New Mexico Life, Accident and Health Insurance
Producer
Examination Content Outlines
Series 18-27
Cross
Reference to
NextGen Class
Notes
Taxonomy
Effective April 30, 2020
Please note: It is very important that you refer to the
Updates/Errata icon on your course dashboard located under
Study Tools. Any updated study material for your state
insurance exam is located in the Updates/Errata icon
150 questions – 2.5 hour time limit
1.0 Insurance Regulation 5%
1.1 Licensing
State Supplement
Process (59A-11-2, 3, 59A-12-12; Reg 13.4.2.8, .9)
State Supplement
Types of licensees (NMSA 59A-11, 59A-12; Reg 13.4.2.7, .11)
State Supplement
Insurance Producers (59A-12-2)
State Supplement
Brokers (59A-12-3)
State Supplement
Consultants (59A-11A-1–8)
Nonresident (59A-12-25) (59A-11-24)
State Supplement
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updates/errata
Temporary (59A-11-4; 59A-12-19; Reg 13.4.2.12)
State Supplement
Maintenance and Duration
State Supplement
Expiration and renewal (59A-11-10, 11; Reg 13.4.2.17, .18)
State Supplement
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Address change (59A-12-17) (59A-11-24)
Continuing education (59A-12-26; Reg 13.4.7.9, .12)
Disciplinary Actions
Suspension, revocation, or refusal to renew (59A-11-8, 10, 14–16,
18)
State Supplement
Cease and desist orders (59A-16-27)
State Supplement
Penalties and fines (59A-1-18, 59A-11-17, 21)
State Supplement
State Supplement
1.2 State regulation
Superintendent's general duties and powers (59A-2-8–10)
State Supplement
Company regulation
State Supplement
Certificate of authority (59A-5-10)
State Supplement
Unfair claim settlement practices (59A-16-20)
State Supplement
Complaint record (59A-16-22)
State Supplement
Appointment of Insurance Producer (59A-11-12; Reg 13.4.2.17)
Termination of Insurance Producer appointment (59A-11-13; Reg
13.4.2.29)
State Supplement
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updates/errata
Insurance Producer regulation
State Supplement
Shared commissions (59A-12-24)
State Supplement
Fiduciary duties (59A-12-22)
State Supplement
Prohibited premiums or charges (59A-16-24)
State Supplement
Unfair trade practices
State Supplement
Misrepresentation (59A-16-4, 23)
State Supplement
False advertising (59A-16-4, 5)
State Supplement
Twisting (59A-16-6)
State Supplement
Defamation (59A-16-10)
State Supplement
Unfair discrimination (59A-16-12, 13, 17(D))
State Supplement
Rebating (59A-16-16–18)
State Supplement
Boycott, coercion, or intimidation (59A-16-19)
State Supplement
Examination of books and records (59A-4-3, 4)
State Supplement
Insurance Fraud Act (59A-16C-1–16)
State Supplement
Consumer information privacy (59A-2-9.3; Reg 13.1.3.1–.28)
State Supplement
1.3 Federal Regulations
Fair Credit Reporting Act (15 USC 1681–1681d)
2.7.1
Fraud and false statements (18 USC 1033, 1034)
1.10.3
2.0 General Insurance 5%
2.1 Concepts
Risk Management Key Terms
1.4
Risk
1.3
Exposure
1.3
Hazard
1.3
Peril
1.3
Loss
1.3
Methods of Handling Risk
1.4
Avoidance
1.4
Retention
1.4
Sharing
1.4
Reduction
1.4
Transfer
1.4
Elements of Insurable Risks
1.5.2
Adverse selection
1.5.3
Reinsurance
1.5.4
2.2 Insurers
Types of insurers
1.6
Stock companies
1.6.1
Mutual companies
1.6.2
Fraternal benefit societies
1.6.3
Risk retention groups
1.6.5
Private versus government insurers
1.7.1, 12.5.2
Authorized versus unauthorized insurers
1.7.3
Domestic, foreign and alien insurers
1.7.2
Financial status (independent rating service)
1.7.5
Marketing (distribution) systems
1.8
2.3 Insurance Producers and General Rules of Agency
