New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 15 - LONG-TERM CARE INSURANCE
Section 13.10.15.10 - LIMITATIONS AND EXCLUSIONS
Universal Citation: 13 NM Admin Code 13.10.15.10
Current through Register Vol. 35, No. 18, September 24, 2024
A. No policy may be delivered or issued for delivery in this state as long-term care insurance if such policy limits or excludes coverage by type of illness, treatment, medical condition or accident, except as follows:
(1) preexisting conditions or
diseases;
(2) mental or nervous
disorders; however, this shall not permit exclusion or limitation of benefits
on the basis of Alzheimer's Disease;
(3) alcoholism and drug addiction;
(4) illness, treatment or medical condition
arising out of:
(a) war or act of war
(whether declared or undeclared);
(b) participation in a felony, riot or
insurrection;
(c) service in the
armed forces or units auxiliary thereto;
(d) suicide (sane or insane), attempted
suicide or intentionally self-inflicted injury; or
(e) aviation (this exclusion applies only to
non-fare-paying passengers).
(5) treatment provided in a government
facility (unless otherwise required by law), services for which benefits are
available under Medicare or other governmental program (except Medicaid), any
state or federal workers compensation, employers liability or occupational
disease law, or any motor vehicle no-fault law, services provided by a member
of the covered persons immediate family and services for which no charge is
normally made in the absence of insurance.
B. This section is not intended to prohibit exclusions and limitations by type of provider or territorial limitations.
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