New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 23 - MANAGED HEALTH CARE PLAN CONTRACTING
Section 13.10.23.12 - DECEPTIVE HEALTH CARE INSURER OR MANAGED HEALTH CARE PLAN NAME
Universal Citation: 13 NM Admin Code 13.10.23.12
Current through Register Vol. 35, No. 18, September 24, 2024
A. A health care insurer or managed health care plan shall not use a deceptive name.
B. A name will be considered deceptive if it unreasonably suggests:
(1) the quality of
care provided by the health care insurer or managed health care plan;
(2) that full benefits are provided for
health care or a specialized area of health care;
(3) that the cost of benefits to enrollees of
the MHCP is lower than the cost of similar benefits purchased elsewhere;
and
(4) in any such case where the
express or implied representation contained in the name is demonstrably untrue
or is not supported by substantial evidence at all times while such name is
used by the health care insurer or MHCP.
C. Nothing in this section limits or restricts the superintendent from determining that a health care insurer or MHCP or solicitor firm name is deceptive for reasons other than those stated herein.
D. A change of a health maintenance organization plan name is a "substantial modification" of the HMO for purposes of Section 59A-46-3D NMSA 1978.
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