reglab/statecodes huggingface dataset:
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This regulation shall apply to reinsurance treaties that cede
				  liabilities pertaining to covered policies, as that term is defined in
				  Subsection B of
				  13.9.21.7 NMAC, issued by any life
				  insurance company domiciled in this state. This regulation and the credit for
				  reinsurance regulation, 13.2.8.1
et seq
NMAC, shall both apply
				  to such reinsurance treaties; provided, that in the event of a direct conflict
				  between the provisions of this regulation and 13.2.8.1
et seq
NMAC, the provisions of this regulation shall apply, but only to the extent of
				  the conflict. Except expressly exempted, this rule will apply to all covered
				  policies in effect as of or after the effective date of the
				  rule.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Sections
				  59A-2-9 and
				  59A-12E-17
				  (2022) NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
November 1, 2023 unless a later date is cited at the end of a
				  section.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of this rule is to conform with established,
				  uniform, national standards governing reserve financing arrangements pertaining
				  to life insurance policies containing guaranteed nonlevel gross premiums,
				  guaranteed nonlevel benefits and universal life insurance policies with
				  secondary guarantees; and to ensure that, with respect to each such financing
				  arrangement, funds consisting of primary security and other security, as
				  defined in Subsections F and G of
				  13.9.21.7 NMAC, are held by or on
				  behalf of ceding insurers in the forms and amounts required herein. In general,
				  reinsurance ceded for reserve financing purposes has one or more of the
				  following characteristics: some or all of the assets used to secure the
				  reinsurance treaty or to capitalize the reinsurer (1) are issued by the ceding
				  insurer or its affiliates; or (2) are not unconditionally available to satisfy
				  the general account obligations of the ceding insurer; or (3) create a
				  reimbursement, indemnification or other similar obligation on the part of the
				  ceding insurer or any if its affiliates (other than a payment obligation under
				  a derivative contract acquired in the normal course and used to support and
				  hedge liabilities pertaining to the actual risks in the policies ceded pursuant
				  to the reinsurance treaty).
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
"Actuarial
				method"
means the methodology used to determine the required level of
				primary security, as described in 13.9.21.9 &
				13.9.21.10 NMAC
B.
"Covered policies"
means the
				following: Subject to the exemptions described in
				13.9.21.13 NMAC, Covered policies
				are those policies, other than grandfathered policies, of the following policy
				types:
(1) Life insurance policies with
				guaranteed nonlevel gross premiums, guaranteed nonlevel benefits, or both,
				except for flexible premium universal life insurance policies; or,
(2) Flexible premium universal life insurance
				policies with provisions resulting in the ability of a policyholder to keep a
				policy in force over a secondary guarantee period.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.8 - UPDATING THE VALUATION MANUAL

Current through Register Vol. 35, No. 13, July 16, 2024
If the national association of insurance commissioners amends
				  the Valuation Manual by the means described in Paragraph (1) of Subsection F of
				  Section 59A-8A-2 NMSA 1978 (2014), the
				  superintendent shall issue a bulletin, pursuant to
				  13.1.2.8 NMAC, stating that the
				  Valuation Manual has been officially amended, stating the effective date of the
				  amended Valuation Manual, and providing a link to the amended
				  manual.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.10 - VALUATION USED FOR THE PURPOSES OF CALCULATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
For the purposes of both calculating the required level of
				  primary security pursuant to the actuarial method, as described in
				  13.9.21.9 NMAC, and determining
				  the amount of primary security and other security, as applicable, held by or on
				  behalf of the ceding insurer, the following shall apply:
A. For assets, including any such assets held
				in trust, that would be admitted under the NAIC Accounting Practices and
				Procedures Manual if they were held by the ceding insurer, the valuations are
				to be determined according to statutory accounting procedures as if such assets
				were held in the ceding insurer's general account and without taking into
				consideration the effect of any prescribed or permitted practices;
				and
B. for all other assets, the
				valuations are to be those that were assigned to the assets for the purpose of
				determining the amount of reserve credit taken. In addition, the asset spread
				tables and asset default cost tables required by VM-20 shall be included in the
				actuarial method if adopted by the NAIC's Life Actuarial (A) Task Force no
				later than the Dec. 31st on or immediately preceding the valuation date for
				which the required level of primary security is being calculated. The tables of
				asset spreads and asset default costs shall be incorporated into the actuarial
				method in the manner specified in VM-20.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.12 - PROHIBITION AGAINST AVOIDANCE

