A.
Noncoordination of benefits Benefits under a plan shall:
(1) be provided under a separate plan,
certificate, or contract of insurance;
(2) have no coordination with the benefits
offered under a health plan; and
(3)
pay benefits regardless of any benefits provided under a health
plan.
B.
No
bundling No carrier, directly or through an affiliated producer, shall
market or sell a bundled combination of accident-only, specified disease,
hospital indemnity and non-subject worker plans. An application that is used in
connection with more than one type of plan subject to this rule shall include a
conspicuous notice that the applicant cannot purchase more than one type of
plan from the carrier using the same application. This provision does not
preclude the same carrier from selling more than one product type to a single
purchaser as long as each policy is available at its own stated premium rate,
independent of the other product types.
A carrier shall not offer or provide memberships or discounts
relating to health care services or products. The provisions of this subsection
shall not apply to a plan sold through a group identified in Paragraphs (1) or
(3) of Subsection A of 59A-23-3 NMSA 1978, or to a bona fide
association.
C.
Major
medical coverage requirement Accident-only, specified disease, hospital
indemnity and non-subject worker plans, excluding blanket coverage compliant
with Section
59A-23-2 NMSA 1978 and group
plans described in Paragraph (1) of Subsection A of 59A-23-3 NMSA 1978, shall
only be issued to persons who acknowledge that the plan is not major medical or
comprehensive health insurance. For purposes of this requirement, short-term,
limited-duration insurance shall not be considered major medical coverage.
(1) An application or enrollment form for a
plan subject to this subsection shall include an attestation by the applicant
affirming that the applicant understands that the individual is not purchasing
major medical insurance at the time of application. An application for a
hospital indemnity plan, or plan offering other fixed indemnity benefits, shall
also include any disclosure required by federal law. The attestation shall be
in writing and signed by the applicant before coverage becomes effective. The
carrier may retroactively apply coverage to the date of application.
(2) A sale of a plan subject to this
subsection is unauthorized if an applicant fails to sign or deliver the
attestation described in this rule.
(3) A carrier shall retain a copy of the
attestation for at least five years.
(4) If a carrier of a plan subject to this
subsection learns, directly or through an agent, that a covered person's major
medical coverage has lapsed or was canceled, the carrier shall send the person
the following notice:
YOUR MAJOR MEDICAL COVERAGE MAY HAVE RECENTLY LAPSED. YOUR
POLICY WITH [IDENTIFY COMPANY] IS NOT MAJOR MEDICAL HEALTH INSURANCE. THE
BENEFITS PROVIDED BY [IDENTIFY COMPANY] DO NOT 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, MEDICAID OR OTHER
MAJOR MEDICAL COVERAGE OPTIONS MAY BE AVAILABLE.
D.
Matrix forms The coverages
governed by this rule are subject to prohibitions on matrix forms as otherwise
specified in New Mexico law.
Notes
N.M. Admin.
Code §
13.10.34.20
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
