New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 34 - STANDARDS FOR ACCIDENT-ONLY, SPECIFIED DISEASE, HOSPITAL INDEMNITY, DISABILITY INCOME, SUPPLEMENTAL, AND NON-SUBJECT WORKER EXCEPTED BENEFITS
Section 13.10.34.7 - DEFINITIONS
Current through Register Vol. 35, No. 18, September 24, 2024
For definitions of terms contained in this rule, refer to 13.10.29 NMAC, unless otherwise noted below.
A. "Accident only plan" means an insurance agreement that conditions a fixed indemnity benefit on the occurrence of an injurious accident.
B. "Certificate" means a document that extends coverage under a group plan to a group member.
C. "Direct response insurer" means a carrier who does not sell its insurance products through producers.
D. "Disability income plan" means an insurance agreement that provides income protection benefits during a period of disability resulting from either sickness, pregnancy, injury or a combination of these.
E. "Domestic co-insured" means a spouse or domestic partner insured under the same plan or certificate.
F. "Hospital indemnity plan" means an insurance agreement that conditions a fixed indemnity benefit on the hospitalization, hospital-based treatment or hospice care of a covered person.
G. "Occupational accident plan" means an accident-only plan that pays a fixed indemnity benefit for injury that results from an occupational accident involving a covered subject worker.
H. "Other fixed indemnity" means a fixed cash benefit payable to a covered person on the occurrence of an event, circumstance or condition, other than or in addition to accident, injury, illness or disability.
I. "Plan" means any individual, group or blanket insurance subject to this rule provided through a standalone policy, certificate, contract or rider.
J. "Non-contributory" means that a covered person pays no premium, membership fee or dues to qualify for coverage or benefits under the plan.
K. "Non-subject worker plan" means an insurance agreement that provides benefits similar to workers' compensation benefits to a self-employed non-subject worker.
L. "Specified disease plan" means an insurance agreement that conditions a fixed indemnity benefit on the occurrence or diagnosis of a specific disease or illness that is either life-threatening or likely to cause a covered person to incur significant financial obligations.
M. "Supplemental plan" means an insurance agreement that provides benefits that supplement coverage under a group major medical, TRICARE or Champus plan.
