New Mexico Administrative Code

A. An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond those limits. B. An advertisement shall not create the impression directly or indirectly that the insurer, its financi…

A. The name of the actual insurer shall be stated in all of its advertisements. The form number or numbers of the policy advertised shall be stated in an advertisement which is an invitation to contract. An advertisement shall not use a trade name, any insurance group designation…

A. An advertisement of a particular policy shall not state or imply that prospective insureds become group or quasi-group members covered under a group policy and as such enjoy special rates or underwriting privileges, unless that is the fact. B. This rule prohibits the solicitat…

A. This rule applies to any accident and health insurance policy advertisement which the insurer knows or reasonably should know is intended for presentation, distribution or dissemination in New Mexico when the presentation, distribution or dissemination is made either directly …

A. An advertisement of an individual policy shall not directly or by implication represent that: (1) a contract or combination of contracts is an introductory, initial or special offer; or (2) applicants will receive substantial advantages not available at a later date, or that t…

An advertisement shall not contain statements which are untrue in fact, or by implication misleading, with respect to the assets, corporate structure, financial standing, age or relative position of the insurer in the insurance business. An advertisement shall not contain a recom…

A. Advertising file: Each insurer shall maintain at its home or principal office a complete file containing every printed, published or prepared advertisement of its individual policies and typical printed, published or prepared advertisements of its blanket, franchise and group …

The superintendent may, in the superintendent's discretion, require the filing with the department of insurance, for review prior to use, of any accident and health insurance advertising material. This advertising material must be filed by the insurer with the department of insur…

Sections 59A-2-9 NMSA 1978.

Permanent.

July 1, 1997, unless a later date is cited at the end of a section or paragraph.

The purpose of this rule is to protect prospective purchasers with respect to the advertisement of accident and health insurance. The rule is intended to assure the clear and truthful disclosure of the benefits, limitations and exclusions of policies sold as accident and health i…

The following definitions apply for purposes of this rule: A. "Accident and health insurance policy" means any policy, plan, certificate, contract, agreement, statement of coverage, rider or endorsement which provides accident or health benefits, medical, surgical or hospital exp…

A. Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its policies. All these advertisements, regardless of by whom written, created, designed or presented, shall be the responsib…

All information required to be disclosed by this rule shall be set out conspicuously and in close conjunction with the statements to which the information relates or under appropriate captions of sufficient prominence that it shall not be minimized, rendered obscure or presented …

Office of Superintendent of Insurance.

The office of superintendent shall, by January 31 of each calendar year, make publicly available on their website, a comprehensive list of all health insurers and group health plans that: A. maintained compliance with the VPA in the preceding year; B. failed to comply with report…

A. Expenditures. Money in the fund shall be expended only for the purposes specified in the VPA, by warrant issued by the secretary of finance and administration pursuant to vouchers approved by the secretary of health. B. Audit. The fund shall be audited in the same manner as ot…

Any person aggrieved by any action, threatened action, or failure to act by the office of superintendent shall have the same right to a hearing before the office of superintendent with respect thereto as provided for in general under Chapter 59A, Article 4 NMSA 1978 and the imple…

These rules apply to every "health insurer" and "group health plan," as defined in the Vaccine Purchasing Act (VPA), providing coverage to residents of New Mexico, regardless of location of the policy, and are therefore subject to compliance obligations under Sections 24-5A-1 thr…

This rule is issued pursuant to the State Rules Act, Sections 14-4-1 et seq. NMSA 1978, Sections 24-5A-6, 24-5A-7, 24-5A-8 NMSA 1978 of the Vaccine Purchasing Act, and Section 59A-2-9 NMSA 1978.

Permanent.

May 6, 2025, unless a later date is cited at the end of a section.

To establish procedures to implement and enforce the provisions of the VPA.

The following definitions apply to this rule and to the implementation of this rule only: A. "advisory committee or immunization practices" has the same meaning as defined in Subsection A of Section 24-5A-2 NMSA 1978; B. "billing cycle" means: Billing Cycle Department's Invoices …

As directed in these rules, every health insurer and group health plan shall annually report to the office of superintendent the number of insured children who are residents of New Mexico under each policy and plan, who were under the age of 19 as of the previous December 31 even…

A. Billing and initial review of invoices shall be conducted by the department pursuant to the VPA and to 7.5.4.13 NMAC. B. Referral. The department shall refer to the office of superintendent any health insurer or group health plan that has failed to fully reimburse the departme…

New Mexico State Corporation Commission [Public Regulation Commission], Department of Insurance, Post Office Box 1269, Santa Fe, NM 87504-1269.

