New Mexico Administrative Code

A. The initial premium charged an insured covered by a long-term care policy shall not increase during the initial three (3) years in which the policy is in force. B. The premium charged to an insured shall not increase due to either: (1) the increasing age of the insured at ages…

Each insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: A. Designation of person to receive notice. (1) No individual long-term care policy or certificate shall be issued until the insurer has received from the…

In addition to the requirement in 13.10.15.17 NMAC, a long-term care insurance policy or certificate shall include a provision which provides for reinstatement of coverage in the event of lapse if the insurer is provided proof that the policy holder or certificate holder became c…

A. Renewability. Individual long-term care insurance policies shall contain a renewability provision. Such provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the coverage is guaranteed renewable or noncancellable…

This rule applies to all long-term care insurance policies and life insurance policies that accelerate benefits for long-term care delivered or issued for delivery in this state on or after January 1, 1999 by insurers; fraternal benefit societies; nonprofit health, hospital and m…

A. This section shall apply as follows: (1) Except as provided in Paragraph (2) of this subsection, this section applies to any long-term care policy or certificate issued in this state on or after January 1, 2004. (2) For certificates issued on or after the effective date of thi…

A. This section applies to any long-term care policy issued in this state on or after January 1, 2004. B. An insurer shall provide the information listed in this subsection to the superintendent along with the form and rate filing required by law. (1) A copy of the disclosure doc…

A. All applications for long-term care insurance policies or certificates, except those which are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant. (1) If an application for long-term care insurance contai…

A. A long-term care insurance policy or certificate shall not, if it provides benefits for home health care or community care services, limit or exclude benefits by: (1) requiring that the insured/claimant would need care in a skilled nursing facility if home health care services…

A. No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations …

A. Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or certificate is inten…

Upon determining that a sale will involve replacement, an insurer, other than an insurer using direct response solicitation methods, or its agent, shall furnish the applicant, prior to issuance or delivery of the individual long-term care insurance policy, a notice regarding repl…

Insurers using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy. The required notice shall be provided in the following manner: NOTICE TO APPLICANT RE…

For purposes of this section, policy means only long-term care insurance and report means on a statewide basis. A. Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agents total annual sales and the amount of lapse…

No agent is authorized to market, sell, solicit or otherwise contact any person for the purpose of marketing long-term care insurance unless the agent has demonstrated his or her knowledge of long-term care insurance and the appropriateness of such insurance by passing a test req…

Sections 59A-2-9, 59A-23A-6 and 59A-23A-9 NMSA 1978.

The Superintendent may, upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision of this rule with respect to a specific long-term care insurance policy or certificate upon a written finding that: A. The modification or su…

A. When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for such benefits shall be determined in accordance with Section 59A-8-5 NMSA 1978. Claim reserves must also be es…

This section does not apply to policies or certificates providing nonforfeiture benefits in accordance with Subsection C of 13.10.15.43 NMAC based on acceptance of the offer of non-forfeiture benefits required by Subsection A of 13.10.15.43 NMAC. This section shall not apply to l…

A. This section shall apply as follows: (1) Except as provided in paragraph (2), this section applies to any long-term care policy or certificate issued in this state on or after January 1, 2004. (2) For certificates issued on or after the effective date of this amended rule unde…

A. An insurer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the superintendent in accordance with filing requirements and procedures prescribed in Chapter …

Issuers of a life insurance policy that funds long-term care benefits entirely by accelerating the death benefit are exempted from 13.10.15.32 NMAC if they provide to the Superintendent: A. a statement that the interest credited to determine cash value accumulations, including lo…

A. Every issuer shall provide a copy of any long-term care insurance advertisement intended for use in this state whether through written, radio or television medium to the Superintendent for review or approval by the Superintendent as required under Section 59A-23A-11 NMSA 1978.…

Every insurer, health care service plan or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: A. establish marketing procedures and agent training requirements to assure that: (1) any marketing activities, including a…

In addition to the practices prohibited in Chapter 59A, Article 16 NMSA 1978, the following acts and practices are prohibited A. Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose o…

A. The primary responsibility of an association endorsing or selling long-term care insurance shall be to educate its members concerning long-term care issues in general so that its members can make informed decisions. Associations shall provide objective information regarding lo…

Permanent.