Current through Register Vol. 35, No. 13, July 16, 2024
No insurer that has covered policies as to which this
				  regulation applies (as set forth in
				  13.9.21.2 NMAC) shall take any
				  action or series of actions, or enter into any transaction or arrangement or
				  series of transactions or arrangements if the purpose of such action,
				  transaction or arrangement or series thereof is to avoid the requirements of
				  this regulation, or to circumvent its purpose and intent, as set forth in
				  13.9.21.6 NMAC.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.13 - EXEMPTIONS

Current through Register Vol. 35, No. 13, July 16, 2024
This rule does not apply to the situations described in this
				  section:
A. Reinsurance of:
(1) policies that satisfy the criteria for
				exemption set forth in
				13.9.13.20 NMAC or
				13.9.13.21 NMAC and which are
				issued before the effective date of this regulation;
(2) portions of policies that satisfy the
				criteria for exemption set forth in
				13.9.21.19 NMAC and which are
				issued before the effective date of this regulation;
(3) any universal life policy that meets all
				of the following requirements:
(a) secondary
				guarantee period, if any, is five years or less;
(b) specified premium for the secondary
				guarantee period is not less than the net level reserve premium for the
				secondary guarantee period based on the Commissioners Standard Ordinary (CSO)
				valuation tables and valuation interest rate applicable to the issue year of
				the policy; and
(c) the initial
				surrender charge is not less than one hundred percent of the first year
				annualized specified premium for the secondary guarantee period.
(4) Credit life
				insurance;
(5) any variable life
				insurance policy that provides for life insurance, the amount or duration of
				which varies according to the investment experience of any separate account or
				accounts; or
(6) any group life
				insurance certificate unless the certificate provides for a stated or implied
				schedule of maximum gross premiums required in order to continue coverage in
				force for a period in excess of one year.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 9 - LIFE INSURANCE AND ANNUITIES › Part 21 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING › Section 13.9.21.14 - SEVERABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
If any provision of this regulation is held invalid, the
				  remainder shall not be affected.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to any person, insurer, health maintenance
				  organization, fraternal benefit society, nonprofit health care plan, New Mexico
				  comprehensive health insurance pool, or health insurance alliance, transacting
				  health insurance or providing health care services as defined herein, in this
				  state.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Authority for this rule derives from the superintendent's
				  powers under Sections 59A-2-9, 59A-16-4, 59A-16-5, 59A-16-18, 59A-16-20,
				  59A-18-14, 59A-22-34, 59A-22-36, 59A-23B-3, 59A-44-30, 59A-44-31, 59A-46-38,
				  59A-47-25, 59A-54-13, and 59A-56-7 NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 113.10.2.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule shall take effect March 1, 1996 [unless a later
				  date is cited at the end of a section].
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The objectives of this rule are to ensure that necessary
				  postpartum health care is provided to newly born children and their mothers in
				  the safest manner and at the earliest possible time, and to regulate trade
				  practices in the insurance business and related businesses by prohibiting
				  unfair or deceptive acts or practices.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. As used in this
				rule, the following terms have the meanings given in the cited section of the
				New Mexico Statutes Annotated 1978:
(1)
				Approved health plans, Section 59A-56-3(B) NMSA 1978;
(2) Fraternal benefit society, Section
				59A-44-1 NMSA 1978;
(3) Health
				insurance alliance, Section 59A-56-3(A) NMSA 1978;
(4) Health maintenance organization, Section
				59A-46-2(M) NMSA 1978;
(5) Insurer,
				Section 59A-1-8 NMSA 1978;
(6)
				Insurance Code, Section 59A-1-1 NMSA 1978;
(7) Superintendent, Section 59A-1-12 NMSA
				1978;
(8) Health facility, Section
				50-23-3(E) NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.15 - INCENTIVES OR PENALTIES PROHIBITED