Insurer as principal
1.9
Insurance Producer/insurer relationship
1.9.1
Authority and powers of Insurance Producers
1.9.1
Express
1.9.1
Implied
1.9.1
Apparent
1.9.1
Responsibilities to the applicant/insured
1.9.2
2.4 Contracts
Elements of a legal contract
1.10.1
Offer and acceptance
1.10.1.2
Consideration
1.10.1.3
Competent parties
1.10.1.4
Legal purpose
1.10.1.1
Distinct characteristics of an insurance contract
1.10.2
Contract of adhesion
1.10.2.1
Personal contract
1.10.2.5
Unilateral contract
1.10.2.4
Conditional contract
1.10.2.6
Legal interpretations affecting contracts
1.10.2.1
Ambiguities in a contract of adhesion
1.10.2.1
Reasonable expectations
1.10.2.3
Indemnity
1.10.2.7
Utmost good faith
1.10.2.3
Representations/misrepresentations
1.10.2.8
Warranties
1.10.2.8
Concealment
1.10.2.9
Fraud
1.10.2.10
Waiver and estoppel
1.10.3.1
3.0 Life Insurance Basics 10%
3.1 Insurable interest (59A-18-4, 5, 7, 8)
State Supplement
3.2 Personal Uses of Life Insurance
3.4
Survivor protection
3.4.2.1
Estate creation
3.4.2.3
Cash accumulation
3.4.2.6
Liquidity
3.4.2.5
Estate conservation
3.4.2.4
3.3 Determining Amount of Personal Life Insurance
3.5
Human life value approach
3.5.1
Needs approach
3.5.2
Types of information gathered
3.5.2.4
Determining lump-sum needs
3.5.2.1
Planning for income needs
3.5.2.2
3.4 Business Uses of Life Insurance including Key Person
3.5.3, 3.5.3.2
3.5 Classes of Life Insurance Policies
3.6
Group versus individual
3.6
Permanent versus term
3.6
Participating versus nonparticipating
3.6
Fixed versus variable life insurance and annuities
Regulation of variable products (SEC, FINRA and New Mexico)
(59A-20-30; Reg 13.9.8.38)
3.6
State Supplement
3.6 Premiums
Factors in premium determination
3.7.1
Mortality
3.7.1
Interest
3.7.1
Expense
3.7.1
Premium payment mode
3.7.3
3.7 Insurance Producer Responsibilities
Solicitation and sales presentations
State Supplement
Advertising
Prohibited advertising of Life and Health Insurance Guaranty
Association (59A-42-13(E))
State Supplement
Illustrations (Reg 13.9.14.10–.31)
State Supplement
Policy summary (Reg 13.9.5.8, .9)
State Supplement
Buyer's guide (Reg 13.9.5.9, .14)
State Supplement
Replacement (Reg 13.9.6.5–.15)
State Supplement
Use and disclosure of insurance information
State Supplement
Field underwriting
2.3
Notice of information practices
Application procedures
State Supplement
2.4, 2.4.1, 2.4.2,
2.4.2.1, 2.4.3
Delivery
2.6.1
Policy review
2.6.2
Effective date of coverage
2.6.4
Premium collection
2.4.7
Statement of good health
2.6.3
State Supplement
3.8 Individual Underwriting by the Insurer
Information sources and regulation
2.5.1
Application
2.5.1.1
Insurance Producer report
2.4.5.1
Attending physician statement
2.5.1.2
Investigative consumer (inspection) report
2.5.1.5, 2.5.1.6
Medical Information Bureau (MIB)
2.5.1.4
Medical examinations and lab tests
2.5.1.3, 2.5.1.3.1
Selection criteria and unfair discrimination (59A-16-11)
State Supplement
Classification of risks
2.5.2
Preferred
2.5.2.2
Standard
2.5.2.1
Substandard
2.5.2.3
4.0 Life Insurance Policies 11%
4.1 Term life insurance
4.4
Level term
4.4.2.1
Annual renewable term
4.4.2.5
Level premium term
4.4.2.1
Decreasing term
4.4.2.2
4.2 Whole Life Insurance
4.5
Limited payment
4.5.2.2
Single premium
4.5.2.3
Modified premium
4.5.2.4
4.3 Flexible Premium Policies
4.6
Adjustable life
4.6.2.1
Universal life
4.6.2.2
4.4 Specialized Policies
4.8
Joint life (first-to-die)
4.8.1
Survivorship life (second-to-die)
4.8.3
Juvenile life
4.8.2
4.5 Group Life Insurance
8.3
Characteristics of group plans
