N.M. Admin. Code § 13.10.25.17 - OPEN ENROLLMENT
A.
Plan availability. An issuer shall not deny or condition the
issuance or effectiveness of any Medicare Supplement policy or certificate
available for sale in this state, nor discriminate in the pricing of a policy
or certificate because of the health status, claims experience, receipt of
health care, or medical condition of an applicant in the case of an application
for a policy or certificate that is submitted prior to or during the six month
period beginning with the first day of the first month in which an individual
is both 65 years of age or older and is enrolled for benefits under Medicare
Part B. Each Medicare Supplement policy and certificate currently available
from an insurer shall be made available to all applicants who qualify under
this subsection without regard to age.
B.
Period of creditable
coverage.
(1) If an applicant
qualifies under Subsection A of this section and submits an application during
the time period referenced in Subsection A and, as of the date of application,
has had a continuous period of creditable coverage of at least six months, the
issuer shall not exclude benefits based on a preexisting condition.
(2) If the applicant qualifies under
Subsection A of this section and submits an application during the time period
referenced in Subsection A and, as of the date of application, has had a
continuous period of creditable coverage that is less than six months, the
issuer shall reduce the period of any preexisting condition exclusion by the
aggregate of the period of creditable coverage applicable to the applicant as
of the enrollment date. The secretary shall specify the manner of the reduction
under this subsection.
C.
Exclusion of benefits. Except as provided in Subsection B of this
section and
13.10.25.18 NMAC and
13.10.25.29 NMAC, Subsection A of
this section shall not be construed as preventing the exclusion of benefits
under a policy, during the first six months, based on a preexisting condition
for which the policyholder or certificate holder received treatment or was
otherwise diagnosed during the six months before the coverage became
effective.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.