25.
ANNOTATIONS
The 2013 amendment,
effective March 29, 2013, authorized the superintendent of insurance to approve the issuance of group life insurance; and after "discretion of the", deleted "commission" and added "superintendent".
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-10 - Dependents' coverage.

Insurance under any group life insurance policy issued pursuant to Sections 59A-21-4 and 59A-21-6 through 59A-21-8 NMSA 1978 may be extended to insure the dependents, or any class or classes thereof, of each employee or member who so elects. The term "dependent" means the spouse of the employee or member and an employee's or member's minor child, including a child beyond the age of majority up to a maximum of twenty-five years of age while attending an educational institution, and such other children of the employee or member as provided within the group life insurance policy. The premiums for the insurance on such dependents may be paid by the group policyholder or by the employee or member or by the group policyholder and the employee or member jointly.
History:
Laws 1984, ch. 127, § 407; 1993, ch. 126, § 3.
ANNOTATIONS
The 1993 amendment,
effective June 18, 1993, in the first sentence, substituted "59A-21-4 and 59A-21-6 through 59A-21-8 NMSA 1978" for "402 (employee groups), 404 (labor union groups), 405 (trustee groups) and 406 (association groups) of this article", deleted "insured" preceding "employee", and deleted the following language which formerly appeared at the end of the sentence: "in amounts in accordance with some plan which precludes individual selection and shall not be in excess of fifty percent of the insurance on the life of such employee or member"; and, in the second sentence, deleted "insured" preceding the first occurrence of "employee" and preceding "employee's", inserted "minor" preceding "child", substituted the language following "minor child" for "under twenty-one (21) years of age, or his child twenty-one (21) years or older who is attending an educational institution and relying upon the insured employee or member for financial support", and made minor stylistic changes.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-11 - Standard and required provisions.

A. No policy of group life insurance shall be delivered in this state unless it contains in substance the provisions as required by Sections 409 through 419 [59A-21-12 to 59A-21-22 NMSA 1978] of this article or provisions which, in the superintendent's opinion, are more favorable to the persons insured, or at least as favorable to the persons insured and more favorable to the policyholder.
B. The provisions set out in Sections 414 through 418 [59A-21-17 to 59A-21-21 NMSA 1978] of this article do not apply to policies issued to a creditor to insure debtors of such creditor.
C. The standard provisions required for individual life insurance shall not apply to group life insurance policies.
D. If a group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions which, in the superintendent's opinion, is or are equitable to the insured persons and to the policyholder; but nothing herein shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies.
History:
Laws 1984, ch. 127, § 408.
ANNOTATIONS
Cross references.
— For existing forms and filings,
see
notes following 59A-5-21 NMSA 1978.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
44 C.J.S. Insurance § 300.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-12 - Grace period.

A group life insurance policy shall contain in substance a provision that the policyholder is entitled to a grace period of thirty-one (31) days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period.
History:
Laws 1984, ch. 127, § 409.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
45 C.J.S. Insurance § 472.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-13 - Noncontestability.

A group life insurance policy shall contain in substance a provision that the validity of the policy shall not be contested, except for nonpayment of premiums, after it has been in force for two (2) years from its date of issue; and that no statement made by any person insured under the policy relating to his insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of two (2) years during such person's lifetime nor unless contained in a written instrument signed by him; provided, however, that no such provision shall preclude assertion at any time of defenses based upon provisions in the policy which relate to eligibility for coverage.
History:
Laws 1984, ch. 127, § 410.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-14 - Statements by insured.

A group life insurance policy shall contain in substance a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such person or in the event of death or incapacity of the insured person, to his beneficiary or personal representative.
History:
Laws 1984, ch. 127, § 411.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-15 - Evidence of insurability.

