New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 22 - MANAGED HEALTH CARE PLAN COMPLIANCE
Section 13.10.22.13 - ADMINISTRATIVE COSTS AND BENEFIT DISCLOSURES
Universal Citation: 13 NM Admin Code 13.10.22.13
Current through Register Vol. 35, No. 6, March 26, 2024
A. Yearly reporting required: On a yearly basis, on or before April 15, each MHCP shall provide the superintendent with a loss ratio for individual contracts and a separate calculation for plans offered in the small group health insurance market by the MHCP. The superintendent may require that the information be prepared on a form supplied by the division.
B. Calculation of the ratio: Calculation of the loss ratio shall be based on the average of a plan's previous three years' experience. The superintendent shall apply or alter this calculation in a manner consistent with New Mexico law.
(1) If the plan has been in existence
for less than three years, than the ratio shall be based on a two year past
plan experience, with a statement as to the length of plan
experience.
(2) If the plan has
been in existence for less than two years, than the ratio shall be based on a
one year past plan experience, with a statement as to the length of plan
experience.
(3) If the plan is new
or has been in existence less than one year, then the MHCP shall report to the
superintendent a loss ratio for a similar plan with an explanation as to why
that plan can be used as an estimated loss ratio for the new plan.
(4) The superintendent shall state on any
materials distributed to the public the bases for the loss ratios.
(5) The superintendent shall provide notice
to brokers, agents, and solicitors engaged in the sale of managed health care
plans regarding the availability and use of the loss ratios for
MHCPs.
(6) The superintendent may
in the future require in addition to the ratio calculations, that each MHCP
provide the division with sample premium costs for various plan designs, to be
used by the superintendent as a guide to purchasing managed health care
products in the state.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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