New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 19 - NON-ADMITTED OR SURPLUS LINES INSURANCE › Part 4 - MULTIPLE EMPLOYER WELFARE ARRANGEMENTS › Section 13.19.4.19 - SELF-FUNDED MEWA STOP-LOSS COVERAGE REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Purchase and alteration.
A
				MEWA must inform the superintendent at least 180 days prior to expiration of
				any required stop-loss insurance policy whether it intends to renew the policy,
				and whether the insurer is willing to renew the policy. Alteration of a
				required stop-loss insurance policy midterm with the effect of reducing
				coverage, and cancellation by the plan midterm, is prohibited. If more than one
				stop-loss insurance policy is obtained in fulfillment of this part's
				requirements, their expiration dates must be the same.
B.
Individual excess.
A MEWA
				shall have and maintain individual excess stop-loss insurance, that provides
				for the insurer to assume all liability in excess of the per person limit per
				year under all coverages the plan offers. The reporting period under this
				coverage shall be no less than one year after the fund year's
				conclusion.
C.
Aggregate
				excess.
A MEWA must have and maintain aggregate excess stop-loss
				insurance that provides for the insurer to assume all liability in excess of a
				specified amount of claim losses for each fund year. The aggregate excess
				coverage may be in the form of incurred basis stop-loss insurance or paid basis
				stop-loss insurance. MEWAs using paid basis stop-loss insurance shall have and
				maintain extended or runoff aggregate excess stop-loss insurance on an incurred
				basis. The extended or runoff coverage shall provide for the insurer to assume
				all liability in excess of a specified amount of claim losses incurred while
				the paid basis stop-loss insurance was in force, but paid after its termination
				or nonrenewal. The reporting period under paid basis insurance shall be no less
				than three months after the fund year's conclusion. The reporting period under
				incurred basis insurance, including extended or runoff insurance shall be no
				less than one year after the fund year's conclusion.
D.
Contractual Requirements.
A
				MEWA shall have and maintain the following language in its required aggregate
				excess stop-loss insurance policy, unless the superintendent determines that a
				policy with that language is not available in the market for stop-loss
				coverage, in which case, the superintendent may determine the requirements
				needed to obtain stop-loss coverage and meet solvency requirements: "The
				insurer shall, at the superintendent's request, assume direct responsibility
				for the MEWA's coverage and all other responsibilities under this chapter and
				related statutes, if the MEWA becomes insolvent, ceases operations without
				authorization, or otherwise fails to fulfill its responsibilities under this
				chapter and related statutes. The insurer may attempt to collect reimbursement
				from the MEWA or an employer member on whose behalf die insurer is called upon
				to pay premium, pay claims, or incur other extraordinary expenses. However, the
				insurer shall fulfill its responsibilities under this section while any
				collection attempts are pending. The insurer's responsibilities extend to all
				matters arising during or attributable to the policy period, and do not
				terminate with the end of the policy period."