A group life insurance policy shall contain in substance a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of his coverage.
History:
Laws 1984, ch. 127, § 412.
ANNOTATIONS
Conditions for acceptance of application allowed.
— The retention of the premium check by the life insurance company, and its failure to give notice of rejection after learning of the death of the applicant, does not constitute an acceptance of the application where applicant has undergone heart surgery, has been refused insurance by other companies, is advised that permission to contact his physician would be required by the company, and that his application would have to be approved by the company before it would become effective.
Stubben v. National Fid. Life Ins. Co.
, 1968-NMSC-013, 78 N.M. 667, 437 P.2d 128.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-16 - Misstatement of age.

A group life insurance policy shall contain in substance a provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, such provision to contain a clear statement of the method of adjustment to be used.
History:
Laws 1984, ch. 127, § 413.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-17 - Payment to beneficiary; funeral expenses.

A group life insurance policy shall contain in substance a provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, except that where the policy contains conditions pertaining to family status the beneficiary may be the family member specified by the policy terms, subject to the provisions of the policy in the event there is no designated beneficiary, as to all or any part of such sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of such sum not exceeding two thousand dollars ($2,000) to any person appearing to the insurer to be equitably entitled thereto by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured.
History:
Laws 1984, ch. 127, § 414.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
What are necessary funeral expenses within coverage of medical payment and funeral expense provision of insurance policy, 87 A.L.R.3d 497.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-18 - Certificate or statement of insurance protection.

A. A group life insurance policy shall contain in substance a provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which he is entitled, to whom the insurance benefits are payable and the rights and conditions set forth in Sections 416, 417, and 418 [59A-21-19, 59A-21-20, 59A-21-21 NMSA 1978] of this article.
B. A group life insurance policy issued to a creditor to insure debtors of such creditor, shall contain in substance a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form which will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid thereunder by reason of his death shall first be applied to reduce or extinguish the indebtedness.
History:
Laws 1984, ch. 127, § 415.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-19 - Conversion privilege; termination of membership in group or by death of employee.

A group life insurance policy shall contain in substance a provision that if the insurance, or any portion of it, on a person covered under the policy or on the dependent of such person ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person shall be entitled to have issued to him by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits, provided application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after such termination, and such individual policy shall be subject to the following requirements:
A. the individual policy shall, at the option of such person be on any one of the forms, except term insurance, then customarily issued by the insurer at the age and for the amount applied for;
B. the individual policy shall be in an amount not in excess of the amount of life insurance which ceases because of such termination, less the amount of any life insurance for which such person becomes eligible under the same or any other group policy within thirty-one (31) days after such termination, provided that any amount of insurance which shall have matured on or before the date of such termination as an endowment payable to the person insured, whether in one sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount which is considered to cease because of such termination; and
C. the premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which such person then belongs and to his age attained on the effective date of the individual policy.
D. subject to the same conditions set forth above, the conversion privilege shall be available (1) to a surviving dependent, if any, at the death of the employee or member, with respect to the coverage under the group policy which terminates by reason of such death and (2) to the dependent of the employee or member upon termination of coverage of the dependent, while the employee or member remains insured under the group policy, by reason of the dependent ceasing to be a qualified family member, by divorce or otherwise, under the group policy.
History:
Laws 1984, ch. 127, § 416.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Failure of employer or insurer to notify employee dropped from payroll of necessity for and time of contribution to group insurance premium, 2 A.L.R.2d 852.
Termination of coverage under group policy with regard to termination of employment, 68 A.L.R.2d 8, 32 A.L.R.4th 1037.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-20 - Conversion privilege; termination of group policy.

A group life insurance policy shall contain in substance a provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured thereunder at the date of such termination whose insurance terminates, including the insured dependent of a covered person, and who has been so insured for at least five (5) years prior to such termination date shall be entitled to have issued to him by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by Section 416 [59A-21-19 NMSA 1978] of this article, except that the group policy may provide that the amount of such individual policy shall not exceed the smaller of:
A. the amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which he is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after such termination; and
B. ten thousand dollars ($10,000).
History:
Laws 1984, ch. 127, § 417.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Rights as between insurer and employer in respect of termination of group annuity insurance agreement, 41 A.L.R.2d 772.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-21 - Conversion privilege; death benefit.

