Chapter 59A, Chapter 59A

A. Every insurer, fraternal benefit society, multiple employer welfare arrangement, health maintenance organization or nonprofit health care plan that provides primary health insurance or health care coverage insuring or covering major medical expenses shall, in determining the i…

requirements. A. All health insurance or health care plan rates filed by an insurer with the superintendent pursuant to Section 59A-18-12 NMSA 1978 shall include all related forms. B. An insurer shall not use a rate without prior approval of the superintendent pursuant to Section…

approval or disapproval. A. The superintendent shall issue a final order within sixty days of the filing date for health insurance filings made on rates. The superintendent shall consider any public comment made pursuant to Subsection H of Section 59A-18-13.2 NMSA 1978. The super…

court of appeals from superintendent. A. In a matter arising from an order of the superintendent on appeal pursuant to Section 59A-18-13.3 NMSA 1978, an aggrieved party may appeal to the court of appeals. B. The court of appeals shall consider the superintendent's order on appeal…

For the purpose of determining the rate of any policy within a closed block of business, the superintendent may require an insurer to pool the experience of a closed block of business with all appropriate blocks of business that are not closed in accordance with Section 59A-18-13…

A. The superintendent shall review any filing, except any filing by a health insurance issuer for a change in rate, made pursuant to Section 59A-18-12 or 59A-18-13 NMSA 1978 within sixty days of the filing date. The superintendent shall approve any form if the superintendent find…

accident and health insurance policies; notice. Subject to the provisions of the Health Insurance Portability Act: A. every accident and health insurance policy that provides hospital, surgical and medical expense benefits and that is delivered, issued for delivery or renewed in …

The superintendent may promulgate reasonable rules and regulations to establish requirements for group coverage discontinuance and replacement. History: 1978 Comp., § 59A-18-16.1, enacted by Laws 1993, ch. 320, § 58.

superintendent; rulemaking; compliance with federal law. A. A small group health plan and a health insurance issuer or multiple employer welfare arrangement offering a small group or individual health insurance plan that provides benefits other than excepted benefits shall: (1) p…

A. Insurance contracts shall contain such standard or uniform provisions as are required by applicable provisions of the Insurance Code [Chapter 59A NMSA 1978] pertaining to contracts of particular kinds of insurance. B. No policy shall contain a provision inconsistent with or co…

No policy shall contain any provision purporting to make any portion of the charter, bylaws or other constituent document of the insurer (other than the subscriber's agreement or power of attorney of a reciprocal insurer) a part of the contract unless such portion is set forth in…

A. Every policy shall be executed in the name of and on behalf of the insurer by its officer, attorney-in-fact, employee or representative duly authorized by the insurer. B. A facsimile signature of any such executing individual may be used in lieu of an original signature. C. No…

As used in this article "policy" means any contract of insurance, indemnity, health care, suretyship or annuity between the insurer and the insured, by whatever name such contract is called, and includes all clauses, riders, endorsements and papers which are a part thereof. Histo…

A. Two (2) or more authorized insurers may jointly issue, and shall be jointly and severally liable on, an underwriters' policy bearing their names. Any one insurer may issue policies in the name of an underwriter's department and such policy shall plainly show the true name of t…

A. A policy delivered or issued for delivery after the effective date of the Insurance Code [Chapter 59A NMSA 1978] to any person in this state in violation of the Insurance Code but otherwise binding on the insurer, shall be held valid, but shall be construed as provided in the …

A. While acting within the scope of authority granted by the insurer, binders or other contracts for temporary insurance may be made by a producer orally or in writing, and shall be deemed to include all the usual terms of the policy as to which the binder was given together with…

pledgees. A. If the original policy is delivered or is so required to be delivered to or for deposit with any vendor, mortgagee or pledgee of any motor vehicle, in which policy any interest of the vendee, mortgagor or pledgor in or with respect to such vehicle is insured, a dupli…

A licensed insurance producer appointed as insurance producer by an insurer shall, in any controversy between the insured or the insured's beneficiary and the insurer, be held to be the agent of the insurer that issued the insurance solicited or applied for, anything in the appli…

Where amounts of insurance under group, blanket or other forms of life, annuity or health insurance coverage are now or hereafter limited to specified dollar amounts by any provision of the Insurance Code, the insurer may, with the superintendent's approval and notwithstanding th…

Whenever the proceeds of or payments under a life or health insurance policy or annuity contract heretofore or hereafter issued become payable in accordance with the terms of the policy or contract, or exercise of any right or privilege thereunder, and the insurer makes payment t…

Upon receiving due notice of a claim of loss under an insurance contract issued or assumed by it, an insurer shall promptly furnish to the insured claimant such forms of proof of loss as it may require for completion by such person, but the insurer shall not have any responsibili…

A. The superintendent shall devise or designate universal forms to be utilized by every health insurer, including health maintenance organizations, nonprofit health plans and fraternal organizations offering any type of health coverage for individuals residing in this state, for …

The acknowledgment by any insurance company of the receipt of notice given under any policy covered by this code [Chapter 59A NMSA 1978], or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not…

A. An insurer or agent may at any time cancel a policy for nonpayment of premium when due, whether the premium is payable directly to the insurer or agent or indirectly under any premium financing plan or extension of credit. The insurer or agent shall give the named insured writ…

As used in the Insurance Code "premium" means the consideration for insurance or for an annuity, by whatever name called. Any "assessment," or any "membership," "policy," "survey," "inspection," "service" or similar fee or other charge in consideration for an insurance or annuity…

As used in Chapter 59A, Article 18 NMSA 1978, "closed block of business" means a policy or group of policies that division rules identify as closed because an insurer no longer markets or sells the policy or group of policies or because the policy's or group of policies' enrollme…

As used in Chapter 59A, Article 18 NMSA 1978, "block of business" means a particular policy or pool that provides health insurance, that an insurer issues to one or more individuals and that includes distinct benefits, services and terms. History: Laws 2011, ch. 144, § 11.

