The Insurance Contract

NMSA 1978 ch. 59A, art. 18

in effect

NMSA 1978, § 59A-18-1 Scope of article

59A-18-1. Scope of article Chapter 59A, Article 18 NMSA 1978 applies as to all insurance policies and annuity contracts of authorized insurers covering individuals resident, or risks located, or insurance protection to be rendered in this state, other than: A. reinsurance; B. policies or contracts not issued for delivery in this state nor delivered in this state, except for contracts for or endorsements of workers' compensation insurance when the workers' compensation risk insured arises from the employment of a worker performing work for an employer in New Mexico and that employer is not domiciled in New Mexico; C. wet marine and transportation insurance; or D. surplus lines insurance contracts, unless such contracts are specifically included by rule. Laws 1984, ch. 127, § 331; 1988, ch. 119, § 3; 2011, ch. 127, § 14; 2021, ch. 108, § 13.

NMSA 1978, § 59A-18-2 "Policy" defined

59A-18-2. "Policy" defined As used in this article "policy" means any contract of insurance, indemnity, health care, suretyship or annuity between the insurer and the insured, by whatever name such contract is called, and includes all clauses, riders, endorsements and papers which are a part thereof. Laws 1984, ch. 127, § 332.

NMSA 1978, § 59A-18-3 "Premium" defined

59A-18-3. "Premium" defined As used in the Insurance Code "premium" means the consideration for insurance or for an annuity, by whatever name called. Any "assessment," or any "membership," "policy," "survey," "inspection," "service" or similar fee or other charge in consideration for an insurance or annuity contract or procurement thereof is part of the premium. Laws 1984, ch. 127, § 333.

NMSA 1978, § 59A-18-3.1 Closed block of business

59A-18-3.1. Closed block of business As used in Chapter 59A, Article 18 NMSA 1978, "closed block of business" means a policy or group of policies that division rules identify as closed because an insurer no longer markets or sells the policy or group of policies or because the policy's or group of policies' enrollment has decreased. Laws 2011, ch. 144, § 10.

NMSA 1978, § 59A-18-3.2 "Block of business" defined

59A-18-3.2. "Block of business" defined As used in Chapter 59A, Article 18 NMSA 1978, "block of business" means a particular policy or pool that provides health insurance, that an insurer issues to one or more individuals and that includes distinct benefits, services and terms. Laws 2011, ch. 144, § 11.

NMSA 1978, § 59A-18-4 Insurable interest; personal insurance

59A-18-4. Insurable interest; personal insurance A. Any individual of competent legal capacity may procure or effect an insurance contract upon his own life or body for the benefit of any person. No person shall procure or cause to be procured any insurance contract upon the life or body of another individual unless the benefits under such contract are payable to the individual insured or his personal representatives, or to a person having, at the time such contract was made, an insurable interest in the individual insured. B. If the beneficiary, assignee or other payee under any contract made in violation of this section receives from the insurer any benefits thereunder accruing upon the death, disablement or injury of the individual insured, the individual insured or personal representative may maintain an action to recover such benefits from the person so receiving them. C. As used in this section, "insurable" interest as to such personal insurance means that every person has an insurable interest in the life, body and health of himself, if an individual, and in the life, body and health of other individuals as follows: (1) in the case of individuals related closely by blood or by law, a substantial interest engendered by love and affection; and (2) in the case of other persons, a lawful and substantial economic interest in having the life, health or bodily safety of the insured individual continue, as distinguished from an interest which would arise only, or would be enhanced in value, by the death, disablement or injury of the individual insured. D. An individual party to a contract or option for purchase or sale of an interest in a business partnership or firm, or of shares of stock of a corporation or of an interest in such shares, has an insurable interest in the life, body and health of each individual party to such contract and for the purposes of such contract only, in addition to any insurable interest which may otherwise exist as to such individual. E. An insurer shall be entitled to rely upon all statements, declarations and representations made by an applicant for insurance relative to the insurable interest of the applicant in the insured; and no insurer shall incur legal liability, except as set forth in the policy, by virtue of any untrue statements, declarations or representations so relied upon in good faith by the insurer. Laws 1984, ch. 127, § 334.

NMSA 1978, § 59A-18-5 Insurable interest, life insurance; exception when certain institutions designated beneficiary

59A-18-5. Insurable interest, life insurance; exception when certain institutions designated beneficiary A. Life insurance contracts may be entered into in which the person paying the consideration for the insurance has no insurable interest in the life of the individual insured, where charitable, benevolent, educational or religious institutions or their agencies are designated irrevocably as the beneficiaries thereof. B. In making such contracts the person paying the premium shall make and sign the application therefor as owner, and shall designate irrevocably a charitable, benevolent, educational or religious institution or an agency thereof as the beneficiary or beneficiaries of such contract. The application shall be signed also by the individual whose life is to be insured. C. Nothing in this section shall prohibit any combination of the applicant, premium payer, owner and beneficiary from being the same person. D. Such a contract shall be valid and binding among the parties thereto, notwithstanding the absence otherwise of an insurable interest in the life of the individual insured. Laws 1984, ch. 127, § 335.

NMSA 1978, § 59A-18-6 Insurable interest, property

59A-18-6. Insurable interest, property A. No contract of insurance of property or of any interest in property or arising from property shall be enforceable as to the insurance except for the benefit of persons having an insurable interest in the things insured as at the time of the loss. B. "Insurable interest" as used in this section means any actual, lawful and substantial economic interest in the safety and preservation of the subject of the insurance free from loss, destruction, pecuniary damage or impairment. Laws 1984, ch. 127, § 336.

NMSA 1978, § 59A-18-7 Power to contract for insurance; purchase of insurance or annuity by minor

59A-18-7. Power to contract for insurance; purchase of insurance or annuity by minor A. Any person of competent legal capacity may contract for insurance. B. Any minor not less than fifteen (15) years of age may, notwithstanding his minority, contract for annuities or for insurance upon his own life or health, or on the person of another individual in whom the minor has an insurable interest. Such a minor shall, notwithstanding such minority, be deemed competent to exercise all rights and powers with respect to or under any such contract as might be exercised by an individual of full legal age, and may at any time surrender his interest in any such contract and give valid discharge for any benefit accruing or money payable thereunder. Such a minor shall not, by reason of his minority, be entitled to rescind, avoid or repudiate the contract, nor to rescind, avoid or repudiate any exercise of a right or privilege thereunder, except that such a minor not otherwise emancipated, shall not be bound by any unperformed agreement to pay by promissory note or otherwise, any premium on any such annuity or insurance contract. Any annuity or insurance contract procured by or for a minor under this subsection shall be made payable either to the minor or his estate or to a person having an insurable interest in the minor's life. Laws 1984, ch. 127, § 337.

