2018 New Mexico Statutes
Chapter 59A - Insurance Code
Article 24A - Medicare Supplements
Section 59A-24A-4 - Standards for policy provisions; authority to promulgate regulations.

A. No medicare supplement policy or certificate, in force in this state, shall contain benefits that duplicate benefits provided by medicare.

B. Notwithstanding any other provisions of law of this state, a medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.

C. The superintendent shall adopt reasonable regulations to establish specific standards for policy provisions contained in medicare supplement policies and certificates. Such standards shall be in addition to and in accordance with applicable laws of this state, except as those laws are modified by the provisions of the Medicare Supplement Act. No requirement of the Insurance Code relating to minimum required policy benefits, other than the minimum standards contained in the Medicare Supplement Act, shall apply to medicare supplement policies and certificates. The standards may cover, but are not limited to:

(1) terms of renewability;

(2) initial and subsequent conditions of eligibility;

(3) nonduplication of coverage;

(4) probationary periods;

(5) benefit limitations, exceptions and reductions;

(6) elimination periods;

(7) requirements for replacement;

(8) recurrent conditions; and

(9) definitions of terms.

D. The superintendent shall adopt reasonable regulations to establish minimum standards for benefits and claims payment, marketing practices, compensation arrangements and reporting practices for medicare supplement policies and certificates.

E. The superintendent may adopt reasonable regulations necessary to conform medicare supplement policies and certificates to the requirements of federal law. The regulations may, but are not limited to:

(1) require refunds or credits if policies or certificates do not meet loss ratio requirements;

(2) establish a uniform methodology for calculating and reporting loss ratios;

(3) assure public access to information in the possession of issuers concerning policies, premiums and loss ratios;

(4) establish an approval process for policy forms, certificate forms and proposed premium increases;

(5) establish procedures for conducting public hearings prior to granting approval to proposed premium increases; and

(6) establish standards for medicare select policies and certificates if the state is authorized to operate as a medicare select state.

F. The superintendent may adopt reasonable regulations that specify prohibited policy or certificate provisions not otherwise specifically authorized by statute that, in the opinion of the superintendent, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a medicare supplement policy or certificate.

History: Laws 1989, ch. 28, § 4; 1990, ch. 110, § 4; 1992, ch. 3, § 4.

Cross references. — For the Insurance Code, see 59A-1-1 NMSA 1978 and notes thereto.

The 1992 amendment, effective March 2, 1992, substituted "policy or certificate" for "insurance policy, subscriber contract or certificate" in Subsection A; added present Subsection B; redesignated former Subsection B as Subsection C; in Subsection C, substituted "adopt" for "issue", inserted "policy", and deleted ", subscriber contracts" following "policies" in the first sentence, and substituted "policies and certificates" for "policies, subscriber contracts or certificates" in the third sentence; added Subsections D and E; redesignated former Subsection C as Subsection F; and, in Subsection F, substituted "adopt" for "issue" and deleted ", subscriber contract" following "policy" near the beginning of the subsection, substituted "that" for "which" near the middle of the subsection, and substituted all of the present language following "proposed" for "for coverage under a medicare supplement policy, subscriber contract or certificate"; and deleted former Subsections D and E, relating to preexisting conditions and to inclusion of applicable standard provisions in policies.