This section shall not apply to life insurance policies that accelerate benefits for long-term care. A. Every issuer shall: (1) develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the a…

A. To determine whether the applicant meets the standards developed by the issuer, the agent and issuer shall develop procedures that take the following into consideration: (1) the ability to pay for the proposed coverage and other pertinent financial information related to the p…

If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy for similar benefits to the…

This section does not apply to life insurance policies or riders containing accelerated long-term care benefits. A. Offer required. No policy or certificate may be delivered or issued for delivery in this state unless a policy or certificate providing for nonforfeiture benefits t…

The requirements of this section apply to all long-term care insurance policies issued on or after January 1, 1999. A. A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and o…

A. The outline of coverage shall be a free-standing document, using no smaller than ten point type. B. The outline of coverage shall contain no material of an advertising nature. C. Text which is capitalized or underscored in the standard format for outline of coverage provided i…

[Company Name] [Address City & State] [Telephone Number] LONG-TERM CARE INSURANCE OUTLINE OF COVERAGE [Policy Number or Group Master Policy and Certificate Number] [Except for policies or certificates which are guaranteed issue, the following caution statement, or language substa…

A. A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Superintendent, shall be provided to all prospective applicants of a long-term care insurance policy or certificat…

In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to thre…

RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATE OF NEW MEXICO FOR THE REPORTING YEAR [ ] Company Name:______________________________________ Address: ____________________________________________ ____________________________________________ Phone Number:_______…

January 1, 1999, unless a later date is cited at the end of a section.

LONG TERM CARE INSURANCE PERSONAL WORKSHEET People buy long-term care insurance for a variety of reasons. These reasons include to avoid spending assets for long-term care, to make sure there are choices regarding the type of care received, to protect family members from having t…

THINGS YOU SHOULD KNOW BEFORE YOU BUY: LONG-TERM CARE INSURANCE Long-term Care Insurance A long-term care insurance policy may pay most of the costs for your care in a nursing home. Many policies also pay for care at home or other community settings. Since policies can vary in co…

LONG-TERM CARE INSURANCE SUITABILITY LETTER Dear [Applicant] Your recent application for long-term care insurance included a personal worksheet which asked questions about your finances and your reasons for buying long-term care insurance. For your protection, state law requires …

POTENTIAL RATE INCREASE DISCLOSURE FORM Instructions: This form provides information to the applicant regarding premium rate schedules, rate schedule adjustments, potential rate revisions, and policyholder options in the event of a rate increase. Insurer shall provide all of the …

The purpose of this rule is to implement Chapter 59A, Article 23A NMSA 1978 to promote the public interest and the availability of long-term care insurance coverage, and to facilitate flexibility and innovation in the development of long-term care insurance.

In additon to the definitions in Section 59A-23A-4 NMSA 1978, the following terms have the meanings given here. A. "Basis for continuation of coverage" means a policy provision which maintains coverage under the existing group policy when such coverage would otherwise terminate a…

No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements. A. Activities of daily living means at least bathing, continen…

The terms guaranteed renewable and noncancelable shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of 13.10.15.20 NMAC. A. No policy issued to an individual shall contain renewal…

Office of Superintendent of Insurance ("OSI").

At the request of a provider, the superintendent shall conduct an external review of a provider grievance as authorized by this section. A. Types of grievances subject to appeal. The superintendent shall only review a provider grievance that pertains to:(1) an alleged violation o…

No person shall be subject to retaliatory action by a carrier for submitting or supporting a grievance or appeal.

A carrier's provider manual shall include a clear statement of a provider's right to grieve, the internal grievance process, the right of appeal and the appeal process. The carrier shall publish its provider grievance plan on a website accessible to any provider.