N.M. Admin. Code § 13.10.34.15 - SUPPLEMENTAL PLAN
A supplemental plan is subject to these additional requirements.
A.
Group coverage
limitation A carrier shall only offer or issue a supplemental plan to a
person who is covered under a primary group major medical, TRICARE or Champus
plan.
B.
Plan design A
supplemental plan must be specifically designed to fill gaps in the primary
coverage. This requirement is satisfied if the coverage is designed to fill
gaps in cost-sharing in the primary coverage, such as coinsurance or
deductibles, or the coverage is designed to provide benefits for items and
services not covered by the primary coverage and that are not essential health
benefits as defined under section 1302(b) of the Patient Protection and
Affordable Care Act in the New Mexico benchmark plan, or the coverage is
designed to both fill such gaps in cost-sharing under, and cover such benefits
not covered by, the primary coverage.
C.
No coordination A
supplemental plan shall not include a coordination-of-benefits provision but
may condition payment of benefits on the covered person becoming obligated to
pay a cost-sharing obligation under the primary coverage.
D.
Indemnity A supplemental plan
shall not offer fixed indemnity benefits.
E.
Filing requirement For each
supplemental plan filed with the superintendent, the carrier shall also file a
separate document specifically identifying any offered benefits that are not
covered by group major medical coverage and are not essential health
benefits.
F.
Exclusions A supplemental plan shall include a provision that
guarantees the plan will not impose an exclusion that does not appear in the
covered person's group major medical plan.
Notes
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