NMSA 1978, § 59A-18-8 Consent of insured; life, health insurance

59A-18-8. Consent of insured; life, health insurance No life or health insurance contract upon an individual, except a contract of group life insurance or of group or blanket health insurance, shall be made or effectuated unless at the time of the making of the contract, such individual applies therefor or has consented thereto in writing, except in the following cases: A. A spouse may effectuate such insurance upon the other spouse; B. Any person having an insurable interest in the life of a minor, or any person upon whom a minor is dependent for support and maintenance, may effectuate insurance upon the life of or pertaining to such minor; and C. Family policies may be issued insuring any two (2) or more members of a family on an application signed by either parent, a stepparent, a guardian, or by a husband or wife. Laws 1984, ch. 127, § 338.

NMSA 1978, § 59A-18-9 Alteration of application; life, health insurance

59A-18-9. Alteration of application; life, health insurance No alteration of any written application for any life or health insurance policy or annuity contract shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurer for administrative purposes only in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant. Laws 1984, ch. 127, § 339.

NMSA 1978, § 59A-18-10 Application as evidence

59A-18-10. Application as evidence A. The insured shall not be bound by any statement made in the application, and no application for issuance of any life or health insurance policy or annuity contract shall be admissible in evidence in any action relative to such policy or contract, unless a true copy of the application was attached to or otherwise made a part of the policy or contract when issued. This subsection does not apply to industrial life insurance policies. B. If any policy of life or health insurance or annuity contract delivered in this state is reinstated or renewed, and the insured, beneficiary, annuitant or assignee of the policy or contract makes written request to the insurer for a copy of the application, if any, for such reinstatement or renewal, the insurer shall, within fifteen (15) days after receipt of such request at its home office or any of its branch offices, deliver or mail a copy of the application to the person making the request. If such copy is not so delivered or mailed, the insurer shall be precluded from introducing the application as evidence in any action or proceeding based upon or involving such policy or contract or its reinstatement or renewal. If such a request is from a beneficiary or assignee, the time within which the insurer is required to furnish a copy of the application shall not begin to run until after receipt of evidence satisfactory to the insurer of the beneficiary's or assignee's vested interest in the policy or contract. C. As to kinds of insurance other than life or health insurance or annuity contract, no application for insurance signed by or on behalf of the insured shall be admissible in evidence in any action between the insured and the insurer arising out of the policy so applied for, if the insurer has failed, at expiration of thirty (30) days after receipt by the insurer at its home office or branch office, of a written demand therefor by or on behalf of the insured, to furnish to the insured a copy of the application reproduced by any legible means. Laws 1984, ch. 127, § 340.

NMSA 1978, § 59A-18-11 Representation in application

59A-18-11. Representation in application A. The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as a part thereof. If any such policy delivered or issued for delivery to any person in this state shall be reinstated or renewed and the insured or the beneficiary or assignee of such policy shall make written request to the insurance company for a copy of the application, if any, for such reinstatement or renewal, the insurance company shall within fifteen days after the receipts of such request at its home office or any branch office of the insurance company, deliver or mail to the person making such request, a copy of such application. If such copy shall not be so delivered or mailed, the insurance company shall be precluded from introducing such application as evidence in any action or proceeding based upon or involving such policy or its reinstatement or renewal. B. No alteration of any written application for any such policy shall be made by any person other than the applicant without his written consent, except that insertions may be made by the insurance company, for administrative purposes only, in such manner as to indicate clearly that such insertions are not to be ascribed to the applicant. C. The falsity of any statement in the application for any policy covered by this Code may not bar the right to recovery thereunder unless such false statement materially affected either the acceptance of the risk or hazard assumed by the insurance company. Laws 1984, ch. 127, § 341.

NMSA 1978, § 59A-18-12 Filing of forms and classifications; review of effect upon insured

59A-18-12. Filing of forms and classifications; review of effect upon insured A. An insurance policy, health care plan or annuity contract shall not be delivered or issued for delivery in this state, nor shall an assumption certificate, endorsement, rider or application that becomes a part of a policy or health care plan be used, until a copy of the form and the classification of risks pertaining to the policy or health care plan has been filed with the superintendent. Except for a filing for health insurance or health care plan rates, a filing shall be made at least sixty days before its proposed effective date. A filing made pursuant to this section shall not become effective nor shall it be used until approved by the superintendent pursuant to Section 59A-18-14 NMSA 1978, at which time it may be used. A filing related to health insurance or health care plan or rates shall be subject to the provisions of Section 5 [59A-18-13 NMSA 1978] of this 2011 act. A filing for any kind of insurance other than life insurance, health care plans or health insurance, as defined in the Insurance Rate Regulation Law, shall be deemed to meet the requirements of Chapter 59A, Article 18 NMSA 1978 to become effective unless disapproved pursuant to Section 59A-18-14 NMSA 1978 by the superintendent before the expiration of the waiting period or an extension of the waiting period; provided, that: (1) this subsection shall not apply as to policies, contracts, endorsements or riders of unique and special character not for general use or offering but designed and used solely as to a particular insured or risk; (2) if the superintendent has exempted a person or a class of persons or a market segment from a part or all of the provisions of the Insurance Rate Regulation Law pursuant to Subsection C of Section 59A-17-2 NMSA 1978, the superintendent also may exempt by rule that person, class of persons or market segment from a part or all of the provisions of this subsection; (3) an insurer subject to the Insurance Rate Regulation Law may authorize an advisory organization to file policy forms, endorsements and other contract language and related attachment rules on its behalf. Reference filings shall be made prior to their use or by other methods the superintendent may allow by rule; and (4) the superintendent may, by rule, exempt various lines and kinds of commercial insurance, as defined in the Insurance Rate Regulation Law, from some or all of the requirements of this subsection. B. A workers' compensation insurance policy covering a risk arising from the employment of a worker performing work for an employer in New Mexico when that employer is not domiciled in New Mexico shall not be issued or become effective, nor shall any endorsement or rider covering such a risk be issued or become effective, until a copy of the form and the classification of risks pertaining thereto have been filed with the superintendent. C. An insured, a beneficiary or, in the public interest of the state, the attorney general, may in writing request the insurer to review the manner in which its filing has been applied as to insurance or health care plan afforded the insured, the beneficiary, or the attorney general. If the insurer fails to make a review and grant appropriate relief within thirty days after the request is received, the insured, the beneficiary or the attorney general may file a written complaint and request for a hearing with the superintendent stating grounds relied upon. If the complaint charges a violation of the Insurance Code and the superintendent finds that the complaint was made in good faith and that the insured, the beneficiary or the attorney general would be aggrieved if the violation is proved, the superintendent shall hold a hearing, with notice to the insured, the beneficiary or the attorney general and insurer stating the grounds of complaint. If upon the hearing the superintendent finds the complaint justified, the superintendent shall order the insurer to correct the matter complained of within a reasonable time specified but not less than twenty days after a copy of the order was mailed to or served upon the insurer. D. All filings submitted pursuant to this section shall be filed electronically. The superintendent may designate an entity to receive the electronic filings submitted pursuant to this section. E. As used in this section, "health insurance" or "health care plan" means a hospital and medical expense-incurred policy, plan or contract offered by a health insurer; nonprofit health service provider; health maintenance organization; managed care organization; or provider service organization; "health insurance" or "health care plan" does not include an individual policy intended to supplement major medical group-type coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy. Laws 1984, ch. 127, § 342; 1987, ch. 244, § 9; 1988, ch. 119, § 4; 1993, ch. 320, § 57; 2002, ch. 64, § 1; 2003, ch. 202, § 11; 2007, ch. 367, § 36; 2009, ch. 182, § 2; 2011, ch. 144, § 2.

