N.M. Admin. Code § 13.19.4.16 - ACCOUNTING STANDARDS AND REPORTING REQUIREMENTS
A.
Annual statement required.
Each self-funded MEWA transacting business in this state shall file annually
with the superintendent statements and reports in compliance with 13.2.5 NMAC.
Additionally, each annual statement shall be filed:
(1) by June 1st of each year, financial
statements audited by a certified public accountant; and
(2) by March 1st of each year, an actuarial
opinion prepared and certified by an actuary who is not an employee of the
self-funded MEWA and who is a fellow of the society of actuaries, a member of
the American academy of actuaries, or an enrolled actuary under the Employee
Retirement Income Security Act of 1974 (29 United
States Code §§
1241 and
1242).
The actuarial opinion shall include:
(a) a
description of the actuarial soundness of the self-funded MEWA, including any
recommended actions that the self-funded MEWA should take to improve its
actuarial soundness:
(b) the
recommended amount of cash reserves the self-funded MEWA should maintain, which
shall not be less than the greater of twenty percent of the total contributions
in the preceding plan year or twenty percent of the total estimated
contributions for the current plan year:
(c) a calculation of cash reserves with
proper actuarial regard for known claims, paid and outstanding, a history of
incurred but not reported claims, claims handling expenses, unearned premiums,
an estimate for bad debts, a trend factor, and a margin for error;
and
(d) the recommended level of
specific and aggregate stop-loss insurance the MEWA arrangement should
maintain.
B.
Renewal contingent upon compliance. The superintendent shall
review the statements and reports required by Subsection A of this section.
Renewal of a self-funded MEWA registration is contingent upon the
superintendent finding that the self-funded MEWA meets the requirements of
Subsection B of
13.19.4.12 NMAC.
C.
Order for actuarial review.
On a finding of good cause, the superintendent may order an actuarial review of
a self-funded MEWA in addition to the actuarial opinion required by this
section. The cost of any such additional actuarial review shall be paid by the
self-funded MEWA.
D.
Quarterly reports. A self-funded MEWA shall file quarterly
financial reports. Quarterly reports shall contain statements for each health
benefits plan offered by the self-funded MEWA pursuant to NAIC standards set
forth in Model Law 430 Section 25 and Section 26.
E.
Examination timeline. The
superintendent shall examine the affairs and conduct of a self-funded MEWA at
least once every three years in the same manner that applies to domestic and
foreign insurers with a certificate of authority to transact insurance in New
Mexico. Expenses of examination shall be paid by each MEWA, or its insurers,
pursuant to Section
59A-4-14 NMSA 1978.
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.