New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 34 - STANDARDS FOR ACCIDENT-ONLY, SPECIFIED DISEASE, HOSPITAL INDEMNITY, DISABILITY INCOME, SUPPLEMENTAL, AND NON-SUBJECT WORKER EXCEPTED BENEFITS › Section 13.10.34.18 - REQUIRED DISCLOSURES AND NOTICES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
General
				notice requirement
An application for an individual plan or plan sold
				through an association or group described in Paragraphs (2) or (4) of
				Subsection A of 59A-23-3 NMSA 1978, other than a disability income plan, shall
				contain in bold, 14-point type, directly above the applicant signature line the
				following notice:
NOTICE TO BUYER: PLEASE REVIEW THIS PLAN CAREFULLY. IT ONLY
				  PROVIDES LIMITED BENEFITS, AND IT DOES NOT ON ITS OWN OR IN COMBINATION WITH
				  OTHER LIMITED BENEFITS POLICIES CONSTITUTE MAJOR MEDICAL INSURANCE. BENEFITS
				  PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL
				  EXPENSES.
TO LEARN IF YOU ARE ELIGIBLE FOR A MAJOR MEDICAL PLAN, PLEASE
				  VISIT [
WWW.BEWELLNM.COM
] OR CALL
				  [1-833-862-3935]. PREMIUM DISCOUNTS, FINANCIAL ASSISTANCE, OR OTHER MAJOR
				  MEDICAL COVERAGE OPTIONS MAY BE AVAILABLE.
B.
Renewal provision
A plan
				shall include a renewal, continuation or nonrenewal provision. The language or
				specification of the provision shall be consistent with the type of plan to be
				issued. The provision shall be appropriately captioned, shall appear on the
				first page of the plan, and shall clearly state the duration of coverage and
				renewal terms.
C.
Riders
A rider, endorsement, or supplement added to a plan after
				its effective date that reduces or eliminates benefits or coverage shall not be
				effective unless signed by the covered person. Signature may include electronic
				signature or voice signature, however, this signature must be recorded by the
				carrier and time-stamped. This signature requirement does not apply to
				certificates issued to covered persons in a group plan. A signature shall not
				be required if the rider, endorsement or supplement reflects a change to the
				plan that is required by law.
D.
Additional premium for riders, endorsements or supplement
If an
				additional premium is charged for benefits specified in a rider, endorsement or
				supplement, the plan or certificate shall specify the premium.
E.
Preexisting conditions
If a
				plan includes any preexisting condition exclusion or limitation, the plan or
				certificate shall include a separate section labeled "Preexisting Conditions,
				Exclusions and Limitations."
F.
Right of return/Free look.
A plan shall include a prominent
				notice, printed on or attached to the first page of the plan, stating that the
				covered person has the right to return the plan, and cancel any associated
				voluntary group membership enrolled in contemporaneous with the plan
				enrollment, within 30 days of its delivery, and to have the premium and
				membership fees refunded in full if the covered person is not satisfied for any
				reason.
G.
Age factors
If age is a factor that reduces aggregate benefits, that factor shall be
				prominently set forth in the outline of coverage.
H.
Conversion privilege
If a
				plan includes a conversion privilege, the provision shall be captioned,
				"Conversion Privilege." The provision shall specify who is eligible for
				conversion and the circumstances that govern conversion, or may state that the
				conversion coverage will be as provided in an approved plan form used by the
				carrier for that purpose.
I.
Medicare supplement notice
(1)
				The outline of coverage delivered with an accident-only, specified disease,
				hospital indemnity, supplemental or non-subject plan shall contain the
				following notice in bold 14-point type:
THIS IS NOT A MEDICARE SUPPLEMENT PLAN. IF YOU ARE ELIGIBLE
				  FOR MEDICARE, ASK FOR INFORMATION ABOUT MEDICARE SUPPLEMENT
				  POLICIES.
(2) A carrier
				shall deliver to persons eligible for Medicare any notice required under
				13.10.25 NMAC.