NMSA 1978, § 59A-24A-1 Short title
59A-24A-1. Short title
Chapter 59A, Article 24A NMSA 1978 may be cited as the "Medicare Supplement Act".
Laws 1989, ch. 28, § 1; 1992, ch. 3, § 1.
Medicare Supplements
NMSA 1978 ch. 59A, art. 24A
in effectNMSA 1978, § 59A-24A-2 Applicability and scope
59A-24A-2. Applicability and scope
A. Except as otherwise specifically provided, the Medicare Supplement Act shall apply to:
(1) all medicare supplement policies delivered or issued for delivery in this state on or after the effective date of that act;
(2) all certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this state; and
(3) insurers issuing policies or certificates under Chapter 59A, Articles 44, 46 and 47 NMSA 1978.
B. The Medicare Supplement Act shall not apply to a master policy or contract of one or more employers or labor organizations or of the trustees of a fund established by one or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.
C. The provisions of the Medicare Supplement Act are not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons, which policies are not marketed or held to be medicare supplement policies or benefit plans, except that policies designed to reimburse or pay as the result of hospitalization for hospital, medical and surgical expenses of persons eligible for medicare are subject to Sections 59A-24A-6 and 59A-24A-8 NMSA 1978.
Laws 1989, ch. 28, § 2; 1992, ch. 3, § 2.
NMSA 1978, § 59A-24A-3 Definitions
59A-24A-3. Definitions
As used in the Medicare Supplement Act:
A. "applicant" means:
(1) in the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits; and
(2) in the case of a group medicare supplement policy, the proposed certificate holder;
B. "certificate" means any certificate delivered or issued for delivery in this state under a group medicare supplement policy;
C. "certificate form" means the document on which a certificate is delivered or issued for delivery;
D. "issuer" means insurance companies, fraternal benefit societies, nonprofit health care plans, health maintenance organizations and any other entities that deliver or issue for delivery in this state medicare supplement policies or certificates;
E. "medicare" means the federal Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended;
F. "medicare supplement policy" means:
(1) a group policy as defined in Chapter 59A, Article 23 NMSA 1978;
(2) an individual policy as defined in Chapter 59A, Article 22 NMSA 1978; or
(3) a group or individual certificate issued pursuant to the Nonprofit Health Care Plan Law [Chapter 59A, Article 47 NMSA 1978] or the Health Maintenance Organization Act [Chapter 59A, Article 46 NMSA 1978] that is advertised, marketed or designed as a supplement to reimbursements under medicare for the hospital, medical or surgical expenses of persons eligible for medicare;
G. "policy form" means the document on which a policy is delivered or issued for delivery by the issuer; and
H. "superintendent" means the superintendent of insurance.
Laws 1989, ch. 28, § 3; 1992, ch. 3, § 3.
NMSA 1978, § 59A-24A-4 Standards for policy provisions; authority to promulgate regulations
59A-24A-4. Standards for policy provisions; authority to promulgate regulations
A. No medicare supplement policy or certificate, in force in this state, shall contain benefits that duplicate benefits provided by medicare.
B. Notwithstanding any other provisions of law of this state, a medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.
C. The superintendent shall adopt reasonable regulations to establish specific standards for policy provisions contained in medicare supplement policies and certificates. Such standards shall be in addition to and in accordance with applicable laws of this state, except as those laws are modified by the provisions of the Medicare Supplement Act. No requirement of the Insurance Code relating to minimum required policy benefits, other than the minimum standards contained in the Medicare Supplement Act, shall apply to medicare supplement policies and certificates. The standards may cover, but are not limited to:
(1) terms of renewability;
(2) initial and subsequent conditions of eligibility;
(3) nonduplication of coverage;
(4) probationary periods;
(5) benefit limitations, exceptions and reductions;
(6) elimination periods;
(7) requirements for replacement;
(8) recurrent conditions; and
(9) definitions of terms.