A group life insurance policy shall contain in substance a provision that if a person insured under the group policy, or the insured dependent of a covered person, dies during the period within which he would have been entitled to have an individual policy issued to him in accordance with Sections 416 or 417 [59A-21-19 or 59A-21-20 NMSA 1978] above and before such an individual policy shall have become effective, the amount of life insurance which he would have been entitled to have issued to him under such individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefor has been made.
History:
Laws 1984, ch. 127, § 418.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-22 - Conversion privilege; extension by failure to give notice.

If any individual insured under a group life insurance policy hereafter delivered in this state becomes entitled under the terms of such policy to have an individual policy of life insurance issued to him without evidence of insurability, subject to making of application and payment of the first premium within the period specified in such policy, and if such individual is not given notice of the existence of such right at least fifteen (15) days prior to the expiration date of such period, then in such event the individual shall have an additional period within which to exercise such right, but nothing herein contained shall be construed to continue any insurance beyond the period provided in such policy. This additional period shall expire fifteen (15) days next after the individual is given such notice but in no event shall such additional period extend beyond sixty (60) days next after the expiration date of the period provided in such policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder shall constitute notice for the purpose of this section.
History:
Laws 1984, ch. 127, § 419.
ANNOTATIONS
Time limit for premium notice.
— Where plaintiffs' decedent was hospitalized and died well within the time during which the policy provisions could be construed to say that he would be billed for the premium, the trial court could not grant summary judgment by concluding that the insurer did not have to provide decedent with a premium notice.
Estate of Griego v. Reliance Standard Life Ins. Co.
, 2000-NMCA-022, 128 N.M. 676, 997 P.2d 150.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-23 - Continuance of coverage during total disability.

Where active employment is a condition of insurance, a group life insurance policy shall contain a provision in substance that an insured may continue coverage during the insured's total disability by timely payment to the policyholder of that portion, if any, of the premium that would have been required from the insured had total disability not occurred. The continuation shall be on a premium paying basis for a period of six (6) months from the date on which the total disability started, but not beyond the earlier of (1) approval by the insurer of continuation of the coverage under any disability provision which the group insurance policy may contain or (2) the discontinuance of the group insurance policy.
History:
Laws 1984, ch. 127, § 420.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-24 - Assignment of interest under policy.

A. Subject to the terms of the policy relating to assignment of incidents of ownership, a person whose life is insured under any policy of group life insurance can assign all or any part of his incidents of ownership under the policy including any right to designate a beneficiary under the policy and any right to have an individual policy issued to him in accordance with Sections 416 through 419 [59A-21-19 to 59A-21-22 NMSA 1978] of this article.
B. Subject to the terms of the policy relating to assignment of incidents of ownership, an assignment of the incidents of ownership by an insured, made either before or after March 8, 1969, is valid for the purpose of vesting in the assignee, in accordance with any provisions included in the assignment about the time at which it is to be effective, all of the incidents of ownership assigned, but without prejudice to the insurer on account of any payment it may make or individual policy it may issue in accordance with Sections 418 and 420 [59A-21-21 and 59A-21-23 NMSA 1978] of this article prior to receipt of notice of the assignment.
History:
Laws 1984, ch. 127, § 421.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance § 690.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-25 - Coverage under group policy issued in another state.

A. No group life insurance coverage shall be offered in this state by an insurer under a policy issued in another state if the superintendent, or the appropriate insurance supervisory public official of another state, has determined that:
(1) issuance of the group policy was contrary to the best interests of the public;
(2) issuance of the group policy was not actuarially sound;
(3) issuance of the group policy did not result in economies of acquisition and administration; or
(4) benefits provided under the group policy are not reasonable in relation to the premiums charged.
B. Upon the superintendent's request the insurer shall promptly furnish to the superintendent a copy of any such group policy and of the certificate of insurance to be issued thereunder.
History:
Laws 1984, ch. 127, § 421a.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-26 - Purpose.