8.3
Types of plan sponsors (59A-21-4–8)
State Supplement
Group underwriting requirements
8.7
Conversion to individual policy (59A-21-19–22)
State Supplement
Continuation of coverage (59A-21-23)
State Supplement
4.6 Credit life insurance (individual versus group)
8.12
5.0 Life Insurance Policy Provisions, Options and Riders 12%
5.1 Individual Standard Provisions
7.3
Ownership
7.4.3
Assignment
7.4.4
Entire contract (59A-20-6)
7.4.5, State Supplement
Modifications
7.4.6
Right to examine (free look)
Reinstatement (59A-20-12, 16)
7.4.1
7.4.8, State
Supplement
7.4.9, State
Supplement
7.4.10, State
Supplement
Incontestability (59A-20-5)
7.4.11, State Supplement
Misstatement of age (59A-20-7)
7.4.13, State Supplement
Exclusions (59A-20-25)
7.6, State Supplement
Settlement of death benefit (59A-20-14)
7.4.14, State Supplement
Prohibited provisions including backdating (59A-20-26)
State Supplement
5.2 Beneficiaries
7.5
Designation options
7.5.1
Individuals
7.5.1.1
Classes
7.5.1.2
Estates
7.5.1.5
Minors
7.5.1.4
Trusts
7.5.1.3
Succession
7.5.2
Revocable versus irrevocable
7.5.3
Common disaster clause
7.5.8
Spendthrift clause
7.5.9
5.3 Settlement Options
6.4
Cash payment
6.4
Interest only
6.4.1
Fixed-period installments
6.4.2
Fixed-amount installments
6.4.3
Life income
6.4.4
Single life
6.4.5
Joint and survivor
6.4.8
Payment of premiums (59A-20-13)
Grace period (59A-20-4)
5.4 Nonforfeiture Options
Cash surrender value
6.7
Extended term
6.7
Reduced paid-up insurance
6.7
5.5 Policy Loan and Withdrawal Options
Cash loans
6.5
Automatic premium loans
6.5.1
Withdrawals or partial surrenders
6.5.2
5.6 Dividend Options
6.6.2
Cash payment
6.6.2.1
Reduction of premium payments
6.6.2.3
Accumulation at interest
6.6.2.2
One-year term option
6.6.2.6
Paid-up additions
6.6.2.4
5.7 Disability Riders
5.4
Waiver of premium
5.4.1
Disability income benefit
5.4.2
Payor benefit life/disability (juvenile insurance)
5.4.3
5.8 Accelerated (Living) Benefit Provisions/Riders
5.5
Conditions for payment
5.5.1
Effect on death benefit
5.5.2
5.9 Riders Covering Additional Insureds
5.6
Spouse/other-insured term rider
5.6.1
Children's term rider
5.6.1
Family term rider
5.6.1
5.10 Riders Affecting the Death Benefit Amount
5.7
Accidental death
5.7.3, 5.7.3.1
Guaranteed insurability
5.7.4
Cost of living
5.7.5
Return of premium
5.7.2
6.0 Annuities 8%
6.1 Annuity Principles and Concepts
9.3
Accumulation period versus annuity period
Owner, annuitant and beneficiary
9.3.1
9.3.2, 9.3.2.1,
9.3.2.2, 9.3.2.3
Insurance aspects of annuities
9.3.3
6.2 Immediate versus Deferred Annuities
9.4
Single premium immediate annuities (SPIAs)
9.4.1
Deferred annuities
9.4.2
Premium payment options
Nonforfeiture
9.4.2.1
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Surrender charges
9.4.2.2
Death benefits
9.4.2.3
6.3 Annuity (benefit) payment options
9.5
Life contingency options
9.5.1
Pure life versus life with guaranteed minimum
9.5.1.1
Single life versus multiple life
9.5.1; 9.5.1.4; 9.5.1.5
Annuities certain (types)
9.5.1.2, 9.5.1.3
6.4 Annuity Products
9.6
Fixed annuities
9.6.1
General account assets
9.6.1.1
Interest rate guarantees (minimum versus current)
9.6.1.2
Level benefit payment amount
9.6.1.3
Equity indexed annuities
9.6.3
6.5 Uses of Annuities
9.7
Lump-sum settlements
9.5.1.2
Personal uses
9.7.1
Qualified retirement plans including group and individual annuities
9.7.2, 9.7.2.1
Personal uses
9.7.1
Individual retirement annuities (IRAs)
9.7.1.3
Tax-deferred growth
9.7.1.2
Retirement income
9.7.1.1
Education funds
9.7.1.4