D. The superintendent shall adopt reasonable regulations to establish minimum standards for benefits and claims payment, marketing practices, compensation arrangements and reporting practices for medicare supplement policies and certificates.
E. The superintendent may adopt reasonable regulations necessary to conform medicare supplement policies and certificates to the requirements of federal law. The regulations may, but are not limited to:
(1) require refunds or credits if policies or certificates do not meet loss ratio requirements;
(2) establish a uniform methodology for calculating and reporting loss ratios;
(3) assure public access to information in the possession of issuers concerning policies, premiums and loss ratios;
(4) establish an approval process for policy forms, certificate forms and proposed premium increases;
(5) establish procedures for conducting public hearings prior to granting approval to proposed premium increases; and
(6) establish standards for medicare select policies and certificates if the state is authorized to operate as a medicare select state.
F. The superintendent may adopt reasonable regulations that specify prohibited policy or certificate provisions not otherwise specifically authorized by statute that, in the opinion of the superintendent, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a medicare supplement policy or certificate.
Laws 1989, ch. 28, § 4; 1990, ch. 110, § 4; 1992, ch. 3, § 4.
NMSA 1978, § 59A-24A-6 Loss ratio standards
59A-24A-6. Loss ratio standards
Medicare supplement policies and other policies designed to reimburse or pay as the result of hospitalization for the hospital, medical and surgical expenses of persons eligible for medicare shall return to policyholders benefits that are reasonable in relation to the premium charged. The superintendent shall issue reasonable regulations to establish minimum standards for loss ratios of medicare supplement policies and other policies designed to reimburse or pay as the result of hospitalization for the hospital, medical and surgical expenses of persons eligible for medicare on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
Laws 1989, ch. 28, § 6; 1990, ch. 110, § 6; 1992, ch. 3, § 5.
NMSA 1978, § 59A-24A-8 Filing of health insurance for seniors; rates and forms
59A-24A-8. Filing of health insurance for seniors; rates and forms
A. The superintendent shall adopt regulations for the review and approval or disapproval of all rate filings or forms made pursuant to Chapter 59A, Articles 15, 18, 44, 46 and 47 NMSA 1978. During the initial review periods provided under Chapter 59A, Articles 15, 18, 44, 46 and 47 NMSA 1978, the superintendent may disapprove any form filed with him.
B. The superintendent may, in addition to any disapproval authority granted in Chapter 59A, Articles 15, 18, 44, 46 and 47 NMSA 1978, disapprove rate filings if the earned premium in the most recent calendar year is less than forty percent of the highest calendar year's earned premium for the form and, in the superintendent's judgment, those rates would result in a dropping of coverage that is not beneficial to the citizens of New Mexico. Alternately, the superintendent may:
(1) require that the experience be combined with the experience of any other form with similar benefits; or
(2) adjust the requested rate.
Laws 1989, ch. 28, § 8; 1990, ch. 110, § 7; 1992, ch. 3, § 6.
NMSA 1978, § 59A-24A-9 Disclosure standards
59A-24A-9. Disclosure standards
A. In order to provide for full and fair disclosure in the sale of medicare supplement policies or certificates, no medicare supplement policy or certificate shall be delivered or issued for delivery in this state unless an outline of coverage is delivered to the applicant at the time application is made.
B. The superintendent shall prescribe the format and content of the outline of coverage required by Subsection A of this section. For purposes of this section, "format" means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include:
(1) a description of the principal benefits and coverage provided in the policy or certificate;
(2) a statement that provides disclosure of any provision concerning automatic renewal premium increases based on the age of a policyholder;
(3) a statement of the renewal provisions, including any reservation by the issuer of a right to change premiums; and
(4) a statement that the outline of coverage is a summary of the policy or certificate issued or applied for and that the policy or certificate should be consulted to determine governing contractual provisions.
C. The superintendent may prescribe by regulation a standard form and content of an informational brochure for persons eligible for medicare that is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies or certificates, the superintendent may require by regulation that the informational brochure be provided to any prospective insured eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies or certificates, the superintendent may require by regulation that the prescribed brochure be provided upon request to any prospective insured eligible for medicare, but the brochure shall be provided no later than the time the policy or certificate is delivered.