Current through Register Vol. 35, No. 13, July 16, 2024
No person, insurer, health maintenance organization,
				  fraternal benefit society, nonprofit health care plan, New Mexico comprehensive
				  health insurance pool, or health insurance alliance, transacting health
				  insurance or providing health care services, as defined herein, in this state,
				  shall provide, directly or indirectly, any financial incentive or disincentive,
				  or grant or deny any special favor or advantage of any kind or nature
				  whatsoever, to any person to encourage or cause early discharge of a hospital
				  inpatient from postpartum care. Notwithstanding the above, this section does
				  not prohibit use of prospective payment systems including, but not limited to,
				  capitation and diagnostic related groupings, that are designed to promote
				  efficiency in appropriate health care delivery.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.16 - PENALTIES

Current through Register Vol. 35, No. 13, July 16, 2024
In addition to any other penalty provided by law or rule,
				  violation of the provisions of this rule is subject to penalties for violation
				  of the Insurance Code.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 2 - MOTHERS AND NEWLY BORN CHILDREN HEALTH SECURITY › Section 13.10.2.17 - SEVERABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
If any section of this rule, or the applicability of any
				  section to any person or circumstance, is for any reason held invalid by a
				  court, the remainder of the rule, or the applicability of such provisions to
				  other persons or circumstances, shall not be affected.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to every health insurer who offers or
				  issues a short-term plan to a resident of New Mexico.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Section
				  59A-23G-1 et seq.
				  NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.5 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
Establish regulatory requirements for short-term health
				  benefit plans. The rule will standardize and simplify the terms and coverages,
				  facilitate public understanding and comparison of coverage, and prohibit
				  provisions that may be misleading or confusing in connection with such
				  plans.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The definitions
				in Section
				59A-23G-2 NMSA 1978
				apply to this rule.
B. Unless
				inconsistent with a term defined in this rule, or the usage of a term in this
				rule, the definitions in 13.10.29 NMAC apply.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.8 - GENERAL REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Duration and non-renewability.
The term of a short-term plan shall
				not exceed three months and shall not be extendable or renewable. Continuation
				and conversion rights of short-term plan dependents extend only to the original
				termination date of the policy.
B.
When issuance prohibited.
A short-term plan shall not be issued to
				an individual, if that person was enrolled in any short-term plan that provided
				the same or similar coverage during the preceding 12 months.
C.
Guaranteed issue.
A
				short-term plan shall be guaranteed issue to eligible applicant's without
				regard to health status or any preexisting condition(s).
D.
Cancellation and rescission.
A short-term plan shall not be cancelled or rescinded except as provided
				herein:
(1) A short-term plan shall not be
				rescinded except in the case of intentional misrepresentation, concealment or
				fraud by the insured or covered person.
(2) A short-term plan shall not be canceled
				except:
(a) as the result of change to or
				implementation of federal or state laws that no longer permit the continued
				offering of the coverage; or
(b)
				due to the covered person's:
(i) nonpayment
				of premium;
(ii) violation of
				published policies of the carrier approved by the superintendent;
(iii) fraudulent acts or material
				misrepresentation; or
(iv) material
				breach of the terms of the plan.
(c) Nothing in this section shall be
				construed to provide a covered person with any benefits they would not
				otherwise be entitled to under a short-term plan.
(3) Notice required.
(a) When a short-term plan is cancelled for
				nonpayment of premium, the insurer shall notify the covered person in writing
				ten days prior to the cancellation date that the plan will be canceled, unless
				payment is made prior to the cancellation date.
(b) When cancellation or rescission is for
				any other authorized reason, the insurer shall notify the covered person in
				writing 20 days prior to the cancellation or rescission date, or the expiration
				date of the short-term plan, whichever occurs first. An insurer may provide
				less than 20 days notice only if the remaining duration of the plan is less
				than 20 days. In such case, notice shall be provided no later than 10 days
				prior to the cancellation or rescission date or the expiration date of the
				plan, whichever occurs first. The notice shall specifically state the reason(s)
				for the cancellation or rescission.
(c) A written notice required by this
				subsection shall be printed in 12 point or larger font, and phrased in simple
				language.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.9 - MANDATORY DISCLOSURES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Disclosure Required
. A short-term plan shall not be offered or
				issued without providing the prospective insured applicant a disclosure in the
				form and with the content specified in this section.
B.
Disclosure format.
The
				standard disclosure shall be displayed prominently in the plan and in the plan
				application, and shall also be delivered as a separate document to the
				applicant upon delivery of the application.
C.
Delivery of disclosure.
The
				applicant must sign an acknowledgement of receipt of the form.
(1) The carrier shall retain each
				acknowledged disclosure form for five years. Signed forms shall be available
				for review by the superintendent upon request.
(2) The standard disclosure form shall not be
				used until it has been filed with and approved in writing by the
				superintendent.
(3) The standard
				disclosure form shall include the following information and shall be presented
				on the first page of any application for coverage in 12-point or larger font
THIS IS SHORT-TERM, LIMITED DURATION HEALTH INSURANCE
				  COVERAGE. THIS PLAN ONLY LASTS FOR AND IS NONREWABLE. THIS COVERAGE IS
				  UNAVAILABLE TO ANY INDIVIDUAL WHO HAS BEEN INSURED BY A SHORT-TERM PLAN WITHIN
				  THE PREVIOUS TWELVE-MONTH PERIOD.
THIS PLAN MAY HAVE DOLLAR LIMITATIONS ON BENEFITS.
THIS COVERAGE DOES NOT COMPLY WITH ALL AFFORDABLE CARE ACT
				  REQUIREMENTS. TO SEE IF YOU QUALIFY FOR FINANCIAL ASSISTANCE AND ENROLL IN
				  AFFORDABLE CARE ACT COVERAGE VISIT
WWW.BEWELLNM.COM
. YOU MAY QUALIFY FOR A SPECIAL
				  ENROLLMENT PERIOD IF YOU HAVE RECENTLY LOST
				  COVERAGE.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.10 - COMPLIANCE FILING REQUIREMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Qualified health plan standard requirements.
A short-term plan is
				subject to the same rate, form, and compliance filings as qualified health
				plans.
B.
Network access
				plan.
An insurer who offers a short-term plan shall file a network
				access plan(s) in SERFF for review and approval by the superintendent annually
				on October 1.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.11 - PENALTIES

