Current through Register Vol. 35, No. 18, September 24, 2024
A.
Filing
policies and certificates. An issuer shall not deliver or issue for
delivery a policy or certificate to a resident of this state unless the policy
form or certificate form has been filed and approved electronically in SERFF or
as otherwise designated by the superintendent, pursuant to Subsection D of
Section
59A-17-9,
Subsection D of Section
59A-18-12
and Subsection B of Section
59A-18-13
NMSA 1978.
B.
Filing riders
and amendments. An issuer shall file any riders or amendments to policy
or certificate forms to delete outpatient prescription drug benefits as
required by the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 only with the superintendent in the state in
which the policy or certificate was issued.
C.
Filing rate change requests.
An issuer shall not use or change premium rates for a Medicare Supplement
policy or certificate unless the rates, rating schedule and supporting
documentation have been filed and approved electronically in SERFF or as
otherwise designated by the superintendent, pursuant to Subsection D of Section
59A-17-9,
Subsection D of Section
59A-18-12
and Subsection B of Section
59A-18-13
NMSA 1978.
D.
Restrictions on
number of forms filed.
(1) Except as
provided in Paragraph (2) of this subsection, an issuer shall not file for
approval more than one form of a policy or certificate of each combination of
type and series for each standard Medicare Supplement benefit plan.
(2) An issuer may offer, with the approval of
the superintendent, up to four additional policy forms or certificate forms of
the same type for the same standard Medicare Supplement benefit plan, one for
each of the following cases:
(a) The inclusion
of new or innovative benefits;
(b)
The addition of either direct response or agent marketing methods;
(c) The addition of either guaranteed issue
or underwritten coverage;
(d) The
offering of coverage to individuals eligible for Medicare by reason of
disability.
(3) For the
purposes of this subsection, a "type" means an individual policy, a group
policy, an individual Medicare Select policy, or a group Medicare Select
policy; "series" means the separate sets of 1990, 2010, and 2020 Standardized
Medicare Supplement Benefit Plans defined in Sections 13.10.25.12, 13.10.25.14,
and
13.10.25.15
NMAC respectively.
E.
Availability of approved forms.
(1) Except as provided in Subparagraph (a) of
this paragraph, an issuer shall continue to make available for purchase any
policy form or certificate form issued after July 1, 1992, that has been
approved by the superintendent, unless constrained by law from doing so. A
policy form or certificate form shall not be considered to be available for
purchase unless the issuer has actively offered it for sale in the previous 12
months.
(a) An issuer may discontinue the
availability of a policy form or certificate form if the issuer provides to the
superintendent in writing its decision at least 60 days prior to discontinuing
the availability of the form of the policy or certificate. After receipt of the
notice by the superintendent, the issuer shall no longer offer for sale the
policy form or certificate form in this state.
(b) An issuer that discontinues the
availability of a policy form or certificate form pursuant to Subparagraph (a)
of this paragraph shall not file for approval a new policy form or certificate
form of the same type for the same standard Medicare Supplement benefit plan as
the discontinued form for a period of five years after the issuer provides
notice to the superintendent of the discontinuance. The period of
discontinuance may be reduced if the superintendent determines that a shorter
period is appropriate.
(2) The sale or other transfer of Medicare
Supplement business to another issuer shall be considered a discontinuance for
the purposes of this subsection.
(3) A change in the rating structure or
methodology shall be considered a discontinuance under Paragraph (1) of this
subsection.
F.
Combining experience for refund calculation.
(1) Except as provided in Paragraph (2) of
this subsection, the experience of all policy forms or certificate forms of the
same type in a standard Medicare Supplement benefit plan shall be combined for
purposes of the refund or credit calculation prescribed in
13.10.25.20
NMAC.
(2) Forms assumed under an
assumption reinsurance agreement shall not be combined with the experience of
other forms for purposes of the refund or credit calculation.
G. An issuer shall not present for
filing or approval a rate structure for its Medicare Supplement policies or
certificates issued after the effective date of the amendment of this
regulation based upon a structure or methodology with any groupings of attained
ages greater than one year. The ratio between rates for successive ages shall
increase smoothly as age increases.