Every group contract must include a provision for reasonable extension of benefits in the event of total disability on the date of discontinuance of the group contract, as required by this section. A. In the case of a group life plan which contains a disability benefit extension …

A. The prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The position of the prior carrier shall be the same whether the group contract holder or other entity secures replacement coverage from a new carrier, the same carrier, s…

A. Each person who is eligible for coverage in accordance with the succeeding carrier's plan of benefits shall be covered by that carrier's plan of benefits. B. Each person not covered under the succeeding carrier's plan of benefits in accordance with 13 NMAC 10.5.12.1 [now Subse…

A. 13 NMAC 10.5.12.2.1 and 10.5.12.4 [now Paragraph (1) of Subsection B of 13.10.5.12 NMAC and Subsection D of 13.10.5.12 NMAC] do not apply to federally qualified HMOs as long as they are not permitted to require actively at work, hospital non-confinement rules, medical evidence…

This rule applies to all group insurance contracts provided by an insurance company or a nonprofit health care plan and all group health maintenance organization contracts issued for delivery in this state, renewed, amended, or under which the level of benefits or premium is alte…

Sections 59A-18-16.1, 59A-46-30 and 59A-47-33 NMSA 1978.

Permanent.

November 1, 1998, unless a later date is cited at the end of a section or paragraph.

The purpose of this rule is to set forth the requirements for discontinuance and replacement of group contracts.

As used in this rule: A. "accrued liability" means liabilities established on the date an injury is sustained or an illness commences. B. "group contract" means a contract for health or disability insurance or an HMO contract made with an employer or other entity that covers a gr…

A. If a group contract provides for automatic discontinuance of the contract after a premium has remained unpaid through the grace period allowed for the payment, the carrier shall be liable for valid claims for covered losses incurred prior to the end of the grace period. The ca…

A. The carrier shall notify the group contract holder of the date the group contract will discontinue and that, unless otherwise provided in the group contract, the carrier shall not be liable for claims for losses incurred after the date of discontinuance. B. The carrier shall a…

New Mexico State Corporation Commission [Public Regulation Commission], Department of Insurance, Post Office Box 1269, Santa Fe, NM 87504-1269.

A. The prepaid dental plan shall submit a statement describing its proposed dental care plan, facilities, and personnel to the director of the health services division for certification. The statement shall indicate the manner which the prepaid dental plan will comply with the fo…

All plans shall include at least the following basic dental services which shall be covered by the prepaid charges set forth in the evidence of coverage. If other dental services will be available to eligible members on a voluntary basis, they must be listed in the plan. Dental s…

A. The prepaid dental plan shall submit a statement which describes the geographic area or areas to be served. (1) A geographic area should be reasonably contiguous and one within which services offered and provided will be reasonably accessible to members and prospective members…

A. The prepaid dental plan shall appoint a designated representative who shall have appropriate education and/or experience to qualify him for the management of the organization. The prepaid dental plan shall define in writing, the authority and duties of the chief executive offi…

A. The prepaid dental plan shall designate a New Mexico licensed dentist as dental director. B. The dental director shall be responsible for planning and implementing the method for the continuing review and evaluation of dental care provided and the continuing education of the p…

A. The prepaid dental plan shall assure that a unit dental record system capable of readily providing necessary clinical information is maintained. B. The dental record shall be maintained at the appropriate provider facility in accordance with acceptable professional standards a…

A. The prepaid dental plan shall provide an effective method for a continuing review and evaluation of the dental care provided to ensure that treatment and level of care were appropriate and adequate, that the quality of dental care provided met with acceptable standards, and th…

A. This rule applies to all prepaid dental organizations in the state of New Mexico. B. The health services division may issue further rules in areas of its responsibilities from time to time and those rules must be considered when interpreting this rule.

Sections 59A-2-9 NMSA 1978.