The purpose of this act [59A-21-26 to 59A-21-28 NMSA 1978] is to permit and set guidelines for life insurers to include in life insurance policies issued after the effective date of this act a provision for periodic adjustment of policy loan interest rates.
History:
1978 Comp., § 59-16-44, enacted by Laws 1983, ch. 283, § 1; 1978 Comp., § 59-16-44, recompiled as § 59A-21-26 by Laws 1987, ch. 259, § 32.
ANNOTATIONS
Compiler's notes.
— Laws 1983, ch. 283, § 4, provided that the provisions of the act shall not apply to any insurance contract issued before the effective date of the act unless the policyholder agrees in writing to the applicability of such provisions.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 21 - Group Life Insurance › Section 59A-21-27 - Definition.

For the purposes of this act [59A-21-26 to 59A-21-28 NMSA 1978], "published monthly average" means "Moody's corporate bond yield average-monthly average corporates" as published by Moody's Investors Service, Inc. or any successor thereto or in the event that "Moody's corporate bond yield average-monthly average corporates" is no longer published, a substantially similar average as established by regulation of the superintendent of insurance.
History:
1978 Comp., § 59-16-45, enacted by Laws 1983, ch. 283, § 2; 1978 Comp., § 59-16-45, recompiled as § 59A-21-27 by Laws 1987, ch. 259, § 32.
ANNOTATIONS
Compiler's notes.
— Laws 1983, ch. 283, § 4, provides that the provisions of the act shall not apply to any insurance contract issued before the effective date of the act unless the policyholder agrees in writing to the applicability of such provisions.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-1 - Scope of article.

Chapter 59A, Article 22 NMSA 1978 applies generally to policies of individual health insurance, including student health plan policies. Nothing in that article shall apply to or affect:
A. any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein;
B. life insurance, endowment or annuity contracts or contracts supplemental thereto that contain only such provisions relating to health insurance as:
(1) provide additional benefits in case of death by accident; and
(2) operate to safeguard such contracts against lapse or to give a special surrender value or special benefit or annuity in event the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract;
C. group or blanket health insurance, except as stated in Chapter 59A, Article 23 NMSA 1978; or
D. reinsurance.
History:
Laws 1984, ch. 127, § 422; 2017, ch. 130, § 14.
ANNOTATIONS
The 2017 amendment,
effective July 1, 2017, included student health plan policies within the scope of Chapter 59A, Article 22 NMSA 1978; in the introductory language, changed "This article" to "Chapter 59A, Article 22 NMSA 1978", after "individual health insurance", added "including student health plan policies", after "Nothing in", deleted "this" and added "that"; in Subsection A, after "any policy of", deleted "workmen's" and added "workers'", and after the semicolon, deleted "or"; and in Subsection C, after "stated in", added "Chapter 59A", and after "Article 23", deleted "of the Insurance Code" and added "NMSA 1978".
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance §§ 547 to 554.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-3 - Required provisions.

