Key Takeaways
- New Mexico requires standard policy provisions for disability income insurance
- Long-term care policies must be guaranteed renewable
- LTC policies must offer inflation protection options
- New Mexico participates in the Long-Term Care Partnership Program
- Disability policies must include minimum grace periods
New Mexico Disability and Long-Term Care Insurance
New Mexico has specific regulations for disability income insurance and long-term care insurance under Chapter 59A NMSA.
Disability Income Insurance
Required Policy Provisions
New Mexico disability policies must include:
| Provision | Requirement |
|---|---|
| Grace Period | Minimum 31 days for annual premium |
| Reinstatement | Must allow reinstatement within specified period |
| Notice of Claim | 20 days after loss begins |
| Time to Pay Claims | Reasonable time after proof of loss |
| Legal Actions | Timing restrictions for lawsuits |
Long-Term Care Insurance
New Mexico has comprehensive LTC insurance regulations:
Required Provisions
| Provision | Requirement |
|---|---|
| Renewability | Must be guaranteed renewable |
| Pre-existing Conditions | Maximum 6-month look-back period |
| Elimination Period | Must be clearly disclosed |
| Inflation Protection | Must offer option |
| Nonforfeiture | Must offer option |
New Mexico Partnership Program
New Mexico participates in the Long-Term Care Partnership Program:
- Purchase a Partnership-qualified LTC policy
- Use benefits for care
- If benefits exhaust, apply for Medicaid
- Asset protection - Keep assets equal to benefits received
LTC Insurance Consumer Protections
New Mexico provides strong consumer protections for LTC insurance:
| Protection | Requirement |
|---|---|
| 30-Day Free Look | Return policy for full refund within 30 days |
| Outline of Coverage | Must provide before application |
| Inflation Protection | Must offer (buyer may decline) |
| Nonforfeiture Options | Must offer (buyer may decline) |
| Rate Increase Disclosure | Must disclose rate increase history |
| Shopper's Guide | Must provide NAIC Shopper's Guide |
LTC Producer Training Requirements
| Training Type | Hours | Frequency |
|---|---|---|
| Initial Training | 8 hours | Before first LTC sale |
| Ongoing Training | 4 hours | Each license renewal period |
| Topics | LTC products, state regulations, ethics | Required |
Exam Tip: LTC insurance has a 30-day free look period in New Mexico (longer than the standard 10-day free look for other life/health products).
Medicare Supplement Insurance
New Mexico regulates Medicare Supplement (Medigap) insurance under NMSA 59A-23A:
Standardized Plans
| Plan Letter | Coverage Level | Availability |
|---|---|---|
| Plan A | Basic benefits | All carriers |
| Plan B | Basic + Part A deductible | Optional |
| Plan D | Basic + skilled nursing, foreign travel | Optional |
| Plan G | Comprehensive (popular) | Optional |
| Plan K | Cost-sharing (50%) | Optional |
| Plan L | Cost-sharing (75%) | Optional |
| Plan N | Copays for office/ER visits | Optional |
Open Enrollment Period
| Feature | Requirement |
|---|---|
| Duration | 6 months from Medicare Part B effective date |
| Guaranteed Issue | Must accept without health questions |
| No Pre-existing Exclusions | During open enrollment |
| Birthday Rule | 30 days around birthday to change plans |
Birthday Rule (New Mexico)
New Mexico has a birthday rule allowing annual plan changes:
| Feature | Detail |
|---|---|
| Window | 30 days before and after birthday |
| Eligibility | Current Medigap policyholders |
| Guaranteed Issue | Cannot be denied for health reasons |
| Same or Lesser Benefits | Can switch to equal or less comprehensive plan |
Important: The birthday rule is a valuable consumer protection unique to some states including New Mexico. Producers should inform Medicare Supplement clients of this annual opportunity.
What is the primary benefit of purchasing a New Mexico Partnership-qualified long-term care policy?
What is the free look period for long-term care insurance in New Mexico?
Does New Mexico have a birthday rule for Medicare Supplement insurance?