N.M. Admin. Code § 13.10.25.32

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.25.32 - APPENDICES

A.Appendix A - medicare supplement refund calculation form. For the required Medicare Supplement Refund Calculation Form for each calendar year, use the form so named and instructions provided in Appendix A of the Model Regulation To Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act - NAIC Model #651, as adopted in 2017, except that on line 7, in place of "(see worksheet for Ratio 1)" use "(sixty-five percent for Individual, seventy-five percent for Group)".

B.Appendix B - form for reporting medicare supplement policies. Use the Form For Reporting Medicare Supplement Policies provided in Appendix B of the Model Regulation To Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act - NAIC Model #651, as adopted in 2017.

C.Appendix C - disclosure statements.

(1) Instructions for use of the disclosure statements for health insurance policies sold to Medicare beneficiaries that duplicate Medicare.

(a) Section 1882 (d) of the federal Social Security Act prohibits the sale of a health insurance policy (the term policy includes certificate) to Medicare beneficiaries that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary's other health coverage and it includes the prescribed disclosure statement on or together with the application for the policy.

(b) All types of health insurance policies that duplicate Medicare shall include one of the attached disclosure statements, according to the particular policy type involved, on the application or together with the application. The disclosure statement may not vary from the attached statements in terms of language or format (type size, type proportional spacing, bold character, line spacing, and usage of boxes around text).

(c) State and federal law prohibits insurers from selling a Medicare Supplement policy to a person that already has a Medicare Supplement policy except as a replacement policy.

(d) Property/casualty and life insurance policies are not considered health insurance.

(e) Disability income policies are not considered to provide benefits that duplicate Medicare.

(f) Long-term care insurance policies that coordinate with Medicare and other health insurance are not considered to provide benefits that duplicate Medicare.

(g) The federal law does not preempt state laws that are more stringent than the federal requirements.

(h) The federal law does not preempt existing state form filing requirements.

(i) Section 1882 of the federal Social Security Act was amended in Subsection (d)(3)(A) to allow for alternative disclosure statements. The disclosure statements already in Appendix C remain. Carriers may use either disclosure statement with the requisite insurance product. However, carriers should use either the original disclosure statements or the alternative disclosure statements and not use both simultaneously.

(2) For the required disclosure statements refer to the various options that are provided in Appendix C of the Model Regulation To Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act - NAIC Model #651, as adopted in 2017.

N.M. Admin. Code § 13.10.25.32

13.10.25.32 NMAC - N, 08/31/09, Adopted by New Mexico Register, Volume XXIX, Issue 24, December 27, 2018, eff. 1/1/2019