A. Except as provided in Subsection B of this section, each such policy delivered or issued for delivery in this state shall contain the provisions specified in Sections 425 through 436 [59A-22-4 to 59A-22-15 NMSA 1978], inclusive, of this article; except, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are in each instance not less favorable in any respect to the insured or beneficiary. Such required provisions shall be preceded individually by the applicable caption shown or, at the insurer's option, by such appropriate individual or group captions or subcaptions as the superintendent may approve.
B. If any provision of this article is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the superintendent's approval, shall omit from such policy any inapplicable provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
History:
Laws 1984, ch. 127, § 424.
ANNOTATIONS
Cross references.
— For existing forms and filings,
see
notes following 59A-5-21 NMSA 1978.
Ambiguous provision construed to favor insured.
— The court's responsibility is to consider the intent of the parties as expressed in the policy, and where questions arise because of ambiguities, a liberal construction in favor of the insured is to be adopted.
Couey v. National Benefit Life Ins. Co.
, 1967-NMSC-044, 77 N.M. 512, 424 P.2d 793.
Words given ordinary meaning.
— In construing the language, the court must read terms and phrases in their usual and ordinary sense unless language of the policy requires something different.
Couey v. National Benefit Life Ins. Co.
, 1967-NMSC-044, 77 N.M. 512, 424 P.2d 793.
No technical interpretation.
— A strict technical or legalistic interpretation of the terms of the policy will not be accepted when it is fully within the power of the insurance company to affirmatively specify some meaning other than that understood by the average individual.
Scott v. New Empire Ins. Co.
, 1965-NMSC-034, 75 N.M. 81, 400 P.2d 953.
Absent provision in policy
defining "accidental means" as something different from that as understood by the general public, words, phrases or terms will be given their ordinary meaning.
Scott v. New Empire Ins. Co.
, 1965-NMSC-034, 75 N.M. 81, 400 P.2d 953.
Limitations period permitted.
— Pursuant to this section, a health insurance policy could contain a four-year limitations period, and 59A-22-14 NMSA 1978 would not bar an action filed within that four-year period.
Willey v. United Mercantile Life Ins. Co.
, 1999-NMCA-137, 128 N.M. 98, 990 P.2d 211.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
43 Am. Jur. 2d Insurance §§ 503 to 522.
45 C.J.S. Insurance §§ 886, 887; 46 C.J.S. Insurance § 1118 et seq.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-4 - Entire contract; changes.

There shall be a provision as follows:
This policy, including the endorsements and attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurance company and unless such approval and countersignature be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.
History:
Laws 1984, ch. 127, § 425.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-6 - Grace period.

There shall be a provision as follows:
A grace period of . . . . . . . . (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.
A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision, "Unless not less than five days prior to the premium due date the insurance company has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted."
History:
Laws 1984, ch. 127, § 427.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-7 - Reinstatement.

There shall be a provision as follows:
If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any agent duly authorized by the insurance company to accept such premium, without requiring in connection therewith an application for reinstatement, shall reinstate the policy; provided, however, that if the insurance company or such agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy will be reinstated upon approval of such application by the insurer or, lacking such approval, upon the thirtieth day following the date of such conditional receipt unless the insurance company has previously notified the insured in writing of its disapproval of such application. The reinstated policy shall cover only loss resulting from such accidental injury as may be sustained after the date of reinstatement and loss due to such sickness as may begin more than ten days after such date. In all other respects the insured and insurance company shall have the same rights thereunder as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed hereon or attached hereto in connection with the reinstatement. Any premium accepted in connection with a reinstatement shall be applied to a period for which premium has not been previously paid, but not to any period more than sixty days prior to the date of reinstatement.
(The last sentence of the above provision may be omitted from any policy which the insured has the right to continue in force subject to its terms by the timely payment of premiums (1) until at least age 50 or, (2) in the case of a policy issued after age 44, for at least five years from its date of issue.)
History:
Laws 1984, ch. 127, § 428.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-8 - Notice of claim.

