N.M. Admin. Code § 13.19.4.30

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

Section 13.19.4.30 - INSURANCE AGENTS AND BROKERS

Any person, including a licensed agent, broker or other individual, soliciting, offering or selling a health benefit plan on behalf of a MEWA to a New Mexico employer or a New Mexico resident shall comply with the following requirements:

A. Prior to completing a sale of individual or small group coverage, disclose to the employer or resident that:

(1) the agent or broker is being compensated for the sale of the health benefit plan;

(2) that the small employer or individual has the option of purchasing insurance on the New Mexico health insurance marketplace;

(3) the eligibility guidelines for Medicaid coverage and financial assistance for coverage through the New Mexico health insurance exchange;

(4) contact information for the New Mexico health insurance exchange; and

(5) a comparison table showing the similarities and differences in coverages between a MEWA with qualified health plans sold in the individual and small group market; and

B. Prior to engaging in or assisting any person to engage in selling health benefits plans through a MEWA, shall document appropriate due diligence to establish, at a minimum; the following:

(1) that the MEWA's insurer or third-party administrator is licensed in the state;

(2) that the MEWA has registered, permitting it to operate in the state;

(3) that the disclosures listed in Paragraph (1) are in the policy document; and

(4) that the advertising and marketing materials that the agent or broker is using have been approved by the superintendent.

N.M. Admin. Code § 13.19.4.30

Adopted by New Mexico Register, Volume XXX, Issue 16, August 27, 2019, eff. 8/27/2019, Amended by New Mexico Register, Volume XXXI, Issue 04, February 25, 2020, eff. 2/25/2020