NMSA 1978, § 59A-18-13 Approval or disapproval of health insurance forms

59A-18-13. Approval or disapproval of health insurance forms A. With policy, endorsement, rider and application forms and classification of risks filed by the insurer with the superintendent under Section 59A-18-12 NMSA 1978 as to health insurance and health care plans, the insurer shall also file with the superintendent its rates applicable to such health insurance forms. An insurer shall not use any form that has not been approved by the superintendent or that is not in effect in accordance with Section 59A-18-14 NMSA 1978. B. All filings submitted pursuant to this section shall be filed electronically. The superintendent may designate an entity to receive the electronic filings submitted pursuant to this section. Laws 1984, ch. 127, § 343; 1987, ch. 244, § 10; 2003, ch. 397, § 1; 2009, ch. 182, § 3; 2011, ch. 144, § 3.

NMSA 1978, § 59A-18-13.1 Adjusted community rating

59A-18-13.1. Adjusted community rating A. Every insurer, fraternal benefit society, multiple employer welfare arrangement, health maintenance organization or nonprofit health care plan that provides primary health insurance or health care coverage insuring or covering major medical expenses shall, in determining the initial year's premium charged for an individual, use only the rating factors of age, geographic area of the place of employment and smoking practices, except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment. B. Separately for an insurer's individual and group policies, no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under nineteen years of age or children nineteen to twenty-five years of age who are full-time students may have rates that are lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from offering rates that differ depending upon family composition. For the purposes of this subsection, "family composition" refers only to whether coverage covers an individual or a family. C. The provisions of this section do not preclude an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from using health status or occupational or industry classification in establishing the amount a large group health benefits plan may be charged for coverage. D. As used in Subsection C of this section, "health status" does not include genetic information. E. The superintendent shall adopt regulations to implement the provisions of this section. Laws 1994, ch. 75, § 26; 1997, ch. 22, § 1; 1997, ch. 243, § 18; 1998, ch. 41, § 1; 2010, ch. 95, § 1; 2019, ch. 259, § 1.

NMSA 1978, § 59A-18-13.2 Health insurance; health care plan rates filing requirements

59A-18-13.2. Health insurance; health care plan rates filing requirements A. All health insurance or health care plan rates filed by an insurer with the superintendent pursuant to Section 59A-18-12 NMSA 1978 shall include all related forms. B. An insurer shall not use a rate without prior approval of the superintendent pursuant to Section 6 [59A-18-13.3 NMSA 1978] of this 2011 act and compliance with the provisions of that act. C. Upon making a filing pursuant to Subsection A of this section, an insurer shall provide written notice to policyholders and beneficiaries potentially affected by the insurer's filing. The language of the notice shall meet the minimum language simplification standards in the Policy Language Simplification Law [59A-19-1 to 59A-19-7 NMSA 1978]. The insurer shall provide, at a minimum, the following in its notice: (1) a summary of the rates, including any percentage changes in the rates; (2) a summary of all related form changes; (3) an explanation of form and rate changes; and (4) the policyholder or beneficiary rights under the Insurance Code [Chapter 59A NMSA 1978], including the right to comment on the filing for the thirty days following the posting on the division's web site as required by Subsection D of this section. D. Within twelve days of the filing, the superintendent shall make available on the division's web site in language that shall meet the minimum language simplification standards in the Policy Language Simplification Law the following information provided by the insurer that relates to each block of business included in the filing: (1) the information required by Subsection C of this section; (2) the proposed rates; (3) a brief description of how the revised rates were determined, including the general description and source of each assumption used; (4) the expected medical loss ratio and, for blocks of business in existence for at least three years, the medical loss ratio for the three years preceding the date of filing, accompanied by supporting information as to how the blocks of business will meet the requirements for medical loss ratio in state and federal law; (5) if medical costs, including utilization and compensation rates, are alleged to justify a rate increase, the filing shall identify in the aggregate the types of expenditures in those categories that support the premium rate increase in the geographic area covered; (6) for blocks of business in existence for at least three years, premium revenues, claims history, losses and reserves for the three years preceding the date of filing, accompanied by supporting documentation; and (7) whether the insurer has ceased to actively offer or sell to new applicants a block of business for which it seeks a rate increase. E. Regarding an insurer's overall insurance operations in the state for the three years preceding the date of filing, the superintendent shall make available on the division's web site, at a minimum, the following information that the insurer provides: (1) a list detailing which blocks of business are open and which are closed to new enrollment; (2) reserves and surpluses for all product lines sold in the state and a reasonable estimate of the expected reserves and surpluses; and (3) changes in total medical and administrative costs over the previous three years. F. The superintendent shall post a link on the division's web site to the most recent annual financial statement and actuarial memorandum that the insurer has filed with the division. G. Notwithstanding any other provision of this section, upon request by an insurer, the superintendent may exempt from disclosure any part of the filing that the superintendent determines to contain proprietary information and that would, if disclosed, harm competition. Pending the superintendent's determination under this subsection, the superintendent shall not disclose the part of a filing that is the subject of an insurer's request. H. On the date that the superintendent posts a filing pursuant to Subsection D of this section, the superintendent shall open a thirty-day public comment period for policyholders and the general public, during which the policyholders and the general public may make comments online or in writing. The superintendent shall post on the division's web site in a manner easily accessible to the public all comments made during the thirty-day public comment period. I. All filings submitted pursuant to this section shall be filed electronically. The superintendent may designate an entity to receive the electronic filings submitted pursuant to this section. J. As used in this section, "health insurance" or "health care plan" means a hospital and medical expense-incurred policy, plan or contract offered by a health insurer; nonprofit health service provider; health maintenance organization; managed care organization; or provider service organization; "health insurance" or "health care plan" does not include an individual policy intended to supplement major medical group-type coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy. Laws 2011, ch. 144, § 5.