7.0 Federal Tax Considerations for Life Insurance and
Annuities 3%
7.1 Taxation of Personal Life Insurance
10.3.1
Amounts available to policyowner
10.3.1.2
Cash value increases
10.3.1.2
Dividends
10.3.1.6
Policy loans
10.3.1.5
Surrenders
10.3.1.3, 10.3.1.4
Amounts received by beneficiary
10.3.1.7
General rule and exceptions
10.3.1.8
Settlement options
10.3.1.7
Values included in insured's estate
10.4, 10.4.1
7.2 Modified Endowment Contracts (MECs)
10.3.4
Modified endowment versus life insurance
10.3.4
Seven-pay test
10.3.4
Distributions
10.3.5.5
7.3 Taxation of Non-Qualified Annuities
10.3.5.1
Individually-owned
10.3.5
Accumulation phase (tax issues related to withdrawals)
9.3.1.1, 10.3.5.2
Annuity phase and the exclusion ratio
10.3.5.4
Distributions at death
10.3.5.5
Corporate-owned
11.4
7.4 Taxation of Individual Retirement Accounts (IRAs)
Traditional IRAs
11.3
Contributions and deductible amounts
11.3.1, 11.3.1.1, 11.3.1.2, 11.3.5
Premature distributions including taxation issues
11.3.3
Annuity phase benefit payments
10.3.5.4
Values included in the annuitant's estate
10.4.2
Amounts received by beneficiary
10.3.1.7
Roth IRAs
11.3.8
Contributions and limits
Distributions
11.3.8
11.3.6, 11.3.7,
11.4.2
7.5 Rollovers and Transfers (IRAs and Qualified Plans)
11.3.4
7.6 Section 1035 Exchanges
10.3.6
8.0 Qualified Plans 1%
8.1 General Requirements
11.4.3
8.2 Federal Tax Considerations
10.3
Tax advantages for employers and employees
11.4
Taxation of distributions (age-related)
11.3.3, 11.3.5
8.3 Plan Types, Characteristics and Purchasers
11.4.4
Simplified employee pensions (SEPs)
11.4.4.6
Self-employed plans (HR 10 or Keogh plans)
11.4.4.3
Profit-sharing and 401(k) plans
11.4.4.4
SIMPLE plans
11.4.4.7
403(b) tax-sheltered annuities (TSAs)
11.4.4.5
9.0 Health Insurance Basics 7%
9.1 Definitions of Perils
Accidental injury
12.3
Sickness
12.3
9.2 Principal Types of Losses and Benefits
Loss of income from disability
12.4
Medical expense
12.4
Dental expense
12.4
Long-term care expense
12.4
9.3 Classes of Health Insurance Policies
Individual versus group
12.5.1
Private versus government
12.5.2
Limited versus comprehensive
12.5.3
9.4 Limited Policies
Limited perils and amounts
12.6
Required notice to insured
12.6
Types of limited policies
12.7
Accident-only
12.7.1
Specified (dread) disease
12.7.2
Hospital indemnity (income)
12.7.3
Credit disability
12.7.4
Blanket insurance (teams, passengers, other)
12.7.5
Prescription drugs
12.7.6
Vision care
12.7.7
9.5 Common Exclusions from Coverage
9.6 Insurance Producer Responsibilities in Individual Health
Insurance
12.8
Marketing requirements
State Supplement
Advertising (Reg 13.10.4.6–.23)
Prohibited advertising of Life and Health Insurance Guaranty
Association (59A-42-13(E))
State Supplement
Sales presentations
State Supplement
Field underwriting
State Supplement
Nature and purpose
State Supplement
Disclosure of information about individuals
State Supplement
Application procedures
2.4
Requirements at delivery of policy
2.6.1
Common situations for errors/omissions
2.8
9.7 Individual Underwriting by the Insurer
2.5
Underwriting criteria
2.5.2
Sources of underwriting information
2.5.1
Application
2.5.1.1
Insurance Producer report
2.4.5.1
Attending physician statement
2.5.1.2
Investigative consumer (inspection) report
2.5.1.5, 2.5.1.6
Medical Information Bureau (MIB)
2.5.1.4
State Supplement
Medical examinations and lab tests (including HIV consent) (RL 2421-2(c))
2.5.1.3.1
Unfair discrimination (59A-16-11, 12.1, 13.2)
State Supplement
Genetic testing (RL 24-21-3–5)
State Supplement
