A.
General notice requirement An application for an individual plan
or plan sold through an association or group described in Paragraphs (2) or (4)
of Subsection A of 59A-23-3 NMSA 1978, other than a disability income plan,
shall contain in bold, 14-point type, directly above the applicant signature
line the following notice:
NOTICE TO BUYER: PLEASE REVIEW THIS PLAN CAREFULLY. IT ONLY
PROVIDES LIMITED BENEFITS, AND IT DOES NOT ON ITS OWN OR IN COMBINATION WITH
OTHER LIMITED BENEFITS POLICIES CONSTITUTE MAJOR MEDICAL INSURANCE. BENEFITS
PROVIDED ARE SUPPLEMENTAL AND ARE NOT INTENDED TO COVER ALL MEDICAL
EXPENSES.
TO LEARN IF YOU ARE ELIGIBLE FOR A MAJOR MEDICAL PLAN, PLEASE
VISIT [WWW.BEWELLNM.COM] OR CALL
[1-833-862-3935]. PREMIUM DISCOUNTS, FINANCIAL ASSISTANCE, OR OTHER MAJOR
MEDICAL COVERAGE OPTIONS MAY BE AVAILABLE.
B.
Renewal provision A plan
shall include a renewal, continuation or nonrenewal provision. The language or
specification of the provision shall be consistent with the type of plan to be
issued. The provision shall be appropriately captioned, shall appear on the
first page of the plan, and shall clearly state the duration of coverage and
renewal terms.
C.
Riders A rider, endorsement, or supplement added to a plan after
its effective date that reduces or eliminates benefits or coverage shall not be
effective unless signed by the covered person. Signature may include electronic
signature or voice signature, however, this signature must be recorded by the
carrier and time-stamped. This signature requirement does not apply to
certificates issued to covered persons in a group plan. A signature shall not
be required if the rider, endorsement or supplement reflects a change to the
plan that is required by law.
D.
Additional premium for riders, endorsements or supplement If an
additional premium is charged for benefits specified in a rider, endorsement or
supplement, the plan or certificate shall specify the premium.
E.
Preexisting conditions If a
plan includes any preexisting condition exclusion or limitation, the plan or
certificate shall include a separate section labeled "Preexisting Conditions,
Exclusions and Limitations."
F.
Right of return/Free look. A plan shall include a prominent
notice, printed on or attached to the first page of the plan, stating that the
covered person has the right to return the plan, and cancel any associated
voluntary group membership enrolled in contemporaneous with the plan
enrollment, within 30 days of its delivery, and to have the premium and
membership fees refunded in full if the covered person is not satisfied for any
reason.
G.
Age factors
If age is a factor that reduces aggregate benefits, that factor shall be
prominently set forth in the outline of coverage.
H.
Conversion privilege If a
plan includes a conversion privilege, the provision shall be captioned,
"Conversion Privilege." The provision shall specify who is eligible for
conversion and the circumstances that govern conversion, or may state that the
conversion coverage will be as provided in an approved plan form used by the
carrier for that purpose.
I.
Medicare supplement notice
(1)
The outline of coverage delivered with an accident-only, specified disease,
hospital indemnity, supplemental or non-subject plan shall contain the
following notice in bold 14-point type:
THIS IS NOT A MEDICARE SUPPLEMENT PLAN. IF YOU ARE ELIGIBLE
FOR MEDICARE, ASK FOR INFORMATION ABOUT MEDICARE SUPPLEMENT
POLICIES.
(2) A carrier
shall deliver to persons eligible for Medicare any notice required under
13.10.25 NMAC.
J.
Outline of coverage requirements Each subject plan and certificate
shall include the outline of coverage that provides a basic overview of the
plan's purpose, benefits, coverage minimums and maximums.
(1) The outline of coverage shall include the
following notice, printed in bold 14-point type:
READ YOUR PLAN CAREFULLY - THIS OUTLINE OF COVERAGE PROVIDES
A VERY BRIEF DESCRIPTION OF THE IMPORTANT FEATURES OF YOUR COVERAGE. THIS IS
NOT THE INSURANCE CONTRACT AND ONLY THE ACTUAL PLAN PROVISIONS WILL DETERMINE
THE TERMS OF COVERAGE. THE PLAN ITSELF SETS FORTH IN DETAIL THE RIGHTS AND
OBLIGATIONS OF BOTH YOU AND YOUR INSURANCE COMPANY. IT IS, THEREFORE, IMPORTANT
THAT YOU READ YOUR PLAN CAREFULLY!
(2) The outline of coverage shall provide
contact information for the OSI consumer assistance bureau.
K.
Delivery of plan documents A
carrier shall not bind coverage for any subject plan without delivering all
plan documents to a prospective insured and allowing the prospective insured 30
calendar days to review those materials. Nothing in this subsection precludes a
carrier from making coverage retroactive to the date that the plan documents
were delivered to the prospective insured. The carrier shall maintain proof of
compliance with this requirement for each sale for five years from the coverage
effective date. For a group plan, either the carrier or the group master
policyholder may satisfy the delivery requirement, but the carrier shall remain
responsible for any failure to do so by the master policyholder. In the case
where the group master policyholder delivers the plan documents to the
prospective policyholders, the carrier shall require the group master
policyholder to attest to the compliance with the requirements of this section
and to provide documents that clearly support the attestation. The carrier
shall not bind coverage until it has received the master policyholder's
attestation.
Notes
N.M. Admin.
Code §
13.10.34.18
Adopted by
New
Mexico Register, Volume XXXI, Issue 18, September 29, 2020, eff.
10/1/2020, Amended
by
New
Mexico Register, Volume XXXIII, Issue 15, August 9, 2022, eff.
7/1/2023
