2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 22 - Health Insurance Contracts › Section 59A-22-2 - Form and content of policy.

No policy of individual health insurance shall be delivered or issued for delivery in this state unless:
A. the entire money and other considerations therefor are expressed therein;
B. the time at which insurance takes effect and terminates is expressed therein;
C. it purports to insure only one person, except as provided in Chapter 59A, Article 23 NMSA 1978, and except that a policy or contract may be issued upon application of the head of a family, who shall be deemed the policyholder, covering members of any one family, including husband, wife, dependent children or any children under the age of twenty-six and other dependents living with the family;
D. every printed portion of the text matter and of any endorsements or attached papers shall be printed in uniform type of which the face shall be not less than ten point (the "text" shall include all printed matter except the name and address of the insurer, name and title of the policy, captions, subcaptions and form numbers), but notwithstanding any provision of this law, the superintendent shall not disapprove any such policy on the ground that every printed portion of its text matter or of any endorsement or attached paper is not printed in uniform type if it shall be shown that the type used is required to conform to the laws of another state in which the insurer is authorized;
E. the exceptions and reductions of indemnity are adequately captioned and clearly set forth in the policy or contract;
F. each separate form, including riders and endorsements, shall be identified by a form number and consecutive page numbers in the lower left-hand corner of each page; and
G. if any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of insurance laws of such other state shall have advised the superintendent that any such policy is not subject to approval or disapproval by such official, the superintendent may by ruling require that such policy meet the standards set forth in Sections 59A-22-3 through 59A-22-25 NMSA 1978.
History:
Laws 1984, ch. 127, § 423; 2021, ch. 108, § 16.
ANNOTATIONS
Cross references.
— For age of dependents,
see
Section 59A-22-30.1 NMSA 1978 and Section 59A-22-34.2 NMSA 1978.
For existing forms and filings,
see
notes following 59A-5-21 NMSA 1978.
The 2021 amendment,
effective July 1, 2021, changed the maximum age of a dependent from nineteen to twenty-six; in Subsection C, after "provided in", added "Chapter 59A", after "Article 23", deleted "of the Insurance Code" and added "NMSA 1978", and after "under the age of", deleted "nineteen (19)" and added "twenty-six"; and in Subsection G, after "Sections", deleted "424 through 446 of this article" and added "59A-22-3 through 59A-22-25 NMSA 1978".
Policy construed as whole.
— The insurance contract must be construed, whenever possible, to give effect to both provisions of the policy, that is, the insuring clause and the excepting clause.
King v. Travelers Ins. Co.
, 1973-NMSC-013, 84 N.M. 550, 505 P.2d 1226.
Ambiguous policy construed to favor insured.
— In the event the policy is ambiguous, the contract will be construed favorably to the insured who did not prepare it.
King v. Travelers Ins. Co.
, 1973-NMSC-013, 84 N.M. 550, 505 P.2d 1226.
If an ambiguity is apparent in the terms of a policy, the court must construe the contract so as to sustain indemnity if the sense and meaning of the instrument are not thereby destroyed.
King v. Travelers Ins. Co.
, 1973-NMSC-013, 84 N.M. 550, 505 P.2d 1226.
Unambiguous terms given ordinary meaning.
— Where there is no ambiguity the court must construe the language of a policy in accordance with the plain, ordinary meaning of its terms.
King v. Travelers Ins. Co.
, 1973-NMSC-013, 84 N.M. 550, 505 P.2d 1226.
Exceptions, limitations and exclusions require narrow construction
on the theory that the insurer, having affirmatively expressed coverage through broad promises, assumes a duty to define any limitations upon that coverage in clear and explicit terms.
King v. Travelers Ins. Co.
, 1973-NMSC-013, 84 N.M. 550, 505 P.2d 1226.
Medical policy covering applicant's dependents only allowed.
— Medical expense policy issued to applicant husband, but excluding coverage as to him while covering wife and children, was issued in accordance with former 59-18-3 NMSA 1978.
Prudential Ins. Co. of Am. v. Anaya
, 1967-NMSC-132, 78 N.M. 101, 428 P.2d 640.
Am. Jur. 2d, A.L.R. and C.J.S. references. —
Validity, construction and effect of provisions in life or accident policy in relation to military service, 36 A.L.R.2d 1018.
Computation of time with respect to fractions of days, in determining duration and termination of risk under accident, health, or hospital policy, 38 A.L.R.2d 768.
Clause in health and accident or similar policy reducing amount of periodic payments after insured reaches specified age, as applicable to disability incurred before such age is reached, 53 A.L.R.2d 552.
What constitutes "hernia" within exclusionary clause of health or accident insurance policy, 55 A.L.R.2d 1020.
What constitutes medical or surgical treatment, or the like, within exclusionary clause of accident policy or accidental death feature of life policy, 65 A.L.R.2d 1449.
Insurer's liability under accident policy which terminates after accidental injury but prior to completion of medical treatment, hospitalization, and the like, 75 A.L.R.2d 876.
What amounts to "infirmity" or "deformity" within accident provision of insurance policy, 75 A.L.R.2d 1238.
Scope and application of provisions of accident policy, or accident feature of life policy, relating to accident in connection with automobile or other motor vehicle, 78 A.L.R.2d 1044.
Effective date of life, health, or accident insurance policy, as between premium date stated in policy, and later date of approval by insurer, 37 A.L.R.3d 933.
Accident insurance: death or disability incident to partaking of food or drink as within provision as to external, violent, and accidental means, 29 A.L.R.4th 1230.
Liability insurance: intoxication or other mental incapacity avoiding application of clause in liability policy specifically exempting coverage of injury or damage caused intentionally by or at direction of insured, 33 A.L.R.4th 983.
Accident insurance: what is "loss" of body member, 51 A.L.R.4th 156.
Accident or life insurance: death by autoerotic asphyxiation as accidental, 62 A.L.R.4th 823.
What service, equipment, or supplies are "medically necessary" for purposes of coverage under medical insurance, 75 A.L.R.4th 763.
Coverage under medical and health insurance plans for services performed by dentists, oral surgeons, and orthodontists, 43 A.L.R.5th 657.
44 C.J.S. Insurance §§ 299, 380, 381.