Classification of risks
2.5.2
Preferred
2.5.2.2
Standard
2.5.2.1
Substandard
2.5.2.3
9.8 Considerations in Replacing Health Insurance
Pre-existing conditions
State Supplement
Benefits, limitations and exclusions
State Supplement
Underwriting requirements
State Supplement
Insurance Producer liability for errors and omissions
2.8
10.0 Individual Health Insurance Policy General Provisions 7%
10.1 Required Provisions
Entire contract; changes (59A-22-4)
Time limit on certain defenses; pre-existing condition exclusions
(59A-22-5)
Grace period (59A-22-6)
Reinstatement (59A-22-7)
Claim procedures (59A-22-8–12)
Physical examinations and autopsy (59A-22-13)
Legal actions (59A-22-14)
Change of beneficiary (59A-22-15)
10.2 Optional Provisions
14.3
14.3.1, State
Supplement
14.3.2, State
Supplement
14.3.3, State
Supplement
14.3.4, State
Supplement
14.3.5, State
Supplement
14.3.10, State
Supplement
14.3.11, State
Supplement
14.3.12, State
Supplement
Misstatement of age (59A-22-18)
14.4
14.4.1, State
Supplement
14.4.2, State
Supplement
Other insurance with same insurer (59A-22-19)
14.4.3, State Supplement
Other insurance with different insurer
14.4
Expense-incurred benefits (59A-22-20)
State Supplement
Other benefits (59A-22-21)
State Supplement
14.4.6, State
Supplement
Change of occupation (59A-22-17)
Unpaid premium (59A-22-23)
Cancellation (59A-22-24)
Conformity with state statutes (59A-22-25)
14.4.7, State Supplement
14.4.8, State
Supplement
10.3 Other General Provisions
14.5
Insuring clause
14.5.2
Consideration clause
14.5.3
Renewability clause
14.5.4
Noncancelable
14.5.4
Guaranteed renewable
14.5.4
Conditionally renewable
14.5.4
Renewable at option of insurer
14.5.4
Nonrenewable (cancelable, term)
14.5.4
11.0 Disability Income and Related Insurance 5%
11.1 Qualifying for Disability Benefits
15.3
Inability to perform duties
15.3.1
Own occupation
15.3.1.1
Any occupation
15.3.1.2
Pure loss of income (income replacement contracts)
15.3.2
Presumptive disability
15.3.3
Requirement to be under physician care
15.3.4
11.2 Individual Disability Income Insurance
Basic total disability plan
15.4.1
Income benefits (monthly indemnity)
15.4.1.1
Elimination and benefit periods
15.4.1.2, 15.4.1.3
Waiver of premium feature
Coordination with social insurance and workers' compensation
benefits
15.4.1.4
Additional monthly benefit (AMB)
15.4.2.1
Social insurance supplement (SIS)
15.4.2.2
Occupational versus nonoccupational coverage
15.4.2.3
At-work benefits
15.4.3
Partial disability benefit
15.4.3.1
Residual disability benefit
15.4.3.2
Other provisions affecting income benefits
15.4.5
Cost of living adjustment (COLA) rider
15.4.5.1
Future increase option (FIO) rider
15.4.5.2
Loss-of-time benefit adjustment (59A-22-22)
State Supplement
Other cash benefits
15.4.6
Accidental death and dismemberment
15.4.6.1
Rehabilitation benefit
15.4.6.2
Medical reimbursement benefit (nondisabling injury)
15.4.6.3
Refund provisions
15.4.7
Return of premium
15.4.7.1
Cash surrender value
15.4.7.1
Exclusions
15.4.8
11.3 Unique Aspects of Individual Disability Underwriting
15.4.9
Occupational considerations
15.4.9.1
Benefit limits
15.4.9
Policy issuance alternatives
15.4.9.3
11.4 Group Disability Income Insurance
15.5
Group versus individual plans
15.5.1
Short-term disability (STD)
15.5.2
Long-term disability (LTD)
15.5.3
11.5 Business Disability Insurance
15.6
Key person disability income
15.6.1
Disability buy-sell policy
15.6.2
11.6 Social Security Disability
15.7
Qualification for disability benefits
15.7.1
Definition of disability
15.7.1