A. An insurer shall for a policy of insurance coverage provide the named insured of the policy with premium and claim data within sixty days of receipt of a written request from the named insured. B. As used in this section "premium and claim data" shall include: (1) the sum of a…

relating to individuals who are eligible for medical benefits under the medicaid program. A. Each individual or group policy or certificate of accident or health insurance that is delivered, issued for delivery or renewed in this state shall include provisions that require benefi…

A. As used in this section: (1) "certificate of insurance" means any document or instrument prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage, but excludes an insurance policy, insurance binder, policy endorsement or aut…

A. An organization that publishes information regarding the effectiveness of community fire protection or building code information, including public protection classifications, community grading, building code effectiveness classifications or fire suppression rating schedules fo…

A. Any individual of competent legal capacity may procure or effect an insurance contract upon his own life or body for the benefit of any person. No person shall procure or cause to be procured any insurance contract upon the life or body of another individual unless the benefit…

institutions designated beneficiary. A. Life insurance contracts may be entered into in which the person paying the consideration for the insurance has no insurable interest in the life of the individual insured, where charitable, benevolent, educational or religious institutions…

A. No contract of insurance of property or of any interest in property or arising from property shall be enforceable as to the insurance except for the benefit of persons having an insurable interest in the things insured as at the time of the loss. B. "Insurable interest" as use…

or annuity by minor. A. Any person of competent legal capacity may contract for insurance. B. Any minor not less than fifteen (15) years of age may, notwithstanding his minority, contract for annuities or for insurance upon his own life or health, or on the person of another indi…

No life or health insurance contract upon an individual, except a contract of group life insurance or of group or blanket health insurance, shall be made or effectuated unless at the time of the making of the contract, such individual applies therefor or has consented thereto in …

No alteration of any written application for any life or health insurance policy or annuity contract shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer for administrative purposes only in such manner…

A. This article [59A-19-1 to 59A-19-7 NMSA 1978] may be referred to as the "Policy Language Simplification Law". B. No other statute of this state setting language simplification standards shall apply as to any policy forms. History: Laws 1984, ch. 127, § 360.

A. This article applies as to all policies, group certificates, benefit or service certificates, contracts, plans or agreements providing coverage as to life or health of human beings, and delivered or issued for delivery in this state by any insurer, fraternal benefit society, n…

For the purposes of this article: A. "issuer" means the insurer, fraternal benefit society, nonprofit health service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization or other organization referred to in Sub…

A. In addition to any other requirements of law, no policy forms shall be delivered or issued for delivery in New Mexico on or after the dates such form must be approved under this article, unless: (1) the text achieves a minimum score of forty (40) on the Flesch reading ease tes…

The superintendent may, in his sole discretion, authorize use of a policy form having a lower score than the Flesch reading ease score required in Paragraph A(1) of Section 362 [59A-19-4 NMSA 1978] of this article if he finds that a lower score: A. will provide a more accurate re…

A. A policy form meeting the requirements of Subsection A of Section 362 [59A-19- 4 NMSA 1978] of this article shall be approved notwithstanding the provisions of any other laws which specify the contents of policies, if the policy form provides for policyholders and claimants pr…

A. This article applies to all policy forms filed with the superintendent on or after July 1, 1984. No policy form shall be delivered or issued for delivery in New Mexico on or after July 1, 1987 unless approved by the superintendent or permitted to be issued under this article. …

This article [Chapter 59A, Article 20 NMSA 1978] applies only to contracts of life insurance, endowments and annuities, other than reinsurance, group life insurance and group annuities; except that Section 395 [59A-20-30 NMSA 1978] (variable contract law) shall also apply as to g…

A. For purposes of this section the "published monthly average" means: (1) the Moody's Corporate Bond Yield Average - Monthly Average Corporates as published by Moody's Investors Service, Inc. or any successor thereto; or (2) if such publication is no longer published, a substant…

If the policy provides that the proceeds may be payable in installments which are determinable at issue of the policy, there shall be a table showing the amount of the guaranteed installments. History: Laws 1984, ch. 127, § 376.

There shall be a provision that unless: A. the policy has been surrendered for its cash surrender value; or B. its cash surrender value has been exhausted; or C. the paid-up term insurance, if any has expired; the policy will be reinstated at any time within three (3) years (or t…

There shall be a provision stating the amount of premium and the time and manner payable. History: Laws 1984, ch. 127, § 378.

There shall be a provision that when a policy shall become a claim by the death of the insured, settlement shall be made upon receipt of due proof of death and, at the insurer's option, surrender of the policy or proof of the interest of the claimant. If an insurer shall specify …