New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 25 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 13.10.25.32 - APPENDICES

Current through Register Vol. 35, No. 13, July 16, 2024
A.
Appendix A
				- medicare supplement refund calculation form.
For the required
Medicare Supplement Refund Calculation
Form for each calendar
				year, use the form so named and instructions provided in Appendix A of the
Model Regulation To Implement the NAIC Medicare Supplement Insurance
				Minimum Standards Model Act - NAIC Model #651
, as adopted in 2017,
				except that on line 7, in place of "(see worksheet for Ratio 1)" use
				"(sixty-five percent for Individual, seventy-five percent for
				Group)".
B.
Appendix B - form
				for reporting medicare supplement policies.
Use the
Form For
				Reporting Medicare Supplement Policies
provided in Appendix B of the
Model Regulation To Implement the NAIC Medicare Supplement Insurance
				Minimum Standards Model Act - NAIC Model #651
, as adopted in
				2017.
C.
Appendix C -
				disclosure statements.
(1)
				Instructions for use of the disclosure statements for health insurance policies
				sold to Medicare beneficiaries that duplicate Medicare.
(a) Section 1882 (d) of the federal Social
				Security Act prohibits the sale of a health insurance policy (the term policy
				includes certificate) to Medicare beneficiaries that duplicates Medicare
				benefits unless it will pay benefits without regard to a beneficiary's other
				health coverage and it includes the prescribed disclosure statement on or
				together with the application for the policy.
(b) All types of health insurance policies
				that duplicate Medicare shall include one of the attached disclosure
				statements, according to the particular policy type involved, on the
				application or together with the application. The disclosure statement may not
				vary from the attached statements in terms of language or format (type size,
				type proportional spacing, bold character, line spacing, and usage of boxes
				around text).
(c) State and federal
				law prohibits insurers from selling a Medicare Supplement policy to a person
				that already has a Medicare Supplement policy except as a replacement
				policy.
(d) Property/casualty and
				life insurance policies are not considered health insurance.
(e) Disability income policies are not
				considered to provide benefits that duplicate Medicare.
(f) Long-term care insurance policies that
				coordinate with Medicare and other health insurance are not considered to
				provide benefits that duplicate Medicare.
(g) The federal law does not preempt state
				laws that are more stringent than the federal requirements.
(h) The federal law does not preempt existing
				state form filing requirements.
(i)
				Section 1882 of the federal Social Security Act was amended in Subsection
				(d)(3)(A) to allow for alternative disclosure statements. The disclosure
				statements already in Appendix C remain. Carriers may use either disclosure
				statement with the requisite insurance product. However, carriers should use
				either the original disclosure statements or the alternative disclosure
				statements and not use both simultaneously.