Current through Register Vol. 35, No. 13, July 16, 2024
In addition to any applicable suspension, revocation or
				  refusal to continue any certificate of authority or license under the Insurance
				  Code, the superintendent may impose a penalty for any violation of this rule in
				  accordance with Sections
				  59A-1-18 and
				  59A-46-25
				  NMSA 1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 3 - MINIMUM STANDARDS FOR SHORT-TERM PLANS › Section 13.10.3.12 - SEVERABILITY

Current through Register Vol. 35, No. 13, July 16, 2024
If any section of this rule, or the applicability of any
				  section to any person or circumstance, is for any reason held invalid by a
				  court of competent jurisdiction, the remainder of the rule, or the
				  applicability of such provisions to other person's or circumstances, shall not
				  be affected.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico State Corporation Commission [Public Regulation
				  Commission], Department of Insurance, Post Office Box 1269, Santa Fe, NM
				  87504-1269.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
A. This rule
				applies to any accident and health insurance policy advertisement which the
				insurer knows or reasonably should know is intended for presentation,
				distribution or dissemination in New Mexico when the presentation, distribution
				or dissemination is made either directly or indirectly by or on behalf of an
				insurer, agent, broker, producer or solicitor, as those terms are defined in
				the Insurance Code, Section 59A-1-1 NMSA 1978 et seq.
B. This rule also applies to the following
				insurance policies to the extent this rule is not in conflict with the
				specifically applicable rule:
(1) Medicare
				supplements (13 NMAC 10.8) [now 13.10.8 NMAC];
(2) Managed Health Care (13 NMAC 10.13) [now
				13.10.13 NMAC];
(3) Long-Term Care
				(13 NMAC 10.15) [now 10.13.15 NMAC]; and
(4) any other policy for which the Insurance
				Code rules require pre-approval of advertisements.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
July 1, 1997, unless a later date is cited at the end of a
				  section or paragraph.
Compiler's note: The words or paragraph, above, are no
					 longer applicable. Later dates are now cited only at the end of sections, in
					 the history notes appearing in
					 brackets.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.6 - OBJECTIVE

