New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 15 - LONG-TERM CARE INSURANCE
Section 13.10.15.21 - INITIAL FILING REQUIREMENTS
Universal Citation: 13 NM Admin Code 13.10.15.21
Current through Register Vol. 35, No. 18, September 24, 2024
A. This section applies to any long-term care policy issued in this state on or after January 1, 2004.
B. An insurer shall provide the information listed in this subsection to the superintendent along with the form and rate filing required by law.
(1) A copy of the
disclosure documents required by 13.10.15.20 NMAC; and
(2) An actuarial certification consisting of
at least the following:
(a) A statement that
the initial premium rate schedule is sufficient to cover anticipated costs
under moderately adverse experience and that the premium rate schedule is
reasonably expected to be sustainable over the life of the form with no future
premium rate increases anticipated;
(b) A statement that the policy design and
coverage provided have been reviewed and taken into consideration;
(c) A statement that the underwriting and
claims adjudication processes have been reviewed and taken into
consideration;
(d) A complete
description of the basis for contract reserves that are anticipated to be held
under the form, to include:
(i) sufficient
detail or sample calculations provided so as to have a complete depiction of
the reserve amounts to be held,
(ii) a statement that the assumptions used
for reserves contain reasonable margins for adverse experience,
(iii) a statement that the net valuation
premium for renewal years does not increase (except for attained-age rating
where permitted), and
(iv) a
statement that the difference between the gross premium and the net valuation
premium for renewal years is sufficient to cover expected renewal expenses; or
if such a statement cannot be made, a complete description of the situation
where this does not occur. An aggregate distribution of anticipated issues may
be used as long as the underlying gross premiums maintain a reasonably
consistent relationship. If the gross premiums for certain age groups appear to
be inconsistent with this requirement, the superintendent may request a
demonstration under Subsection C of this section based on a standard age
distribution.
(e) A
statement that the premium rate schedule is not less than the premium rate
schedule for existing similar policy forms also available from the insurer
except for reasonable differences attributable to benefits; or a comparison of
the premium schedules for similar policy forms that are currently available
from the insurer with an explanation of the differences
C. The superintendent may request an actuarial demonstration that benefits are reasonable in relation to premiums.
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