There shall be a provision as follows:
Written notice of claim must be given to the insurance company within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurance company at . . . . . . . . . . (insert the location of such office as the insurer may designate for the purpose) or to any authorized agent of the insurance company, with information sufficient to identify the insured, shall be deemed notice to the insurance company.
(In a policy providing a loss-of-time benefit which may be payable for at least two years, an insurance company may at its option insert the following between the first and second sentences of the above provision:
Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least two years, he shall at least once in every six months after having given notice of claim, give to the insurer notice of continuance of said disability, except in the event of legal incapacity. The period of six months following any filing of proof by the insured or any payment by the insurance company on account of such claim or any denial of liability in whole or in part by the insurance company shall be excluded in applying this provision. Delay in the giving of such notice shall not impair the insured's right to any indemnity which would otherwise have accrued during the period of six months preceding the date on which such notice is actually given.)
History:
Laws 1984, ch. 127, § 429.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Clause requiring notice of claim within specified time or as soon as reasonably possible, or the like, 17 A.L.R.3d 530.
Modern status of rules requiring liability insurer to show prejudice to escape liability because of insured's failure or delay in giving notice of accident or claim, or in forwarding suit papers, 32 A.L.R.4th 141.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-9 - Claim forms.

There shall be a provision as follows:
The insurance company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice the claimant shall be deemed to have complied with the requirements of this policy as to proof of loss upon submitting, within the time fixed in the policy for filing proofs of loss, written proof covering the occurrence, the character and the extent of the loss for which claim is made.
History:
Laws 1984, ch. 127, § 430.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-10 - Proofs of loss.

There shall be a provision as follows:
Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination of the period for which the insurer is liable and in case of claim for any other loss within ninety days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.
History:
Laws 1984, ch. 127, § 431.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-11 - Time of payment of claims.

There shall be a provision as follows:
Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written proof of loss, all accrued indemnities for loss for which this policy provides periodic payment will be paid . . . . . . . . . . (insert period for payment which must not be less frequently than monthly) and any balance remaining unpaid upon the terminatiion [termination] of liability will be paid immediately upon receipt of due written proof.
History:
Laws 1984, ch. 127, § 432.
ANNOTATIONS
Bracketed material.
— The bracketed material was inserted by the compiler and is not part of the law.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-12 - Payment of claims.

There shall be a provision as follows:
Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such designation or provision is then effective, such indemnity shall be payable to the estate of the insured. Any other accrued indemnities unpaid at the insured's death may, at the option of the insurer, be paid either to such beneficiary or to such estate. All other indemnities will be payable to the insured.
(The following provisions, or either of them, may be included with the foregoing provision at the option of the insurance company.)
(If any indemnity of this policy shall be payable to the estate of the insured, or to an insured or beneficiary who is a minor or otherwise not competent to give valid release, the insurance company may pay such indemnity, up to an amount not exceeding $. . . . . (insert an amount which shall not exceed one thousand dollars ($1,000), to any relative by blood or connection by marriage of the insured or beneficiary who is deemed by the insurance company to be equitably entitled thereto. Any payment made by the insurance company in good faith pursuant to this provision shall fully discharge the insurance company to the extent of such payment.)
(Subject to any written direction of the insured in the application or otherwise all or a portion of any indemnities provided by this policy on account of hospital, nursing, medical or surgical services may, at the insurance company's option and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services; but it is not required that the service be rendered by a particular hospital or person.)
History:
Laws 1984, ch. 127, § 433.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-13 - Physical examination and autopsy.

There shall be a provision as follows:
The insurance company at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law.
History:
Laws 1984, ch. 127, § 434.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-14 - Legal actions.

There shall be a provision as follows:
No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action shall be brought after the expiration of three years after the time written proof of loss is required to be furnished.
History:
Laws 1984, ch. 127, § 435.
ANNOTATIONS
Limitations period permitted.
— Pursuant to 59A-22-3 NMSA 1978, a health insurance policy could contain a four-year limitations period, and this section would not bar an action filed within that four-year period.
Willey v. United Mercantile Life Ins. Co.
, 1999-NMCA-137, 128 N.M. 98, 990 P.2d 211.
2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-15 - Change of beneficiary.

There shall be a provision as follows:
Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender or assignment of this policy or to any change of beneficiary or beneficiaries, or to any other changes in this policy.
History:
Laws 1984, ch. 127, § 436.
ANNOTATIONS
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Change of beneficiary of life or accident policy by will, 25 A.L.R.4th 1164.