NMSA 1978, § 59A-18-13.3 Health insurance filings; grounds and procedure for approval or disapproval

59A-18-13.3. Health insurance filings; grounds and procedure for approval or disapproval A. The superintendent shall issue a final order within sixty days of the filing date for health insurance filings made on rates. The superintendent shall consider any public comment made pursuant to Subsection H of Section 59A-18-13.2 NMSA 1978. The superintendent shall issue findings and shall approve any rates on the following grounds: (1) the proposed rate is in compliance with federal law and the Insurance Code; (2) the proposed rate does not contain, or incorporate by reference, any inconsistent, ambiguous or misleading clause, exception or condition that deceptively affects the risk purported to be assumed in the general coverage of the contract or that encourages misrepresentation of the policy or its benefits; (3) the proposed rate is actuarially sound and is supported by the actuarial memorandum submitted; (4) the proposed rate is reasonable, not excessive or inadequate and not unfairly discriminatory; and (5) the proposed rate is based upon administrative expenses that are permitted by federal and state law. B. In order to determine whether the proposed rates are reasonable, actuarially sound and based on reasonable administrative expenses, the superintendent shall consider, at a minimum: (1) the financial position of the insurer's insurance operations in the state, including surplus and reserves as reported in the latest three years' financial statements filed by the insurer; (2) information provided to the superintendent for calculation of the amount of the insurer's direct services reimbursement pursuant to Section 59A-22-50, 59A-23C-10, 59A-46-51 [repealed] or 59A-47-46 NMSA 1978 [repealed]; (3) any anticipated change in the number of enrollees if the proposed rate is approved; (4) changes to covered benefits or health benefit plan design; (5) the insurer's compliance with all federal and state requirements for pooling risk and for participation in risk adjustment programs in effect under federal and state law; and (6) the reliability and accuracy of the information provided in order to assure a meaningful review. C. No final order shall be issued until after the close of the public comment period pursuant to Subsection H of Section 59A-18-13.2 NMSA 1978. D. In rate filings for which the superintendent holds a hearing on reconsideration pursuant to Section 59A-4-15 NMSA 1978, the superintendent shall issue a final order within sixty days of the hearing. E. A final order of the superintendent under this section may be appealed to the court of appeals pursuant to the provisions of Section 59A-18-13.5 NMSA 1978 within twenty days. F. As used in this section, "health insurance" or "health care plan" means a hospital and medical expense- incurred policy, plan or contract offered by a health insurer; nonprofit health service provider; health maintenance organization; managed care organization; or provider service organization; "health insurance" or "health care plan" does not include an individual policy intended to supplement major medical group-type coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy. Laws 2011, ch. 144, § 6; 2013, ch. 74, § 23.

NMSA 1978, § 59A-18-13.5 Review of health insurance or plan rates; appeal to court of appeals from superintendent

59A-18-13.5. Review of health insurance or plan rates; appeal to court of appeals from superintendent A. In a matter arising from an order of the superintendent on appeal pursuant to Section 59A-18-13.3 NMSA 1978, an aggrieved party may appeal to the court of appeals. B. The court of appeals shall consider the superintendent's order on appeal and reverse the order only if the court determines: (1) after evaluation of the record of evidence as a whole, that the superintendent's decision was not based on substantial evidence as to whether the proposed rates are reasonable, actuarially sound and based on reasonable administrative expenses; (2) that the superintendent's decision was arbitrary, capricious or an abuse of discretion; or (3) that the superintendent's decision on appeal is otherwise not in accordance with law. Laws 2011, ch. 144, § 8; 2013, ch. 74, § 24.

NMSA 1978, § 59A-18-13.6 Pooling of closed blocks of business

59A-18-13.6. Pooling of closed blocks of business For the purpose of determining the rate of any policy within a closed block of business, the superintendent may require an insurer to pool the experience of a closed block of business with all appropriate blocks of business that are not closed in accordance with Section 59A-18-13.1 NMSA 1978. An insurer shall not apply a rate penalty or surcharge beyond that which reflects the experience of a pool combined in accordance with this section. Laws 2011, ch. 144, § 9.

NMSA 1978, § 59A-18-14 Grounds, procedure for disapproval

59A-18-14. Grounds, procedure for disapproval A. The superintendent shall review any filing, except any filing by a health insurance issuer for a change in rate, made pursuant to Section 59A-18-12 or 59A-18-13 NMSA 1978 within sixty days of the filing date. The superintendent shall approve any form if the superintendent finds that it complies with the Insurance Code [Chapter 59A NMSA 1978] and shall disapprove any form, classification of risks or rate only on one or more of the following grounds: (1) if the form is in any respect in violation of or does not comply with the Insurance Code; (2) if the form contains, or incorporates by reference where such incorporation is otherwise permissible, any inconsistent, ambiguous or misleading clauses or exceptions and conditions that deceptively affect the risk purported to be assumed in the general coverage of the contract, or that encourage misrepresentation of the policy or its benefits; (3) if the benefits offered are unreasonably restricted in relation to the premium charged; (4) if the form has a title, heading or other indication of its provisions that is misleading or if the form is printed in such type or manner of reproduction as to be difficult to read; or (5) if purchase of the form is being solicited by advertising, communication or dissemination of information that is deceptive or misleading. B. If the superintendent disapproves any form during the sixty-day review period, the superintendent shall give the insurer written notice of the disapproval, stating the grounds for the disapproval. C. After expiration of the sixty-day review period referred to in Subsection A of this section or at any time after having approved a form, the superintendent may, after a hearing thereon, disapprove a form or withdraw a previous approval on any of the grounds stated in Subsection A of this section. The superintendent's order issued on such hearing shall state the grounds for disapproval or withdrawal of previous approval and the date, not less than twenty days after the date of the order, when disapproval or withdrawal of approval shall become effective. D. Any filing for a rate by a health insurance issuer shall be reviewed pursuant to the provisions of Section 6 [59A-18-13.3 NMSA 1978] of this 2011 act. E. As used in this section, "health insurance issuer" means a health insurer; nonprofit health service provider; health maintenance organization; managed care organization; or provider service organization that offers a hospital and medical expense-incurred policy, plan or contract; "health insurance issuer" does not include a person that offers an individual policy intended to supplement major medical group-type coverage such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or any other limited-benefit health insurance policy. Laws 1984, ch. 127, § 344; 1987, ch. 244, § 11; 2011, ch. 144, § 4.

NMSA 1978, § 59A-18-16 Continuation of coverage and conversion rights; accident and health insurance policies; notice

