New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 15 - LONG-TERM CARE INSURANCE › Section 13.10.15.19 - REQUIRED DISCLOSURE PROVISIONS

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Renewability.
Individual
				long-term care insurance policies shall contain a renewability provision. Such
				provision shall be appropriately captioned, shall appear on the first page of
				the policy, and shall clearly state that the coverage is guaranteed renewable
				or noncancellable. This provision shall not apply to policies which do not
				contain a renewability provision, and under which the right to non-renew is
				reserved solely to the policyholder. A long-term care insurance policy or
				certificate, other than the one where the insured does not have the right to
				change premium, shall include a statement that premium rates may
				change.
B.
Riders and
				endorsements.
Except for riders or endorsements by which the insurer
				effectuates a request made in writing by the insured under an individual
				long-term care insurance policy, all riders or endorsements added to an
				individual long-term care insurance policy after date of issue or at
				reinstatement or renewal which reduce or eliminate benefits or coverage in the
				policy shall require signed acceptance by the individual insured. After the
				date of policy issue, any rider or endorsement which increases benefits or
				coverage with a concomitant increase in premium during the policy term must be
				agreed to in writing signed by the insured, except if the increased benefits or
				coverage are required by law. Where a separate additional premium is charged
				for benefits provided in connection with riders or endorsements, such premium
				charge shall be set forth in the policy, rider or endorsement.
C.
Payment of benefits.
A
				long-term care insurance policy which provides for the payment of benefits
				based on standards described as usual and customary, reasonable and customary
				or words of similar import shall include a definition of such terms and an
				explanation of such terms in its accompanying outline of coverage.
D.
Limitations.
If a long-term
				care insurance policy or certificate contains any limitations with respect to
				preexisting conditions, such limitations shall appear as a separate paragraph
				of the policy or certificate and shall be labeled as Preexisting Condition
				Limitations.
E.
Other
				limitations or conditions on eligibility for benefits.
A long-term care
				insurance policy or certificate containing any limitations or conditions for
				eligibility other than those prohibited in Paragraphs (6) and (7) of Section
				59A-23A-6C NMSA 1978 shall set forth a description of such limitations or
				conditions, including any required number of days of confinement, in a separate
				paragraph of the policy or certificate and shall label such paragraph
				Limitations or Conditions on Eligibility for Benefits.
F.
Disclosure of tax
				consequences.
With regard to life insurance policies which provide an
				accelerated benefit for long-term care, a disclosure statement is required at
				the time of application for the policy or rider and at the time the accelerated
				benefit payment request is submitted that receipt of these accelerated benefits
				may be taxable, and that assistance should be sought from a personal tax
				advisor. The disclosure statement shall be prominently displayed on the first
				page of the policy or rider and any other related documents.