N.M. Admin. Code § 13.10.5.7

Current through Register Vol. 35, No. 20, October 22, 2024

Section 13.10.5.7 - DEFINITIONS

As used in this rule:

A."accrued liability" means liabilities established on the date an injury is sustained or an illness commences.

B."group contract" means a contract for health or disability insurance or an HMO contract made with an employer or other entity that covers a group of persons, identified as individuals, because of their relationship to the covered entity.

C."HMO" means health maintenance organization as defined in 59A-46-2 NMSA 1978.

D."prior carrier" means the carrier of group coverage provided by the employer or other entity immediately prior to the effective date of discontinuance and which has or has not been replaced by a succeeding carrier's coverage plan.

E."succeeding carrier" means the carrier of group coverage provided by an employer or other entity which is issued within ninety days after the discontinuance of the prior plan.

F."totally disabled" means:

(1) for covered employees, the inability because of injury or disease to perform regular or customary occupational duties; and after benefits have been paid for twenty-four months, the inability to perform the duties of any gainful occupation for which the employee is reasonably fitted by training, education, or experience; or

(2) for dependents or retired employees, the inability because of injury or disease to engage in substantially all of the normal activities of a person in good health of like age and sex.

N.M. Admin. Code § 13.10.5.7

11/1/98; Recompiled 11/30/01