D. The superintendent may adopt regulations for captions or notice requirements determined to be in the public interest and designed to inform a prospective insured that particular insurance coverages are not medicare supplement coverages for all health insurance policies sold to persons eligible for medicare by reason of age. The regulations shall not apply to the following policies:
(1) medicare supplement;
(2) disability income;
(3) basic, catastrophic or major medical expense; or
(4) single, premium or nonrenewable.
E. The superintendent may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of health policies or certificates by persons eligible for medicare.
Laws 1989, ch. 28, § 9; 1992, ch. 3, § 7.
NMSA 1978, § 59A-24A-10 Notice of free examination
59A-24A-10. Notice of free examination
Medicare supplement policies and certificates shall have a notice printed prominently on the first page of the policy or certificate or attached to the policy stating that the applicant shall have the right to return the policy or certificate within thirty days of delivery and have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid in a timely manner directly to the applicant by the issuer.
Laws 1989, ch. 28, § 10; 1992, ch. 3, § 8.
NMSA 1978, § 59A-24A-11 Limitation of sales of medicare supplement policies and other policies designed to reimburse or pay as the result of hospitalization for hospital, medical or surgical expenses
59A-24A-11. Limitation of sales of medicare supplement policies and other policies designed to reimburse or pay as the result of hospitalization for hospital, medical or surgical expenses
The superintendent may establish reasonable rules and regulations to restrict the sale of medicare supplement policies and other policies designed to reimburse or pay as the result of hospitalization for hospital, medical or surgical expenses that result in over-insurance to an insured.
Laws 1989, ch. 28, § 11; 1992, ch. 3, § 9.
NMSA 1978, § 59A-24A-12 Filing requirements for advertising
59A-24A-12. Filing requirements for advertising
A. Every issuer of medicare supplement insurance policies or certificates in this state shall provide a copy of any medicare supplement advertisement intended for use in this state, whether through written, radio or television medium, to the superintendent for review and approval. The advertisement shall comply with all applicable laws of this state.
B. Persons who market medicare supplement insurance policies or certificates in this state shall not advertise any policies or certificates unless:
(1) the issuer of the policy or certificate has provided the superintendent with a copy of the advertisement; and
(2) the superintendent has reviewed and approved the advertisement.
Laws 1989, ch. 28, § 12; 1992, ch. 3, § 10.
NMSA 1978, § 59A-24A-13 Administrative procedures
59A-24A-13. Administrative procedures
Regulations adopted pursuant to the Medicare Supplement Act shall be subject to the provisions of 59A-2-9 NMSA 1978.
Laws 1989, ch. 28, § 13.
NMSA 1978, § 59A-24A-14 Penalties
59A-24A-14. Penalties
In addition to any other applicable penalties for violations of the Insurance Code, the superintendent may impose penalties pursuant to the provisions of Section 59A-1-18 NMSA 1978, for a violation of the Medicare Supplement Act. The superintendent may require issuers violating any provision of the Medicare Supplement Act or regulations adopted pursuant to that act to cease marketing any medicare supplement policy or certificate in this state that is related directly or indirectly to a violation or may require the issuer to take actions that are necessary to comply with the provisions of that act, or both.
Laws 1989, ch. 28, § 14; 1992, ch. 3, § 11.
NMSA 1978, § 59A-24A-15 Medicare supplement policy; provisions relating to individuals who are eligible for medical benefits under the medicaid program
59A-24A-15. Medicare supplement policy; provisions relating to individuals who are eligible for medical benefits under the medicaid program
A. Each medicare supplement policy that is delivered, issued for delivery or renewed in this state shall include provisions that require benefits paid on behalf of a child or other insured person under the policy to be paid to the human services department [health care authority department] when:
(1) the human services department [health care authority department] has paid or is paying benefits on behalf of the child or other insured person under the state's medicaid program pursuant to Title XIX of the federal Social Security Act, 42 U.S.C. 1396, et seq.;
(2) payment for the services in question has been made by the human services department [health care authority department] to the medicaid provider; and
(3) the issuer is notified that the insured individual receives benefits under the medicaid program and that benefits must be paid directly to the human services department [health care authority department].
