2018 New Mexico Statutes
Chapter 59A - Insurance Code
Article 24A - Medicare Supplements
Section 59A-24A-9 - Disclosure standards.
A. In order to provide for full and fair disclosure in the sale of medicare supplement policies or certificates, no medicare supplement policy or certificate shall be delivered or issued for delivery in this state unless an outline of coverage is delivered to the applicant at the time application is made.
B. The superintendent shall prescribe the format and content of the outline of coverage required by Subsection A of this section. For purposes of this section, "format" means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include:
(1) a description of the principal benefits and coverage provided in the policy or certificate;
(2) a statement that provides disclosure of any provision concerning automatic renewal premium increases based on the age of a policyholder;
(3) a statement of the renewal provisions, including any reservation by the issuer of a right to change premiums; and
(4) a statement that the outline of coverage is a summary of the policy or certificate issued or applied for and that the policy or certificate should be consulted to determine governing contractual provisions.
C. The superintendent may prescribe by regulation a standard form and content of an informational brochure for persons eligible for medicare that is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies or certificates, the superintendent may require by regulation that the informational brochure be provided to any prospective insured eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies or certificates, the superintendent may require by regulation that the prescribed brochure be provided upon request to any prospective insured eligible for medicare, but the brochure shall be provided no later than the time the policy or certificate is delivered.
D. The superintendent may adopt regulations for captions or notice requirements determined to be in the public interest and designed to inform a prospective insured that particular insurance coverages are not medicare supplement coverages for all health insurance policies sold to persons eligible for medicare by reason of age. The regulations shall not apply to the following policies:
(1) medicare supplement;
(2) disability income;
(3) basic, catastrophic or major medical expense; or
(4) single, premium or nonrenewable.
E. The superintendent may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of health policies or certificates by persons eligible for medicare.
History: Laws 1989, ch. 28, § 9; 1992, ch. 3, § 7.
The 1992 amendment, effective March 2, 1992, deleted "contracts" or "subscriber contracts" following "policies" and deleted "by reason of age" following "medicare" several times throughout the section; rewrote Subsection B(2), which formerly read: "a statement of the exceptions, reductions and limitations contained in the policy, contract or certificate"; substituted "issuer" for "insurer" in Subsection B(3); substituted "informational" for "information" in the second sentence in Subsection C; and rewrote the first sentence in Subsection D.
