New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 14 - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP HEALTH INSURANCE CONTRACTS
Section 13.10.14.22 - MINIMUM MORBIDITY STANDARDS FOR VALUATION OF SPECIFIED INDIVIDUAL CONTRACT HEALTH INSURANCE BENEFITS
Universal Citation: 13 NM Admin Code 13.10.14.22
Current through Register Vol. 35, No. 6, March 26, 2024
A. Disability Income Benefits Due to Accident or Sickness.
(1)
Contract Reserves.
(a) For contracts
issued on or after January 1, 1997, the 1985 commissioners individual
disability tables A (85CIDA); or The 1985 commissioners individual disability
tables B (85CIDB). Each insurer shall elect, with respect to all individual
contracts issued in any one statement year, whether it will use tables A or
tables B as the minimum standard. The insurer may, however, elect to use the
other tables with respect to any subsequent statement year.
(b) For contracts issued on or after January
1, 1965 and prior to january 1, 1997, the 1964 commissioners disability table
(64 CDT).
(2)
Claim Reserves.
(a) For claims
incurred on or after July 1, 2003, the 1985 commisioners individual disability
table A (85CIDA) with claim termination rates multiplied by the adjustment
factors in 13.10.14.26 NMAC. The 85CIDA table so adjusted shall be known as the
1985 commissioners individual disability table C (85CIDC).
(b) For claims incurred prior to July 1,
2003, each insurer may elect which of the following:
(i) the minimum morbidity standard in effect
for contract reserves on currently issued contracts, as of the date the claim
is incurred or
(ii) the standard in
Subparagraph (a). Once the insurer elects to calculate reserves for all open
claims on the latter, all future valuations must be on that basis.
B. Hospital Benefits, Surgical Benefits and Maternity Benefits. (Scheduled benefits or fixed time period benefits only).
(1)
Contract Reserves.
(a) [Reserved]
(b) Contracts issued on or after January 1,
1997, the 1974 medical expense tables, table A, transactions of the
society of actuaries, volume 03X, page 63. Refer to the paper (in the
same volume, page 9) to which this table is appended, including its
discussions, for methods of adjustment for benefits not directly valued in
table A: "development of the 1974 medical expense benefits,"
Houghton and Wolf.
(2)
Claim reserves. No specific standard. See Subsection E of
13.10.14.22 NMAC.
C. Cancer expense benefits. (Scheduled benefits or fixed time period benefits only).
(1)
Contract
reserves. Contracts issued on or after January 1, 1997, the 1985 NAIC
cancer claim cost tables.
(2)
Claim reserves. No specific standard. See Subsection E of
13.10.14.22 NMAC.
D. Accidental Death Benefits.
(1)
Contract reserve. Contracts issued on or after January 1, 1997,
the 1959 accidental death benefits table.
(2)
Claim reserves. Actual
amount incurred.
E. Other Individual Contract Benefits.
(1)
Contract Reserves. For all
other individual contract benefits, morbidity assumptions are to be determined
as provided in the reserve standards.
(2)
Claim Reserves. For all
benefits other than disability, claim reserves are to be determined as provided
in the standards.
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