59A-18-16. Continuation of coverage and conversion rights; accident and health insurance policies; notice Subject to the provisions of the Health Insurance Portability Act: A. every accident and health insurance policy that provides hospital, surgical and medical expense benefits and that is delivered, issued for delivery or renewed in this state on or after January 1, 1985 shall provide: (1) if an individual policy, covered family members the right to continue such policy as the named insured or through a conversion policy upon the death of the named insured or upon the divorce, annulment or dissolution of marriage or legal separation of the spouse from the named insured; or (2) if a group policy: (a) each member or employee of the group insured the right to continue such coverage for a period of six months and thereafter through a conversion policy upon termination of membership or employment with the group insured; and (b) covered family members of an employee or member of the group insured the right to continue such coverage through a converted or separate policy upon the death of the member or employee of the group insured or upon the divorce, annulment or dissolution of marriage or legal separation of the spouse from the member or employee of the group insured. Where a continuation of coverage or conversion is made in the name of the spouse of the named insured or the spouse of the employee or member of the group insured, such coverage may, at the option of the spouse, include coverage for dependent children for whom the spouse has responsibility for care and support; B. the right to a continuation of coverage or conversion pursuant to this section shall not exist with respect to any member or employee of the group insured or any covered family member in the event the coverage terminates for nonpayment of premium, nonrenewal of the policy or the expiration of the term for which the policy is issued. With respect to any member or employee of the group insured or any covered family member who is eligible for medicare or any other similar federal or state health insurance program, the right to a continuation of coverage or conversion shall be limited to coverage under a medicare supplement insurance policy as defined by the rules and regulations adopted by the superintendent; C. coverage continued through the issuance of a converted or separate policy shall be provided at a reasonable, nondiscriminatory rate to the insured and shall consist of a form of coverage then being offered by the insurer as a conversion policy in the jurisdiction where the person exercising the conversion right resides that most nearly approximates the coverage of the policy from which conversion is exercised. Continued and converted coverages shall contain renewal provisions that are not less favorable to the insured than those contained in the policy from which the conversion is made, except that the person who exercises the right of conversion is entitled only to have included a right to coverage under a medicare supplement insurance policy, as defined by the rules and regulations adopted by the superintendent, after the attainment of the age of eligibility for medicare or any other similar federal or state health insurance program; D. at the time of inception of coverage, the insurer shall furnish to each covered family member who is eighteen years of age or over and to each employee or member of the group insured a statement setting forth in summary form the continuation of coverage and conversion provisions of the policy; E. the insurer shall notify in writing each employee or member, upon that employee's or member's termination of employment or membership with the group insured, of the continuation and conversion provisions of the policy. The employer may give the written notice specified herein. The employer should notify the insurer of the employee's or member's change of status and last known address. Under no circumstances shall the employer have any civil liability under the conversion provisions of the Insurance Code; F. the eligible employee or member of the group insured or covered family member exercising the continuation or conversion right shall notify the employer or insurer and make payment of the applicable premium within thirty days following the date of the notification given by the insurer pursuant to Subsection E of this section. There shall be no lapse of coverage during the period in which conversion is available; G. coverage shall be provided through continuation or conversion without additional evidence of insurability and shall not impose any preexisting condition, limitations or other contractual time limitations; H. benefits otherwise payable under a converted or separate policy may be reduced so they are not, during the first policy year of the converted or separate policy, in excess of those that would have been payable under the policy from which conversion is exercised. Benefits, if any, otherwise payable under a converted or separate policy are not payable for a loss claimed under the policy from which conversion is exercised; and I. any probationary or waiting period set forth in the converted or separate policy is deemed to commence on the effective date of the applicant's coverage under the original policy. Laws 1984, ch. 127, § 345.1; 1987, ch. 259, § 18; 1997, ch. 243, § 19; 2019, ch. 259, § 2.

NMSA 1978, § 59A-18-16.1 Group coverage discontinuance and replacement

59A-18-16.1. Group coverage discontinuance and replacement The superintendent may promulgate reasonable rules and regulations to establish requirements for group coverage discontinuance and replacement. 1978 Comp., § 59A-18-16.1, enacted by Laws 1993, ch. 320, § 58.

NMSA 1978, § 59A-18-16.2 Health insurance or health plan form and rate filings; superintendent; rulemaking; compliance with federal law

59A-18-16.2. Health insurance or health plan form and rate filings; superintendent; rulemaking; compliance with federal law A. A small group health plan and a health insurance issuer or multiple employer welfare arrangement offering a small group or individual health insurance plan that provides benefits other than excepted benefits shall: (1) provide the essential health benefits defined by the superintendent under Subsection B of this section; (2) limit cost sharing for such coverage in accordance with Subsection D of this section; and (3) provide coverage without cost sharing for preventive benefits in accordance with Subsection E of this section. B. The superintendent shall define by rule the essential health benefits package to include at least the following general categories and the items and services covered within the categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services, including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. C. In defining the essential health benefits pursuant to Subsection B of this section, the superintendent shall: (1) ensure that such essential health benefits reflect an appropriate balance among the categories described in that subsection, so that benefits are not unduly weighted toward any category; (2) not make coverage decisions, determine reimbursement rates, establish incentive programs or design benefits in ways that discriminate against individuals because of their age, disability or expected length of life; (3) take into account the health care needs of diverse segments of the population, including women, children, persons with disabilities and other groups; (4) ensure that health benefits established as essential not be subject to denial to individuals against their wishes on the basis of the individual's age or expected length of life or of the individual's present or predicted disability, degree of medical dependency or quality of life; (5) provide that if a plan is offered through the New Mexico health insurance exchange, another health insurance plan offered through the New Mexico health insurance exchange shall not fail to be treated as a qualified health plan solely because the plan does not offer coverage of benefits offered through the standalone plan that are otherwise required; and (6) periodically update the essential health benefits under Subsection B of this section to address any gaps in access to coverage or changes in the evidence base identified by the superintendent. D. A group health plan and a health insurance issuer offering a group or individual health insurance plan shall not establish a restricted lifetime or annual limit on the dollar value of benefits for any participant or beneficiary with respect to benefits that are essential health benefits, as determined by the superintendent. The provisions of this subsection shall not be construed to prevent a group health plan or health insurance plan from placing annual or lifetime per-beneficiary limits on specific covered benefits that are not essential health benefits, to the extent that these limits are otherwise permitted under federal or state law. E. The superintendent shall adopt and promulgate rules specifying the maximum cost-sharing amounts for which an insured may be held liable for payment of covered benefits under any health insurance plan that provides benefits other than excepted benefits, including deductibles, coinsurance, copayments or similar charge, and any other expenditure required of an insured individual with respect to essential health benefits covered under the plan, but not including premiums, balance billing amounts for non-network providers or spending for non-covered services. F. Any rules that the office of superintendent of insurance intends to adopt and promulgate pursuant to this section shall be adopted no later than the first day of February of the year prior to the first plan year for which the rules would be effective. G. A group health plan and a health insurance issuer offering a group or individual health insurance plan that provides benefits other than excepted benefits shall provide coverage for and shall not impose any cost-sharing requirements for: (1) items or services that have in effect a rating of "A" or "B" in the current recommendations of the United States preventive services task force; (2) immunizations that have in effect a recommendation from the department of health, with respect to the insured for which immunization is considered; (3) with respect to infants, children and adolescents, preventive care and screenings provided for in the comprehensive guidelines supported by the health resources and services administration of the United States department of health and human services; and (4) with respect to women, additional preventive care and screenings to those described in Paragraph (1) of this subsection, as provided for in comprehensive guidelines supported by the health resources and services administration of the United States department of health and human services. H. The provisions of Subsection G of this section shall not be construed to prohibit a health insurance plan or health insurance issuer from providing coverage for services in addition to those recommended by the United States preventive services task force or to deny coverage for services that are not described in this section. The superintendent shall establish by rule a minimum interval between the date on which a recommendation described in Paragraphs (1) and (2) of Subsection G of this section or a guideline under Paragraph (3) of Subsection G of this section is issued and the plan year with respect to which the requirement described in Subsection G of this section is effective with respect to the service described in such recommendation or guideline; provided that the interval shall not be less than one year from the date the federal recommendation or guideline is published. I. If a health insurance plan is offered as a qualified health plan through the New Mexico health insurance exchange, the insurer offering the qualified health plan shall also offer that plan through the health insurance exchange as a plan that restricts enrollment to individuals who, as of the beginning of a plan year, have not attained the age of twenty-one years. J. The superintendent shall adopt rules: (1) to define terms used regarding forms, rates, reviews and blocks of business that an insurer or health care plan submits in filing matters; (2) to govern any additional filing requirements the superintendent deems appropriate; (3) to provide notice of hearings and the grounds on which the hearings have been requested; (4) to meet criteria for review in accordance with federal law; and (5) that the superintendent deems appropriate to carry out the provisions of Chapter 59A, Article 18 NMSA 1978. K. Except as provided by state or federal rule or law, nothing in this section shall be construed to prohibit a health insurance carrier from appropriately using reasonable health care cost management techniques. L. As used in this section, "excepted benefits" means benefits furnished pursuant to the following: (1) coverage-only accident or disability income insurance; (2) coverage issued as a supplement to liability insurance; (3) liability insurance; (4) workers' compensation or similar insurance; (5) automobile medical payment insurance; (6) credit-only insurance; (7) coverage for on-site medical clinics; (8) other similar insurance coverage specified in regulations under which benefits for medical care are secondary or incidental to other benefits; (9) the following benefits if offered separately: (a) limited scope dental or vision benefits; (b) benefits for long-term care, nursing home care, home health care, community-based care or any combination of those benefits; and (c) other similar limited benefits specified in regulations; (10) the following benefits, offered as independent noncoordinated benefits: (a) coverage only for a specified disease or illness; or (b) hospital indemnity or other fixed indemnity insurance; and (11) the following benefits if offered as a separate insurance policy: (a) medicare supplemental health insurance as defined pursuant to Section 1882(g)(1) of the federal Social Security Act; and (b) coverage supplemental to the coverage provided pursuant to Chapter 55 of Title 10 USCA and similar supplemental coverage provided to coverage pursuant to a group health plan. Laws 2011, ch. 144, § 12; 2019, ch. 259, § 3; 2025 (1st S.S.), ch. 5, § 7; repealed and reenacted by Laws 2025 (1st S.S.), ch. 5, § 13.

