Current through Register Vol. 35, No. 18, September 24, 2024
A. This section shall apply as follows:
(1) Except as provided in Paragraph (2) of
this subsection, this section applies to any long-term care policy or
certificate issued in this state on or after January 1, 2004.
(2) For certificates issued on or after the
effective date of this amended rule under a long-term care insurance policy as
defined in Paragraph (1) of Subsection C of Section 59A-23A-4 NMSA 1978, which
policy was in force at the time this amended rule became effective, the
provisions of this section shall apply on the policy anniversary following July
1, 2004.
B. Other than
policies for which no applicable premium rate or rate schedule increases can be
made, insurers shall provide all of the information listed in this subsection
to the applicant at the time of application or enrollment, unless the method of
application does not allow for delivery at that time. In such a case, an
insurer shall provide all of the information listed in this section to the
applicant no later than at the time of delivery of the policy or certificate.
(1) A statement that the policy may be
subject to rate increases in the future;
(2) An explanation of potential future
premium rate revisions, and the policyholder's or the certificate holder's
option in the event of a premium rate revision;
(3) The premium rate or rate schedules
applicable to the applicant that will be in effect untill a request is made for
an increase;
(4) A general
explanation for applying premium rate or rate schedule adjustments that shall
include:
(a) A description of when premium
rate or rate schedule adjustments will be effective; and
(b) The right to a revised premium rate or
rate schedule as provided in Paragraph (2) of this subsection if the premium
rate or rate schedule is changed;
(5) Information regarding each premium rate
increase on this form or similar policy forms over the past ten (10) years for
this state that a minimum identifies:
(a) The
policy forms for which premium rates have been increased;
(b) The calendar years when the form was
available for purchase; and
(c) The
amount or percent of each increase. The percentage may be expressed as a
percentage of the premium rate prior to increase, and may also be expressed as
minimum and maximum percentages if the rate increase is variable by rating
characteristics.
(6) The
insurer may, in a fair manner, provide additional explanatory information
related to the rate increases.
(7)
An insurer shall have the right to exclude form the disclosure premium rate
increases that only apply to blocks of business acquired from other
nonaffiliated insurers or the long-term care policies acquired form other
nonaffiliated insurers when those increases occurred prior to the
acquisition.
(8) If an acquiring
insurer files for a rate increase on a long-term care policy form acquired from
nonaffiliated insurers or a block of policy forms acquired from nonaffiliated
insurers on or before the later of the effective date of this section or the
end of a twenty-four (24) month period following the acquisition of the block
or policies, the acquiring insurer may exclude the rate increase from the
disclosure. However, the nonaffiliated selling company shall include the
disclosure of that rate increase in accordance with paragraph (5) of this
subsection.
(9) If the acquiring
insurer in Paragraph (8) of this subsection files for a subsequent rate
increase, even within the 24 month period, on the same policy form acquired
from nonaffiliated insurers or block of policy forms acquired from
nonaffiliated insurers referenced in Paragraph (8) of this subsection, the
acquiring insurer must make all disclosure required by Paragraph (5) of this
subsection, including disclosure of the earlier rate increase referenced in
Paragraph (8) of this subsection.
C. An applicant shall sign an acknowledgement
at the time of application, unless the method of application does not allow for
signature at that time, that the insurer made the disclosure required under
Subsection B of this section. If due to the method of application the applicant
cannot sign an acknowledgement at the time of application, the applicant shall
sign no later than at the time of delivery of the policy or
certificate.
D. An insurer shall
use the forms in 13.10.15.50 and 13.10.15.53 NMAC to comply with the
requirements of this section.
E. An
insurer shall provide notice of an upcoming premium rate schedule increase to
all policyholders or certificate holders, if applicable, at least sixty (60)
days prior to the implementation of the premium rate schedule increase by the
insurer. The notice shall include the information required by Subsection B of
this section when the rate increase is implemented.