Current through Register Vol. 35, No. 13, July 16, 2024
The purpose of this rule is to protect prospective purchasers
				  with respect to the advertisement of accident and health insurance. The rule is
				  intended to assure the clear and truthful disclosure of the benefits,
				  limitations and exclusions of policies sold as accident and health insurance.
				  The rule establishes guidelines and permissible and impermissible standards of
				  conduct in the advertising of accident and health insurance in a manner which
				  prevents unfair, deceptive and misleading advertising and is conducive to
				  accurate presentation and description to the insurance-buying public through
				  the advertising media and material used by insurance agents and
				  companies.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
The following definitions apply for purposes of this
				  rule:
A.
"Accident and health
				insurance policy"
means any policy, plan, certificate, contract,
				agreement, statement of coverage, rider or endorsement which provides accident
				or health benefits, medical, surgical or hospital expense benefits, or dental
				or vision benefits, whether on an indemnity, reimbursement, service or prepaid
				basis, except when issued in connection with another kind of insurance other
				than life and except disability, waiver of premium, double indemnity or
				accelerated death benefits included in life insurance and annuity
				contracts.
B.
"Advertisement:"
(1)
				Advertisement means:
(a) printed and published
				material, audio visual material, and descriptive literature of an insurer used
				in direct mail, newspapers, magazines, radio scripts, TV scripts, billboards
				and similar displays;
(b)
				descriptive literature and sales aids of all kinds issued by an insurer, agent,
				producer, broker or solicitor for presentation to members of the
				insurance-buying public, including but not limited to circulars, leaflets,
				booklets, depictions, illustrations, form letters and lead-generating devices
				of all kinds as herein defined;
(c)
				prepared sales talks, presentations and material for use by agents, brokers,
				producers and solicitors whether prepared by the insurer or the agent, broker,
				producer or solicitor; and
(d)
				advertising material included with a policy when the policy is delivered and
				material used in the solicitation of renewals and reinstatements.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.8 - SYSTEM OF CONTROL AND IDENTIFICATION

Current through Register Vol. 35, No. 13, July 16, 2024
A. Every insurer shall establish and at all
				times maintain a system of control over the content, form and method of
				dissemination of all advertisements of its policies. All these advertisements,
				regardless of by whom written, created, designed or presented, shall be the
				responsibility of the insurer whose policies are so advertised.
B. Advertising materials which are reproduced
				in quantity shall be identified by form numbers or other identifying means.
				This identification shall be sufficient to distinguish an advertisement from
				any other advertising materials, policies, applications or other materials used
				by the insurer.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.9 - METHOD OF DISCLOSURE OF REQUIRED INFORMATION

Current through Register Vol. 35, No. 13, July 16, 2024
All information required to be disclosed by this rule shall
				  be set out conspicuously and in close conjunction with the statements to which
				  the information relates or under appropriate captions of sufficient prominence
				  that it shall not be minimized, rendered obscure or presented in an ambiguous
				  fashion or intermingled with the context of the advertisements so as to be
				  confusing or misleading.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.10 - FORM AND CONTENT OF ADVERTISEMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. The format and content of an advertisement
				of an accident or health insurance policy shall be sufficiently complete and
				clear to avoid deception or the capacity or tendency to mislead or deceive.
				Whether an advertisement has a capacity or tendency to mislead or deceive shall
				be determined by the superintendent from the overall impression that the
				advertisement may be reasonably expected to create upon a person of average
				education or intelligence, within the segment of the public to which it is
				directed.
B. Advertisements shall
				be truthful and not misleading in fact or in implication. Words or phrases, the
				meaning of which is clear only by implication or by familiarity with insurance
				terminology, shall not be used.
C.
				An insurer must clearly identify its accident and health insurance policy as an
				insurance policy. A policy trade name must be followed by the words "Insurance
				Policy" or similar words clearly identifying the fact that an insurance policy
				or health benefits product (in the case of health maintenance organizations,
				prepaid health plans and other direct service organizations) is being
				offered.
D. No insurer, agent,
				broker, producer, solicitor or other person shall solicit a resident of this
				state for the purchase of accident and health insurance in connection with or
				as the result of the use of advertisement by the person or any other persons,
				where the advertisement:
(1) contains any
				misleading representations or misrepresentations, or is otherwise untrue,
				deceptive or misleading with regard to the information imparted, the status,
				character or representative capacity of the person or the true purpose of the
				advertisement; or
(2) otherwise
				violates the provisions of this rule.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.12 - NECESSITY FOR DISCLOSING POLICY PROVISIONS RELATING TO RENEWABILITY, CANCELLABILITY AND TERMINATION