NMSA 1978, § 59A-18-17 Standard provisions, in general

59A-18-17. Standard provisions, in general A. Insurance contracts shall contain such standard or uniform provisions as are required by applicable provisions of the Insurance Code [Chapter 59A NMSA 1978] pertaining to contracts of particular kinds of insurance. B. No policy shall contain a provision inconsistent with or contradictory to a standard or uniform provision used or required to be used, but the superintendent may approve a substitute provision that is, in the superintendent's opinion, not less favorable in any particular to the insured, owner or beneficiary than the provision otherwise required or that is designed to comply with Chapter 59A, Article 19 NMSA 1978. C. Insurance coverage provided in residential property insurance policies shall provide coverage for the cost to repair or replace without deduction for depreciation. If the insured elects to effectuate repairs to the property by the insured's own self, a reasonable overhead expense shall be allowed. D. In lieu of the provisions required by the Insurance Code for contracts for particular kinds of insurance, substantially similar provisions required by the laws of the domicile of a foreign or alien insurer may be used when approved by the superintendent. E. A policy issued by a domestic insurer for delivery in another jurisdiction may contain any provision required or permitted under the laws of such jurisdiction. F. To protect consumers as well as enhance the value of consumer information systems, the superintendent may specify minimum coverage provisions that homeowners insurance policies, private passenger non-fleet automobile insurance policies or other lines or kinds of insurance policies that are priced in a consumer information system shall contain, provided that such minimum coverage provisions are contained in the majority of policies in force in New Mexico for that line or kind of insurance. An insurer that does not offer a policy that contains the minimum coverage provisions specified by the superintendent for a line or kind of insurance shall not be included in a consumer information system for that line or kind of insurance. The superintendent shall not compel an insurer to offer a policy containing minimum coverage provisions specified by the superintendent. Laws 1984, ch. 127, § 346; 1993, ch. 85, § 1; 2007, ch. 367, § 37.

NMSA 1978, § 59A-18-18 Charter, bylaw provisions

59A-18-18. Charter, bylaw provisions No policy shall contain any provision purporting to make any portion of the charter, bylaws or other constituent document of the insurer (other than the subscriber's agreement or power of attorney of a reciprocal insurer) a part of the contract unless such portion is set forth in full in the policy. Laws 1984, ch. 127, § 347.

NMSA 1978, § 59A-18-19 Execution of policies

59A-18-19. Execution of policies A. Every policy shall be executed in the name of and on behalf of the insurer by its officer, attorney-in-fact, employee or representative duly authorized by the insurer. B. A facsimile signature of any such executing individual may be used in lieu of an original signature. C. No policy which is otherwise valid shall be rendered invalid by reason of the apparent execution thereof on behalf of the insurer by the imprinted facsimile signature of an individual not authorized so to execute as of the date of the policy. Laws 1984, ch. 127, § 348.

NMSA 1978, § 59A-18-20 Underwriters' and combination policies

59A-18-20. Underwriters' and combination policies A. Two (2) or more authorized insurers may jointly issue, and shall be jointly and severally liable on, an underwriters' policy bearing their names. Any one insurer may issue policies in the name of an underwriter's department and such policy shall plainly show the true name of the insurer. B. Two (2) or more insurers may, with the superintendent's approval, issue a combination policy containing additional provisions substantially as follows: (1) that the insurers executing the policy shall be severally liable for the full amount of any loss or damage, according to the terms of the policy, or for specified percentages or amounts thereof, aggregating the full amount of insurance under the policy; and (2) that service of process, or of any notice or proof of loss required by such policy, upon any of the insurers executing the policy shall constitute service upon all such insurers. C. This section does not apply to cosurety obligations. Laws 1984, ch. 127, § 349.

NMSA 1978, § 59A-18-21 Validity, construction of noncomplying forms

59A-18-21. Validity, construction of noncomplying forms A. A policy delivered or issued for delivery after the effective date of the Insurance Code [Chapter 59A NMSA 1978] to any person in this state in violation of the Insurance Code but otherwise binding on the insurer, shall be held valid, but shall be construed as provided in the Insurance Code. B. Any condition, omission or provision not in compliance with the requirements of the Insurance Code and contained in any policy, rider or endorsement issued after the effective date of the Insurance Code and otherwise valid shall not thereby be rendered invalid but shall be interpreted and applied in accordance with such condition, omission or provision as would have applied had the same been in full compliance with the Insurance Code. Laws 1984, ch. 127, § 350.

NMSA 1978, § 59A-18-22 Binders

59A-18-22. Binders A. While acting within the scope of authority granted by the insurer, binders or other contracts for temporary insurance may be made by a producer orally or in writing, and shall be deemed to include all the usual terms of the policy as to which the binder was given together with such applicable endorsements as are designated in the binder, except as superseded by the clear and express terms of the binder. B. No binder shall be valid beyond the issuance of the policy as to which given, or beyond ninety days for written binders, fifteen days for oral, from its effective date, whichever period is the shorter. C. If the policy has not been issued, a binder may be extended or renewed beyond such ninety or fifteen days with the written approval of the insurer. D. This section shall not apply as to life or health insurances; and binders under the standard fire policy are governed by Section 492 of the Insurance Code and not by this section. Laws 1984, ch. 127, § 351; 2021, ch. 108, § 14.

