TITLE 13 INSURANCE
CHAPTER 10 HEALTH INSURANCE
PART 3 MINIMUM
STANDARDS FOR SHORT-TERM PLANS
13.10.3.1 ISSUING AGENCY: Office of Superintendent of Insurance.
[13.10.3.1
NMAC - N, 10/01/2020]
13.10.3.2 SCOPE: This rule applies to every health insurer
who offers or issues a short-term plan to a resident of New Mexico.
[13.10.3.2
NMAC - N, 10/01/2020]
13.10.3.3 STATUTORY AUTHORITY: Section 59A-23G-1 et seq. NMSA 1978.
[13.10.3.3
NMAC - N, 10/01/2020]
13.10.3.4 DURATION: Permanent.
[13.10.3.4
NMAC - N, 10/01/2020]
13.10.3.5 OBJECTIVE: Establish regulatory requirements for
short-term health benefit plans. The
rule will standardize and simplify the terms and coverages, facilitate
public understanding and comparison of coverage, and prohibit provisions that
may be misleading or confusing in connection with such plans.
[13.10.3.5 NMAC - N, 10/01/2020]
13.10.3.6 EFFECTIVE DATE: October 1, 2020, unless a later date is
cited at the end of a section.
[13.10.3.6
NMAC - N, 10/01/2020]
13.10.3.7 DEFINITIONS:
A. The definitions in
Section 59A-23G-2 NMSA 1978 apply to this rule.
B. Unless
inconsistent with a term defined in this rule, or the usage of a term in this
rule, the definitions in 13.10.29 NMAC apply.
[13.10.3.7
NMAC – N, 10/01/2020]
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 applicants 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or rescinded except as provided herein: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short-term plan shall not be rescinded except in the case of intentional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.
[13.10.3.8
NMAC - N, 10/01/2020]
13.10.3.9 MANDATORY DISCLOSURES
A. Disclosure Required.
A short-term plan shall not be offered
or issued without providing the prospective insured applicant a disclosure in
the form and with the content specified in this section.
B. Disclosure format. The standard disclosure shall be displayed
prominently in the plan and in the plan application, and shall also be
delivered as a separate document to the applicant upon delivery of the
application.
C. Delivery of
disclosure. The applicant must sign
an acknowledgement of receipt of the form.
(1) The
carrier shall retain each acknowledged disclosure form for five years. Signed forms shall be available for review by
the superintendent upon request.
(2) The standard disclosure form
shall not be used until it has been filed with and approved in writing by the
superintendent.
(3) The standard disclosure form
shall include the following information and shall be presented on the first
page of any application for coverage in 12-point or larger font:
THIS IS SHORT-TERM, LIMITED
DURATION HEALTH INSURANCE COVERAGE. THIS PLAN ONLY LASTS FOR [Insert Duration] AND
IS NONREWABLE. THIS COVERAGE IS UNAVAILABLE TO ANY INDIVIDUAL WHO HAS BEEN
INSURED BY A SHORT-TERM PLAN WITHIN THE PREVIOUS TWELVE-MONTH PERIOD.
THIS PLAN MAY HAVE DOLLAR
LIMITATIONS ON BENEFITS.
THIS COVERAGE DOES NOT COMPLY
WITH ALL AFFORDABLE CARE ACT REQUIREMENTS. TO SEE IF YOU QUALIFY FOR FINANCIAL
ASSISTANCE AND ENROLL IN AFFORDABLE CARE ACT COVERAGE VISIT WWW.BEWELLNM.COM.
YOU MAY QUALIFY FOR A SPECIAL ENROLLMENT PERIOD IF YOU HAVE RECENTLY LOST
COVERAGE.
[13.10.3.9
NMAC - N, 10/01/2020]
13.10.3.10 COMPLIANCE FILING REQUIREMENTS:
A. Qualified health plan standard requirements. A short-term plan is subject to the
same rate, form, and compliance filings as qualified health plans.
B. Network access plan. An insurer who offers a short-term plan
shall file a network access plan(s) in SERFF for review and approval by the
superintendent annually on October 1.
[13.10.3.11
NMAC - N, 10/01/2020]
13.10.3.11 PENALTIES: In addition to any applicable
suspension, revocation or refusal to continue any certificate of authority or
license under the Insurance Code, the superintendent may impose a penalty for any violation of this rule in accordance with
Sections 59A-1-18 and 59A-46-25 NMSA 1978.
[13.10.3.10
NMAC - N, 10/01/2020]
13.10.3.12 SEVERABILITY: If any section of this rule, or the
applicability of any section to any person or circumstance, is for any reason
held invalid by a court of competent jurisdiction, the remainder of the rule,
or the applicability of such provisions to other persons or circumstances,
shall not be affected.
[13.10.3.11
NMAC - N, 10/01/2020]
History of
13.10.3 NMAC: [RESERVED]