Current through Register Vol. 35, No. 13, July 16, 2024
An advertisement which is an invitation to contract shall
				  disclose the provisions relating to renewability, cancellability and
				  termination and any modification of benefits, losses covered, or premiums
				  because of age or for other reasons, in a manner which shall not minimize or
				  render obscure the qualifying conditions.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.13 - TESTIMONIALS OR ENDORSEMENTS BY THIRD PARTIES

Current through Register Vol. 35, No. 13, July 16, 2024
A. Testimonials and endorsements used in
				advertisements must be genuine, represent the current opinion of the author, be
				applicable to the policy advertised and be accurately reproduced. The insurer,
				in using a testimonial or endorsement, makes as its own all of the statements
				contained therein, and the advertisement, including the statement, is subject
				to all the provisions of these rules. When a testimonial or endorsement is used
				more than one year after it was originally given, a confirmation must be
				obtained.
B. A person shall be
				deemed a "spokesperson" if the person making the testimonial or endorsement:
(1) has a financial interest in the insurer
				or a related entity as a stockholder, director, officer, employee or
				otherwise;
(2) has been formed by
				the insurer, is owned or controlled by the insurer, its employees, or the
				person or persons who own or control the insurer;
(3) has any person in a policy-making
				position who is affiliated with the insurer in any of the above described
				capacities; or
(4) is in any way
				directly or indirectly compensated for making a testimonial or
				endorsement.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.14 - USE OF STATISTICS

Current through Register Vol. 35, No. 13, July 16, 2024
A. An
				advertisement relating to the dollar amounts of claims paid, the number of
				persons insured, or similar statistical information relating to any insurer or
				policy shall not use irrelevant facts, and shall not be used unless it
				accurately reflects all of the relevant facts. This type of advertisement shall
				not imply that the statistics are derived from the policy advertised unless
				that is the fact, and when applicable to other policies or plans shall
				specifically so state.
(1) An advertisement
				shall specifically identify the accident and health insurance policy to which
				statistics relate and where statistics are given which are applicable to a
				different policy, it must be stated clearly that the data do not relate to the
				policy being advertised.
(2) An
				advertisement using statistics which describe an insurer, such as assets and
				liabilities, corporate structure, financial standing, age, product lines or
				relative position in the insurance business, may be irrelevant and, if used at
				all, must be used with extreme caution because of the potential for misleading
				the public. As a specific example, an advertisement for accident and health
				insurance which refers to the amount of life insurance which the company has in
				force or the amounts paid out in life insurance benefits is not permissible
				unless the advertisement clearly indicates the amount paid out for each line of
				insurance.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.15 - IDENTIFICATION OF PLAN OR NUMBER OF POLICIES

Current through Register Vol. 35, No. 13, July 16, 2024
A. When a choice of the amount of benefits is
				referred to, an advertisement which is an invitation to contract shall disclose
				that the amount of benefits provided depends upon the plan selected and that
				the premium will vary with the amount of the benefits selected.
B. When an advertisement which is an
				invitation to contract refers to various benefits which may be contained in two
				or more policies, other than group master policies, the advertisement shall
				disclose that these benefits are provided only though a combination of the
				policies.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.16 - DISPARAGING COMPARISONS AND STATEMENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. An advertisement shall not directly or
				indirectly make unfair or incomplete comparisons of policies or benefits or
				comparisons of non-comparable policies of other insurers, and shall not
				disparage competitors, their policies, services or business methods, and shall
				not disparage or unfairly minimize competing methods of marketing
				insurance.
B. An advertisement
				shall not contain statements such as "no red tape" or "here is all you do to
				receive benefits."
C.
				Advertisements which state or imply that competing insurance coverages
				customarily contain certain exceptions, reductions or limitations not contained
				in the advertised policies are unacceptable unless the exceptions, reductions
				or limitations are contained in a substantial majority of the competing
				coverages.
D. Advertisements which
				state or imply that an insurer's premiums are lower or that its loss ratios are
				higher because its organizational structure differs from that of competing
				insurers are unacceptable.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.17 - JURISDICTIONAL LICENSING AND STATUS OF INSURER

