2018 New Mexico Statutes
Chapter 59A - Insurance Code
Article 22 - Health Insurance Contracts
Section 59A-22-3 - Required provisions.
A. Except as provided in Subsection B of this section, each such policy delivered or issued for delivery in this state shall contain the provisions specified in Sections 425 through 436 [59A-22-4 to 59A-22-15 NMSA 1978], inclusive, of this article; except, that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are in each instance not less favorable in any respect to the insured or beneficiary. Such required provisions shall be preceded individually by the applicable caption shown or, at the insurer's option, by such appropriate individual or group captions or subcaptions as the superintendent may approve.
B. If any provision of this article is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the superintendent's approval, shall omit from such policy any inapplicable provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
History: Laws 1984, ch. 127, § 424.
Cross references. — For existing forms and filings, see notes following 59A-5-21 NMSA 1978.
Ambiguous provision construed to favor insured. — The court's responsibility is to consider the intent of the parties as expressed in the policy, and where questions arise because of ambiguities, a liberal construction in favor of the insured is to be adopted. Couey v. National Benefit Life Ins. Co., 1967-NMSC-044, 77 N.M. 512, 424 P.2d 793.
Words given ordinary meaning. — In construing the language, the court must read terms and phrases in their usual and ordinary sense unless language of the policy requires something different. Couey v. National Benefit Life Ins. Co., 1967-NMSC-044, 77 N.M. 512, 424 P.2d 793.
No technical interpretation. — A strict technical or legalistic interpretation of the terms of the policy will not be accepted when it is fully within the power of the insurance company to affirmatively specify some meaning other than that understood by the average individual. Scott v. New Empire Ins. Co., 1965-NMSC-034, 75 N.M. 81, 400 P.2d 953.
Absent provision in policy defining "accidental means" as something different from that as understood by the general public, words, phrases or terms will be given their ordinary meaning. Scott v. New Empire Ins. Co., 1965-NMSC-034, 75 N.M. 81, 400 P.2d 953.
Limitations period permitted. — Pursuant to this section, a health insurance policy could contain a four-year limitations period, and 59A-22-14 NMSA 1978 would not bar an action filed within that four-year period. Willey v. United Mercantile Life Ins. Co., 1999-NMCA-137, 128 N.M. 98, 990 P.2d 211.
Am. Jur. 2d, A.L.R. and C.J.S. references. — 43 Am. Jur. 2d Insurance §§ 503 to 522.
45 C.J.S. Insurance §§ 886, 887; 46 C.J.S. Insurance § 1118 et seq.
