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 13.10.34.16 - NON-SUBJECT WORKER PLAN

Current through Register Vol. 35, No. 13, July 16, 2024
A non-subject worker plan is subject to these additional
				  requirements.
A.
Eligibility
A non-subject worker plan shall only be offered or
				sold to a person who is self-employed and not subject to New Mexico workers'
				compensation law protections. A carrier shall investigate and evaluate the
				self-employment status of each applicant for an individual non-subject worker
				plan, and of each person who applies to enroll in a group non-subject worker
				plan. An attestation of self-employment by an applicant shall not relieve a
				carrier from these duties. 1099 income, standing alone, is insufficient proof
				of self-employment.
B.
Notice
An application for individual coverage, and an enrollment
				form for group coverage, shall include this notice, printed in 14-point type:
THE INSURANCE YOU ARE APPLYING FOR IS NOT A MAJOR MEDICAL
				  INSURANCE PLAN. THE INSURANCE YOU ARE APPLYING FOR DOES NOT OFFER ANY BENEFIT
				  FOR MEDICAL CARE YOU REQUIRE FOR AN OFF-WORK INJURY OR ILLNESS.
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, MEDICAID OR OTHER
				  MAJOR MEDICAL COVERAGE OPTIONS MAY BE AVAILABLE.
C.
Benefit requirements
The
				benefits provided under a non-subject worker plan are limited to medical
				expense reimbursement, wage loss replacement and lump-sum payment for permanent
				or temporary disability (full or partial) sustained by a covered person as a
				result of an on-the-job injury or occupational disease. A subject plan may
				provide any combination of such benefits, subject to the benefit levels
				rule.
D.
Benefit
				levels
The benefits offered under a non-subject worker plan shall be no
				less than what a covered person would be entitled to receive if that person's
				self-employment was subject to New Mexico workers' compensation laws. A subject
				plan may provide lower benefit levels, and omit some such benefits, provided
				the carrier offers an applicant a plan that would provide workers' compensation
				equivalent benefits, and the covered person rejects that offer in writing. The
				rejection document shall include the following attestation printed in 14-point
				type:
[CARRIER] OFFERED APPLICANT AN INSURANCE PLAN THAT INCLUDED
				  BENEFITS EQUIVALENT TO WHAT APPLICANT WOULD BE ENTITLED TO IF THE APPLICANT'S
				  SELF-EMPLOYMENT WAS SUBJECT TO NEW MEXICO WORKERS' COMPENSATION LAWS. THE
				  MONTHLY PREMIUM FOR THAT COVERAGE WOULD BE [$XX]. APPLICANT ELECTED TO PURCHASE
				  THIS PLAN WHICH PROVIDES LESS COVERAGE THAN WOULD BE AVAILABLE TO A SUBJECT
				  WORKER UNDER THE NEW MEXICO WORKERS COMPENSATION LAWS. THE MONTHLY PREMIUM FOR
				  THIS PLAN IS [$XX]. [CARRIER] OFFERED APPLICANT A CHART SHOWING THE DIFFERENCES
				  BETWEEN THIS PLAN AND THE FULL COVERAGE PLAN AND OFFERED TO EXPLAIN THOSE
				  DIFFERENCES.
I ATTEST THAT THE STATEMENT ABOVE IS TRUE AND CORRECT:
________________________________________________________
				  _______________________
[APPLICANT NAME] DATE
E.
Notice to Workers' Compensation
				Administration
Upon the sale of any non-subject worker plan, the carrier
				shall file a disclosure notice with the New Mexico Workers' Compensation
				Administration Employer Compliance Bureau. The notice shall contain the
				following information:
(1) name of covered
				person;
(2) covered person's
				occupation;
(3) name, address, and
				telephone number of any group sponsor of the plan; and
(4) effective dates of the
				plan.