New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 24 - GENETIC INFORMATION NONDISCRIMINATION - MEDICARE SUPPLEMENT PLANS › Section 13.10.24.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
As used in this rule:
A. "certificate" means any certificate
				delivered or issued for delivery in this state under a group medicare
				supplement policy;
B. "family
				member" means, with respect to an individual, any other individual who is a
				first-degree, second-degree, third-degree, or fourth-degree relative of such
				individual;
C. "genetic
				information" means, with respect to any individual, information about such
				individual's genetic tests, the genetic tests of family members of such
				individual, and the manifestation of a disease or disorder in family members of
				such individual; such term includes, with respect to any individual, any
				request for, or receipt of, genetic services, or participation in clinical
				research which includes genetic services, by such individual or any family
				member of such individual; any reference to genetic information concerning an
				individual or family member of an individual who is a pregnant woman, includes
				genetic information of any fetus carried by such pregnant woman, or with
				respect to an individual or family member utilizing reproductive technology,
				includes genetic information of any embryo legally held by an individual or
				family member; the term "genetic information" does not include information
				about the sex or age of any individual;
D. "genetic services" means a genetic test,
				genetic counseling (including obtaining, interpreting, or assessing genetic
				information), or genetic education;
E. "genetic test" means an analysis of human
				DNA, RNA, chromosomes, proteins, or metabolites, that detect genotypes,
				mutations, or chromosomal changes; the term "genetic test" does not mean an
				analysis of proteins or metabolites that does not detect genotypes, mutations,
				or chromosomal changes; or an analysis of proteins or metabolites that is
				directly related to a manifested disease, disorder, or pathological condition
				that could reasonably be detected by a health care professional with
				appropriate training and expertise in the field of medicine involved;
F. "issuer of a medicare supplement policy or
				certificate" includes insurance companies, fraternal benefit societies,
				nonprofit health care plans, health maintenance organizations and any other
				entity delivering or issuing for delivery in this state medicare supplement
				policies or certificates, and includes a third-party administrator, or other
				person acting for or on behalf of such issuer;
G. "medicare" means the "Health Insurance for
				the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then
				constituted or later amended;
H.
				"medicare supplement policy" means a group or individual policy of insurance or
				a subscriber contract other than a policy issued pursuant to a contract under
				Section 1876 of the federal Social Security Act (
				42 U.S.C. Section
				1395 et seq.) or an issued policy under a
				demonstration project specified in
				42 U.S.C. Section
				1395 ss(g)(1), which is advertised, marketed
				or designed primarily as a supplement to reimbursements under medicare for the
				hospital, medical or surgical expenses of persons eligible for medicare;
				"medicare supplement policy" does not include medicare advantage plans
				established under medicare part C, outpatient prescription drug plans
				established under medicare part D, or any health care prepayment plan (HCPP)
				that provides benefits pursuant to an agreement under Section 1833(a)(1)(A) of
				the Social Security Act;
I.
				"secretary" means the secretary of the United States department of health and
				human services;
J. "underwriting
				purposes" means:
(1) rules for, or
				determination of, eligibility (including enrollment and continued eligibility)
				for benefits under the policy;
(2)
				the computation of premium or contribution amounts under the policy;
(3) the application of any pre-existing
				condition exclusion under the policy; and
(4) other activities related to the creation,
				renewal, or replacement of a contract of health insurance or health
				benefits.