N.M. Admin. Code § 13.7.5.12 - CONTENT OF RECORD RELEASE AUTHORIZATION FORMS

Whenever a record release authorization form is used by an insurer or insurance support organization to obtain a protected person's authorization for the types of persons specified in the form to release records which may contain confidential abuse information about the protected person to the insurer or insurance support organization, the record release authorization form must:

A. be written in plain language;

B. be dated;

C. specify the types of persons authorized to release records which may contain confidential abuse information about the protected person;

D. name the insurer and identify by generic reference representatives of the insurer to whom the protected person is authorizing information to be released;

E. specify the purposes for which the released information is being collected;

F. specify the length of time such authorization shall remain valid, which shall be no longer than:

(1) in the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits:

(a) thirty (30) months from the date the authorization is signed if the application or request involves life, health or disability insurance;

(b) one (1) year from the date the authorization is signed if the application or request involves property or casualty insurance;

(2) in the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy:

(a) the term of coverage of the policy if the claim is for a health insurance benefit;

(b) the duration of the claim if the claim is not for a health insurance benefit.

G. advise the protected person that he or she is entitled to:

(1) receive a copy of the record release authorization form; [and]

(2) revoke the record release authorization in writing, r5effective ten days after receipt by the insurer, but that doing so may result in an application or claim being denied or may otherwise adversely affect a pending insurance action.

Notes

N.M. Admin. Code § 13.7.5.12

1/1/99; Recompiled 11/30/01