B. The notice required under Paragraph (3) of Subsection A of this section may be accomplished through an attachment to the claim by the human services department [health care authority department] for insurance benefits when the claim is first submitted by the human services department [health care authority department] to the issuer.
C. Notwithstanding any other provisions of law, checks in payment for claims pursuant to any medicare supplement policy for health care services provided to persons who are also eligible for benefits under the medicaid program and provided by medical providers qualified to participate under the policy shall be made payable to the provider. The issuer may be notified that the insured individual is eligible for medicaid benefits through an attachment to the claim by the provider for insurance benefits when the claim is first submitted by the provider to the issuer.
D. No medicare supplement policy delivered, issued for delivery or renewed in this state or after the effective date of this section shall contain any provision denying or limiting insurance benefits because services are rendered to an insured who is eligible for or who has received medical assistance under the medicaid program of this state, unless:
(1) the medicare supplement policy or certificate has been suspended at the request of a policy or certificate holder for a period not to exceed twenty-four months; and
(2) during the period of suspension, the policy or certificate holder is entitled to medical assistance pursuant to Title XIX of the federal Social Security Act, 42 U.S.C. 1396, et seq.
1978 Comp., § 59A-24-8, enacted by Laws 1989, ch. 183, § 4, recompiled as § 59A-24A-15 by Laws 1990, ch. 110, § 8; 1992, ch. 3, § 12.
NMSA 1978, § 59A-24A-16 Rules and regulations; procedures
59A-24A-16. Rules and regulations; procedures
Rules and regulations adopted pursuant to the provisions of the Medicare Supplement Act shall be subject to the provisions of Section 59A-2-9 NMSA 1978.
1978 Comp., § 59A-24A-16, enacted by Laws 1992, ch. 3, § 13.
NMSA 1978, § 59A-24A-17 Annual open enrollment. (Effective January 1, 2027.)
59A-24A-17. Annual open enrollment. (Effective January 1, 2027.)
A. Every issuer participating in the market for medicare supplement policies shall offer an annual open enrollment period to all eligible policyholders. Each eligible policyholder's open enrollment period shall commence with the first day of the eligible policyholder's birthday month and remain open for at least sixty days thereafter. During the open enrollment period:
(1) each eligible policyholder may purchase any medicare supplement policy of an equal or lesser value to the eligible policyholder's current medicare supplement policy offered in this state; and
(2) an issuer shall:
(a) guarantee the issuance of any medicare supplement policy offered in this state; and
(b) not deny, delay or condition the issuance or effectiveness, or discriminate in the price of coverage, of a medicare supplement policy based on the health status, claims, experience, receipt of health care or medical condition of an eligible policyholder.
B. A medicare supplement policy obtained by an eligible policyholder pursuant to Subsection A of this section shall not have any coverage exclusions related to preexisting conditions that would have been covered under the eligible policyholder's previous medicare supplement policy.
C. At least thirty days before the beginning of an eligible policyholder's open enrollment period, but not more than sixty days before the beginning of the open enrollment period, the issuer of an eligible policyholder's medicare supplement policy shall notify the eligible policyholder of:
(1) the dates on which the open enrollment period begins and ends;
(2) the rights provided to the eligible policyholder by this section; and
(3) any modifications to the medicare supplement policy currently held by the eligible policyholder or any adjustments to the premiums charged for that policy.
D. The form and content of the notification required pursuant to Subsection C of this section shall be filed with and approved by the superintendent prior to distribution to eligible policyholders.
Laws 2026, ch. 10, § 2.
Source: New Mexico Compilation Commission (nmonesource.com)URL: https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.doFetched: 10/20/2026