Current through Register Vol. 35, No. 13, July 16, 2024
A. An advertisement which is intended to be
				seen or heard beyond the limits of the jurisdiction in which the insurer is
				licensed shall not imply licensing beyond those limits.
B. An advertisement shall not create the
				impression directly or indirectly that the insurer, its financial condition or
				status, or the payment of its claims, or the merits, desirability, or
				advisability of its policy forms or kinds or plans of insurance are approved,
				endorsed or accredited by any division or agency of this state or the United
				States government.
C. An
				advertisement shall not imply that approval, endorsement or accreditation of
				policy forms or advertising has been granted by any division or agency of the
				state or federal government. "Approval" of either policy forms or advertising
				shall not be used by an insurer to imply or state that a governmental agency
				has endorsed or recommended the insurer, its policies, advertising or its
				financial condition.
D.
				Advertisements must disclose that premium rates and forms have not been
				approved by the superintendent, if that is the fact.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.18 - IDENTITY OF INSURER

Current through Register Vol. 35, No. 13, July 16, 2024
A. The name of
				the actual insurer shall be stated in all of its advertisements. The form
				number or numbers of the policy advertised shall be stated in an advertisement
				which is an invitation to contract. An advertisement shall not use a trade
				name, any insurance group designation, name of the parent company of the
				insurer, name of a particular division of the insurer, service mark, slogan,
				symbol or other device which without disclosing the name of the actual insurer
				would have the capacity and tendency to mislead or deceive as to the true
				identity of the insurer.
B. No
				advertisement shall use any combination of words, symbols, or physical
				materials which by their content, phraseology, shape, color or other
				characteristics are so similar to combination of words, symbols or physical
				materials used by agencies of the federal government or of this state, or
				otherwise appear to be of a nature that it tends to confuse or mislead
				prospective insureds into believing that the solicitation is in some manner
				connected with an agency of the municipal, state or federal
				government.
C. Advertisements,
				envelopes or stationery which employ words, letters, initials, symbols or other
				devices which are so similar to those used in governmental agencies or by other
				insurers are not permitted if they may lead the public to believe:
(1) that the advertised coverages are somehow
				provided by or are endorsed by the governmental agencies or the other insurers;
				or
(2) that the advertiser is the
				same as, is connected with or is endorsed by the governmental agencies or the
				other insurers.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.19 - GROUP OR QUASI-GROUP IMPLICATIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A. An advertisement of a particular policy
				shall not state or imply that prospective insureds become group or quasi-group
				members covered under a group policy and as such enjoy special rates or
				underwriting privileges, unless that is the fact.
B. This rule prohibits the solicitations of a
				particular class, such as governmental employees, by use of advertisements
				which state or imply that their occupational status entitles them to reduced
				rates on a group or other basis when, in fact, the policy being advertised is
				sold only on an individual basis at regular rates.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.20 - INTRODUCTORY, INITIAL OR SPECIAL OFFERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. An advertisement of an individual policy
				shall not directly or by implication represent that:
(1) a contract or combination of contracts is
				an introductory, initial or special offer; or
(2) applicants will receive substantial
				advantages not available at a later date, or that the offer is available only
				to a specified group of individuals, unless that is the fact.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.21 - STATEMENTS ABOUT AN INSURER

