N.M. Admin. Code § 13.10.3.8

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

Section 13.10.3.8 - GENERAL REQUIREMENTS

A.Duration and non-renewability. The term of a short-term plan shall not exceed three months and shall not be extendable or renewable. Continuation and conversion rights of short-term plan dependents extend only to the original termination date of the policy.

B.When issuance prohibited. A short-term plan shall not be issued to an individual, if that person was enrolled in any short-term plan that provided the same or similar coverage during the preceding 12 months.

C.Guaranteed issue. A short-term plan shall be guaranteed issue to eligible applicant's without regard to health status or any preexisting condition(s).

D.Cancellation and rescission. A short-term plan shall not be cancelled or rescinded except as provided herein:

(1) A short-term plan shall not be rescinded except in the case of intentional misrepresentation, concealment or fraud by the insured or covered person.

(2) A short-term plan shall not be canceled except:

(a) as the result of change to or implementation of federal or state laws that no longer permit the continued offering of the coverage; or

(b) due to the covered person's:

(i) nonpayment of premium;

(ii) violation of published policies of the carrier approved by the superintendent;

(iii) fraudulent acts or material misrepresentation; or

(iv) material breach of the terms of the plan.

(c) Nothing in this section shall be construed to provide a covered person with any benefits they would not otherwise be entitled to under a short-term plan.

(3) Notice required.

(a) When a short-term plan is cancelled for nonpayment of premium, the insurer shall notify the covered person in writing ten days prior to the cancellation date that the plan will be canceled, unless payment is made prior to the cancellation date.

(b) When cancellation or rescission is for any other authorized reason, the insurer shall notify the covered person in writing 20 days prior to the cancellation or rescission date, or the expiration date of the short-term plan, whichever occurs first. An insurer may provide less than 20 days notice only if the remaining duration of the plan is less than 20 days. In such case, notice shall be provided no later than 10 days prior to the cancellation or rescission date or the expiration date of the plan, whichever occurs first. The notice shall specifically state the reason(s) for the cancellation or rescission.

(c) A written notice required by this subsection shall be printed in 12 point or larger font, and phrased in simple language.

E.Prohibition against pre-existing condition exclusion. A carrier shall not exclude coverage of a benefit covered under a short-term plan due to any preexisting condition(s) or other conditions disclosed on the application of coverage.

F.Waiting periods. A carrier shall not impose a waiting period for a benefit covered under a short-term plan.

N.M. Admin. Code § 13.10.3.8

Adopted by New Mexico Register, Volume XXXI, Issue 18, September 29, 2020, eff. 10/1/2020