NMSA 1978, § 59A-18-23 Delivery of policy, motor vehicle vendors, mortgagees, pledgees

59A-18-23. Delivery of policy, motor vehicle vendors, mortgagees, pledgees A. If the original policy is delivered or is so required to be delivered to or for deposit with any vendor, mortgagee or pledgee of any motor vehicle, in which policy any interest of the vendee, mortgagor or pledgor in or with respect to such vehicle is insured, a duplicate of the policy setting forth the name and address of the insurer, insurance classification of vehicle, type of coverage, limits of liability, premiums for the respective coverages, and duration of the policy, or memorandum thereof containing the same information, shall be delivered by the vendor, mortgagee or pledgee to each such vendee, mortgagor or pledgor named in the policy or coming within the group of persons designated in the policy to be so included. If the policy does not provide coverage of legal liability of the vendee, mortgagor or pledgor for injury to persons or damage to property of third parties, a statement of such fact shall be printed, written or stamped conspicuously on the face of the duplicate policy or memorandum. B. This section does not apply to inland marine floater policies. Laws 1984, ch. 127, § 352.

NMSA 1978, § 59A-18-24 Insurance producers; whom they represent

59A-18-24. Insurance producers; whom they represent A licensed insurance producer appointed as insurance producer by an insurer shall, in any controversy between the insured or the insured's beneficiary and the insurer, be held to be the agent of the insurer that issued the insurance solicited or applied for, anything in the application or policy to the contrary notwithstanding; and a broker licensed to transact insurance business in this state, in any controversy between the insured or the insured's beneficiary and the insurer issuing the insurance through its licensed insurance producer at request of the broker, shall be held to be the agent of the insured, anything in the application or policy to the contrary notwithstanding, unless under particular circumstances it is found that the broker is representing the insurer. This section shall not apply as to surplus line brokers, nor as to acts of the insurance producer in fraud or attempted fraud of the insurer or acts of the broker in fraud or attempted fraud of the insured. Laws 1984, ch. 127, § 353; 2016, ch. 89, § 60.

NMSA 1978, § 59A-18-25 Allowance for inflation

59A-18-25. Allowance for inflation Where amounts of insurance under group, blanket or other forms of life, annuity or health insurance coverage are now or hereafter limited to specified dollar amounts by any provision of the Insurance Code, the insurer may, with the superintendent's approval and notwithstanding the statutory limit otherwise applicable, increase the dollar amount of coverage in particular policies or contracts as reasonably necessary to offset devaluation of dollar purchasing power because of inflation, and to provide current coverage in amount reasonably related to dollar purchasing power at the time such statutory limit was enacted. The superintendent may promulgate reasonable rules and regulations for effectuation of this section under which the increased amounts of coverage may be applied generally and without approval by the superintendent of increases in each instance. Laws 1984, ch. 127, § 354.

NMSA 1978, § 59A-18-26 Payment discharges insurer

59A-18-26. Payment discharges insurer Whenever the proceeds of or payments under a life or health insurance policy or annuity contract heretofore or hereafter issued become payable in accordance with the terms of the policy or contract, or exercise of any right or privilege thereunder, and the insurer makes payment thereof in accordance with the terms of the policy or contract or in accordance with any written assignment thereof, the person then designated in the policy, contract or assignment as being entitled thereto shall be entitled to receive such proceeds or payments and to give full acquittance therefor; and such payments shall fully discharge the insurer from all claims under the policy or contract unless, before payment is made, the insurer has received at its home office written notice by or on behalf of some other person that such other person claims to be entitled to such payment or some interest in the policy or contract. Laws 1984, ch. 127, § 355.

NMSA 1978, § 59A-18-27 Forms of proof of loss to be furnished

59A-18-27. Forms of proof of loss to be furnished Upon receiving due notice of a claim of loss under an insurance contract issued or assumed by it, an insurer shall promptly furnish to the insured claimant such forms of proof of loss as it may require for completion by such person, but the insurer shall not have any responsibility for or with respect to completion of such proof or the manner of any such completion or attempted completion. Laws 1984, ch. 127, § 356.

NMSA 1978, § 59A-18-27.1 Universal claim forms

59A-18-27.1. Universal claim forms A. The superintendent shall devise or designate universal forms to be utilized by every health insurer, including health maintenance organizations, nonprofit health plans and fraternal organizations offering any type of health coverage for individuals residing in this state, for the purpose of receiving claims under their policies. In preparing the forms, the superintendent may consult with insurers, trade associations and other interested parties. Upon adoption of the final forms by the superintendent, he shall notify the insurers affected by sending them a specimen copy of the adopted forms and an explanation of the requirements of this section. Every covered insurer shall begin using the adopted forms not later than six months following the date of the superintendent's notification. B. A health insurer may not refuse to accept a claim submitted on uniform claim forms adopted pursuant to Subsection A of this section, but may accept claims submitted on any other form. C. A health insurer does not violate this section by using a claim form that the insurer has been required to use by the state or federal government. 1978 Comp., § 59A-18-27.1, enacted by Laws 1993, ch. 126, § 2.

NMSA 1978, § 59A-18-28 Notice; waiver

59A-18-28. Notice; waiver The acknowledgment by any insurance company of the receipt of notice given under any policy covered by this code [Chapter 59A NMSA 1978], or the furnishing of forms for filing proofs of loss, or the acceptance of such proofs, or the investigation of any claim thereunder shall not operate as a waiver of any of the rights of the insurance company in defense of any claim arising under such policy. Laws 1984, ch. 127, § 357.

NMSA 1978, § 59A-18-29 Cancellation of certain policies

59A-18-29. Cancellation of certain policies A. An insurer or agent may at any time cancel a policy for nonpayment of premium when due, whether the premium is payable directly to the insurer or agent or indirectly under any premium financing plan or extension of credit. The insurer or agent shall give the named insured written notice of the cancellation not less than ten days prior to the effective date of the cancellation. B. An insurer may cancel its policy without cause at any time within sixty days following original issuance and effective date of the policy. The insurer shall give the named insured written notice of the cancellation not less than ten days prior to the effective date of the cancellation, which effective date shall fall within the sixty-day period. C. Subject to Subsection A of this section, after expiration of the sixty-day period referred to in Subsection B of this section, an insurer or agent shall not cancel except for reasonable cause such policies and for such causes, and with advance notice of cancellation for such period of time, as may from time to time be provided by rules and regulations of the superintendent. Such rules and regulations may also require that statement of the reasons for cancellation be contained in the notice of cancellation given to specified persons. D. Notice of cancellation shall be given using any communication method authorized by the named insured, or by personal delivery to the named insured or by mailing the notice postage-paid addressed to the named insured at the address last of record with the insurer. Notice so mailed shall be deemed given when deposited in a mail depository of the United States post office. E. There shall be no liability on the part of and no cause of action shall arise against an insurer or other person for furnishing information as to reasons for cancellation or for a statement made or information given pursuant to this section. F. This section shall not apply as to life insurance or annuity contracts, health insurance contracts, title insurance, inland marine insurance contracts, or to an insurance policy that by its terms is not cancellable during the term of the policy at the option of the insurer. Laws 1984, ch. 127, § 358; 2021, ch. 108, § 15.