Current through Register Vol. 35, No. 13, July 16, 2024
An advertisement shall not contain statements which are
				  untrue in fact, or by implication misleading, with respect to the assets,
				  corporate structure, financial standing, age or relative position of the
				  insurer in the insurance business. An advertisement shall not contain a
				  recommendation by any commercial rating system unless it clearly indicates the
				  purpose of the recommendation and the limitations of the scope and extent of
				  the recommendations.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.22 - ENFORCEMENT PROCEDURES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Advertising file:
Each insurer shall maintain at its home or
				principal office a complete file containing every printed, published or
				prepared advertisement of its individual policies and typical printed,
				published or prepared advertisements of its blanket, franchise and group
				policies hereafter disseminated in this or any other state, whether or not
				licensed in the other state, with a notation attached to each advertisement
				which shall indicate the manner and extent of distribution and the form number
				of any policy advertised. This file shall be subject to regular and periodical
				inspection by the department of insurance. All these advertisements shall be
				maintained in the file for a period of either five years or until the filing of
				the next regular report on examination of the insurer, whichever is the longer
				period of time.
B.
Certificate of compliance:
Each insurer required to file an annual
				statement which is now or which hereafter becomes subject to the provisions of
				this rule must file with the department of insurance, with its annual
				statement, a certificate of compliance executed by an authorized officer of the
				insurer wherein it is stated that, to the best of his or her knowledge,
				information and belief, the advertisements which were disseminated by the
				insurer during the preceding statement year complied or were made to comply in
				all respects with the provisions of this rule and the insurance laws of New
				Mexico as implemented and interpreted by this rule.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 4 - ADVERTISING ACCIDENT AND HEALTH INSURANCE › Section 13.10.4.23 - FILING FOR PRIOR REVIEW

Current through Register Vol. 35, No. 13, July 16, 2024
The superintendent may, in the superintendent's discretion,
				  require the filing with the department of insurance, for review prior to use,
				  of any accident and health insurance advertising material. This advertising
				  material must be filed by the insurer with the department of insurance not less
				  than thirty days prior to the date the insurer desires to use the
				  advertisement.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 5 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 13.10.5.1 - ISSUING AGENCY

Current through Register Vol. 35, No. 13, July 16, 2024
New Mexico State Corporation Commission [Public Regulation
				  Commission], Department of Insurance, Post Office Box 1269, Santa Fe, NM
				  87504-1269.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 5 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 13.10.5.2 - SCOPE

Current through Register Vol. 35, No. 13, July 16, 2024
This rule applies to all group insurance contracts provided
				  by an insurance company or a nonprofit health care plan and all group health
				  maintenance organization contracts issued for delivery in this state, renewed,
				  amended, or under which the level of benefits or premium is altered or
				  modified, covering persons as employees of employers or as members of unions or
				  associations.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 5 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 13.10.5.3 - STATUTORY AUTHORITY

Current through Register Vol. 35, No. 13, July 16, 2024
Sections 59A-18-16.1, 59A-46-30 and 59A-47-33 NMSA
				  1978.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 5 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 13.10.5.5 - EFFECTIVE DATE

Current through Register Vol. 35, No. 13, July 16, 2024
November 1, 1998, unless a later date is cited at the end of
				  a section or paragraph.
Compiler's note: The words or paragraph, above, are no
					 longer applicable. Later dates are now cited only at the end of sections, in
					 the history notes appearing in
					 brackets.
New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 5 - GROUP COVERAGE DISCONTINUANCE AND REPLACEMENT › Section 13.10.5.7 - DEFINITIONS

Current through Register Vol. 35, No. 13, July 16, 2024
As used in this rule:
A.
"accrued liability"
means
				liabilities established on the date an injury is sustained or an illness
				commences.
B.
"group
				contract"
means a contract for health or disability insurance or an HMO
				contract made with an employer or other entity that covers a group of persons,
				identified as individuals, because of their relationship to the covered
				entity.
C.
"HMO"
means
				health maintenance organization as defined in 59A-46-2 NMSA 1978.
D.
"prior carrier"
means the
				carrier of group coverage provided by the employer or other entity immediately
				prior to the effective date of discontinuance and which has or has not been
				replaced by a succeeding carrier's coverage plan.
E.
"succeeding carrier"
means
				the carrier of group coverage provided by an employer or other entity which is
				issued within ninety days after the discontinuance of the prior plan.
F.
"totally disabled"
means:
(1) for covered employees, the inability
				because of injury or disease to perform regular or customary occupational
				duties; and after benefits have been paid for twenty-four months, the inability
				to perform the duties of any gainful occupation for which the employee is
				reasonably fitted by training, education, or experience; or
(2) for dependents or retired employees, the
				inability because of injury or disease to engage in substantially all of the
				normal activities of a person in good health of like age and sex.