TITLE 13 INSURANCE
CHAPTER 6 LIFE AND HEALTH INSURANCE POLICIES AND
RATES
PART 2 LIFE
AND HEALTH MATRIX POLICY FORM FILING
13.6.2.1 ISSUING
AGENCY: NM Office of Superintendent of Insurance,
P.O. Box 1689, Santa Fe, NM 87504-1689.
[13.6.2.1 NMAC - N, 04/01/2018]
13.6.2.2 SCOPE: This rule applies to all life and health
insurers issuing individual life or health insurance policies or group life or
health insurance policies sitused in New Mexico.
[13.6.2.2 NMAC - N, 04/01/2018]
13.6.2.3 STATUTORY AUTHORITY:
Sections 59A-1-10
through 59A-1-17; 59A-2-7 through 59A-2-9; 59A-5-10; 59A-6-l;
59A-18-12; 59A- 18-13.2;
59A-18-16.l; 59A-18-16.2;
59A-21-l et seq.; 59A-22-l et seq. NMSA 1978.
[13.6.2.3 NMAC - N, 04/01/2018]
13.6.2.4 DURATION: Permanent.
[13.6.2.4 NMAC - N, 04/01/2018]
13.6.2.5 EFFECTIVE
DATE: April 1, 2018 unless a later date is cited at
the end of a section.
[13.6.2.5 NMAC - N, 04/01/2018]
13.6.2.6 OBJECTIVE: The purpose of this rule is to address
the use of forms previously filed and approved on a matrix basis for New
Mexico-sitused group policyholders or for individual
policies issued to New Mexico residents.
[13.6.2.6 NMAC - N, 04/01/2018]
13.6.2.7 DEFINITIONS: As used in this rule:
A. “Group policy” means a contract for group life or group
health insurance made between an insurer and an employer, association, trust or
other group that covers individuals based on their relationships to the group
policy holder with or without the covered individuals’ dependents. Group policy does not include the certificate
of insurance delivered to individuals insured under such contracts.
B. “Health insurance” has the meaning as set forth in
Section 59A-7-3 NMSA 1978.
C. “Individual” has the meaning set forth in Subsection
B of Section 59A-1-10 NMSA 1978.
D. “Insurer” has the meaning set forth in Section
59A-1-8 NMSA 1978.
E. “Life insurance” has the meaning as set forth in Section
59A-7-2 NMSA 1978.
F. “Matrix form” means a policy or certificate consisting
of multiple insert pages or paragraphs each with its own unique identifiable
form number, allowing for the creation of multiple policies, certificates or
applications by using combinations of the insert pages and paragraphs. Matrix forms do not include riders,
amendments, endorsements, declaration pages, schedule pages and
certificate/policy specification pages and a matrix form is not created by the
addition of such forms.
G. “SERFF” means the national association of
insurance commissioners (NAIC) system for electronic rate and form filings.
H. “Subscriber” means an individual whose employment or
other group status, except family dependency, is the basis for their coverage
for group insurance.
[13.6.2.7
NMAC - N, 04/01/2018]
13.6.2.8 ISSUANCE OF MATRIX FORMS PROHIBITED: No insurance policies or related
certificates issued to New Mexico - sitused group
policyholders or individual insurance policies issued to New Mexico residents
with effective dates of July 1, 2019, or later may include matrix-based forms,
subject to the exception as described in 13.6.1.9 NMAC.
[13.6.2.8 NMAC - N, 04/01/2018]
13.6.2.9 EXCEPTIONS FOR PREVIOUSLY
APPROVED MATRIX FORMS: Matrix forms
previously filed with and approved by the superintendent may continue to be
used as follows:
A. Matrix forms
previously filed with and approved by the superintendent may continue to be
marketed and sold in this state, provided that the individual policy or group
policy becomes effective on or before July 1, 2019.
B. Coverage
provided under individual policies or group policies and certificates that
include matrix-based forms may continue if the individual policy or group
policy was issued prior to July 1, 2019.
Coverage may also be extended to new subscribers under existing group
insurance plans that use matrix-based forms that have been approved and are in
use as of July 1, 2019.
C. Changes to
policies or certificates using previously filed and approved matrix forms,
affiliated forms, and rates subject to Subsections A and B of this section,
including but not limited to changes required to maintain compliance with state
or federal statutory or regulatory laws or requirements, shall not require an
insurer to issue new non-matrix forms and will be permitted, provided the
following requirements are met:
(1) Any
changes that fall outside the scope of approved variability of previously
approved matrix-based forms shall require a form filing of a rider,
endorsement, or amendment and must be submitted to the superintendent for
approval;
(2) A
sample issue specimen of the applicable matrix-based policy or certificate
forms including every insert page and form to be included in the policy or
certificate as it will be issued to the policyholder or certificate holder and
that is the subject of the filing must be provided with the SERFF filing in the
supporting document tab;
(3) any modification in a matrix-based form that also requires a
change to the previously approved rates must include a corresponding rate
filing; and
(4) A
rate filing subject to Subsections A and B of this section affecting an entire
class or block of coverage under this section, will be
subject to the superintendent’s review and approval.
[13.6.2.9 NMAC - N, 04/01/2018]
History of
13.6.2 NMAC: [RESERVED]