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 13.10.34.19 - REQUIREMENTS FOR REPLACEMENT OF INDIVIDUAL PLAN COVERAGE

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Required questions.
An application for an individual plan or a
				plan sold through an association or group described in Paragraphs (2) or (4) of
				Subsection A of 59A-23-3 NMSA 1978 shall ask whether the insurance requested
				will replace any other plan subject to this rule.
B.
Notice requirement.
Upon
				determining that a sale will involve replacement of a plan, a carrier, other
				than a direct response carrier, or its agent, shall furnish the applicant,
				prior to issuance or delivery of the plan, the notice described in Subsection C
				below. A direct response carrier shall deliver to the applicant, upon issuance
				of the plan, the notice described in Subsection D below. No notice is required
				for the solicitation of accident-only or single premium nonrenewal policies.
				The carrier shall retain proof of notice for five years from the coverage
				effective date.
C.
Non-direct
				response carrier notice
NOTICE TO APPLICANT REGARDING REPLACEMENT OF LIMITED BENEFIT
				  HEALTH INSURANCE
According to [your application] [information you have
				  furnished], you intend to lapse or otherwise terminate existing insurance and
				  replace it with a plan to be issued by [insert company name] Insurance company.
				  For your own information and protection, you should be aware of and seriously
				  consider certain factors that may affect the insurance protection available to
				  you under the new plan.
(1) Health
				conditions that you may presently have, (preexisting conditions) may not be
				immediately or fully covered under the new plan. This could result in denial or
				delay of a claim for benefits under the new plan, whereas a similar claim might
				have been payable under your present plan.
(2) You may wish to secure the advice of your
				present insurer or its agent regarding the proposed replacement of your present
				plan. This is not only your right, but it is also in your best interests to
				make sure you understand all the relevant factors involved in replacing your
				present coverage.
(3) If, after due
				consideration, you still wish to terminate your present plan and replace it
				with new coverage, be certain to truthfully and completely answer all questions
				on the application concerning your medical and health history. Failure to
				include all material medical information on an application may provide a basis
				for the company to deny any future claims and to refund your premium as though
				your plan had never been in force. After the application has been completed and
				before you sign it, reread it carefully to be certain that all information has
				been properly recorded.
The above "Notice to Applicant" was delivered to me
				  on:
____________________________
(Date)
____________________________
(Applicant's Signature)