NMSA 1978, § 59A-18-30 Disclosure of premium and claim data

59A-18-30. Disclosure of premium and claim data A. An insurer shall for a policy of insurance coverage provide the named insured of the policy with premium and claim data within sixty days of receipt of a written request from the named insured. B. As used in this section "premium and claim data" shall include: (1) the sum of all premiums charged or billed by the insurer for the insurance policy; (2) the sum of all amounts paid out pursuant to claims covered under the policy; (3) a list of all pending claims against the policy which are open; and (4) cumulative loss or claim reserves chargeable to the policy. C. None of the provisions of this section shall be applicable to life insurance policies or group insurance policies. 1978 Comp., § 59A-18-31, enacted by Laws 1987, ch. 281, § 1.

NMSA 1978, § 59A-18-31 Accident and health policy or certificate provisions relating to individuals who are eligible for medical benefits under the medicaid program

59A-18-31. Accident and health policy or certificate provisions relating to individuals who are eligible for medical benefits under the medicaid program A. Each individual or group policy or certificate of accident or health insurance 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 or certificate 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 insurer 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 insurer. C. Notwithstanding any other provisions of law, checks in payment for claims pursuant to any individual or group policy or certificate of accident or health insurance for health care services provided to insured individuals who are also eligible for benefits under the medicaid program and provided by medical providers qualified to participate under the policy or certificate shall be made payable to the provider. The insurer 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 insurer. D. No individual or group accident or health policy or certificate delivered, issued for delivery or renewed in this state on 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. E. To the extent that payment for covered expenses has been made pursuant to the state medicaid program for health care items or services furnished to an individual, in any case where an insurer has a legal liability to make payments, the state is considered to have acquired the rights of the individual to payment by the insurer for those health care items or services. 1978 Comp., § 59A-18-31, enacted by Laws 1989, ch. 183, § 1; 1994, ch. 64, § 1.

NMSA 1978, § 59A-18-32 Certificates of property or casualty insurance

59A-18-32. Certificates of property or casualty insurance A. As used in this section: (1) "certificate of insurance" means any document or instrument prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage, but excludes an insurance policy, insurance binder, policy endorsement or automobile insurance identification or information card; and (2) "insurance producer" means a person required to be licensed pursuant to the laws of New Mexico to sell, solicit or negotiate property or casualty insurance. B. A person shall not prepare, issue or require the issuance of a certificate of insurance on property, operations or risks located in New Mexico unless an insurer or an agent of an insurer has filed the certificate of insurance form with the superintendent at least sixty days before its proposed effective date. The superintendent shall review any filing made pursuant to this subsection within sixty days of the filing date. The superintendent shall prohibit the use of a certificate of insurance form if the form: (1) is unfair, misleading or deceptive; (2) violates public policy; or (3) violates any law, including any rule promulgated by the superintendent. C. If the superintendent prohibits a certificate of insurance form during the sixty-day review period, the superintendent shall give the insurer written notice of the disapproval, stating the grounds for disapproval. After the expiration of the sixty-day review period, a filing shall be deemed to meet the requirements of this section to become effective unless prohibited pursuant to this section. D. An individual insurer shall not be required to file a certificate of insurance form if that form is: (1) the current edition of a standard certificate of insurance form that is promulgated by the association for cooperative operations research and development, the American association of insurance services or the insurance services office and that is filed with and approved by the superintendent pursuant to Subsection E of this section; or (2) a certificate of insurance form whose content and wording are specifically provided for by federal law or regulation or a law or rule of New Mexico. E. The superintendent shall review any filing made pursuant to Paragraph (1) of Subsection D of this section within sixty days of the filing date. A filing made pursuant to Paragraph (1) of Subsection D of this section shall not be used until approved by the superintendent. The superintendent shall approve any form if the superintendent finds that it complies with the Insurance Code. After the expiration of the sixty-day review period, a filing shall be deemed to meet the requirements of this section to become effective unless disapproved pursuant to this subsection. F. A filing submitted pursuant to this section shall be filed electronically. The superintendent may designate an entity to receive the electronic filings submitted pursuant to this section. G. A certificate of insurance is not an insurance policy and does not affirmatively or negatively amend, extend or alter the coverage afforded by the policy to which the certificate of insurance refers. A certificate of insurance shall not confer to any person new or additional rights beyond the express provisions of the insurance policy to which it refers. H. A person shall not: (1) alter or modify a certificate of insurance form filed with the superintendent; or (2) prepare, issue or require the issuance of a certificate of insurance that: (a) contains any false or misleading information concerning the insurance policy to which the certificate of insurance refers; or (b) purports to affirmatively or negatively alter, amend or extend the coverage provided by the insurance policy to which the certificate of insurance refers. I. A contract number or description in a certificate of insurance shall not indicate that the insurance policy complies with the insurance or indemnification requirements of a contract. A person shall not certify in a certificate of insurance that the insurance policy to which it refers complies with the insurance or indemnification requirements of a contract. J. An insurer or insurance producer shall notify a person of the cancellation or nonrenewal of or material change to an insurance policy only if that person has the right to notice pursuant to the terms of the insurance policy or an endorsement to an insurance policy. The insurance policy or endorsement to an insurance policy shall govern the terms and conditions of the notice. A certificate of insurance shall not alter the terms and conditions of the notice. K. The provisions of this section apply to all certificates of insurance issued in connection with property, operations or risks in New Mexico, regardless of the location of the policyholder, insurer, insurance producer or person requiring the issuance of a certificate of insurance. L. A certificate of insurance or any other document or correspondence prepared, issued or required in violation of this section shall be void. Laws 2013, ch. 100, § 2.

NMSA 1978, § 59A-18-33 Notice

59A-18-33. Notice A. An organization that publishes information regarding the effectiveness of community fire protection or building code information, including public protection classifications, community grading, building code effectiveness classifications or fire suppression rating schedules for use by residential property insurers in this state, shall provide notice of any unfavorable change in a community's classification to the office of superintendent of insurance. B. Upon receiving notice of an unfavorable change in a community's public protection classification, community grading, building code effectiveness classification or fire suppression rating schedule, the office of superintendent of insurance shall issue a bulletin notifying insurers of the change and the communities affected and instructing insurers to notify customers who may be adversely affected by the unfavorable change within ninety days of the publication of the bulletin. Laws 2019, ch. 84, § 1.

Source: New Mexico Compilation Commission (nmonesource.com)URL: https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.doFetched: 10/20/2026