Waiting period
15.7.1
Disability income benefits
15.7.2
11.7 Workers' Compensation
15.8
15.4.2
Eligibility
15.8
Benefits
15.8
12.0 Medical Plans 9%
12.1 Medical Plan Concepts
16.3
Fee-for-service basis vs. prepaid basis vs. expense basis
16.3.1
Expense based basis versus indemnity
16.3.3
Specified coverages versus comprehensive care
16.3.2
Benefit schedule versus usual/reasonable/customary charges
16.3.3
Any provider versus limited choice of providers
16.3.4
Insureds versus subscribers/participants
16.3.5
Qualified Health Plans
EPOs
13.3.4
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HDHPs
22.6.2
12.2 Types of Providers and Plans
16.4
Limited Benefits Insurance
12.6
Indemnity Plan Features
Excepted Benefit Plans
12.7.3
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Hospital Indemnity Insurance
12.7.3
Accident-Only Insurance
12.7.1
Specified disease
12.7.2
Major medical insurance (comprehensive coverage)
16.4.2
Characteristics
16.4.2
Participating vs. Non-Participating providers
Deductibles, Copay, and Coinsurance
16.3.4
16.4.2.2; 17.3.1.3;
16.4.2.3
Emergency care
17.3.2.1.1
Preventive Care Services
17.3.2.1
Common limitations
Provisions affecting cost to insured
16.4.2.6
16.4.2.2, 16.4.2.3,
16.4.2.4, 16.4.2.5
Qualified Health Plans (QHPs)
13.3.4
General characteristics
13.3.4
EHBs
13.3.3.1
CSR and APTCs
13.3.4.2
Special Enrollment Periods
13.3.4
Preventive Care Services
13.3.3.6
Maximum Out-of-Pocket
13.3; 16.4.2.5
Open Enrollment Period
13.3.4
Pre-existing Exclusions
13.3.3.7
Health maintenance organizations (HMOs)
17.3
General characteristics
17.3.1
Preventive care services
17.3.2.1
Primary care physician versus referral (specialty) physician
17.3.1.4
Emergency care
17.3.2.1.1
Hospital services
17.3.2.2
Other basic services
17.3.2.3
Preferred provider organizations (PPOs) (§59A-22A)
17.4
General characteristics
17.4
Open panel or closed panel
17.4.1
Types of parties to the provider contract
17.4.2
Point-of-service (POS) plans
17.5
Nature and purpose
17.5
PCP referral (gatekeeper PPO)
17.5
HDHP plans
22.6.2
Features and purpose
Features and purpose
22.6.2
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kaplanfinancial.com;
updates/errata
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kaplanfinancial.com;
updates/errata
Indemnity plan features
17.6
12.3 Cost Containment in Health Care Delivery
17.7
Cost-saving services
17.7.1
Preventive care
17.7.1.1
Hospital outpatient benefits
17.7.1.2
Alternatives to hospital services
17.7.1.2
Utilization management
17.7.2
Prospective review
17.7.2
Concurrent review
17.7.2
Grievance procedures
17.7.2
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updates/errata
Exclusive Provider Organization Plans
Network Adequacy
12.4 New Mexico eligibility requirements and benefit offers
(individual and group)
Dependent child age limit (§59A-22-30.1)
State Supplement
Continued coverage of handicapped children (59A-22-33)
State Supplement
Newborn child coverage (59A-22-34)
State Supplement
Adopted child coverage (59A-22-34.1)
State Supplement
Child enrollment; noncustodial parents (59A-22-34.2)
State Supplement
Home health care coverage (59A-22-36)
State Supplement
Managed Health Care Rule (Reg 13.10.13.8–.12)
State Supplement
Mental health parity (59A-23E-18)
State Supplement
Women's health care benefits
State Supplement
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updates/errata
Patient Protection Act (59A-57-3)
12.5 HIPAA (Health Insurance Portability and Accountability
Act) Requirements
18.9
Eligibility
18.9.1
Guaranteed issue
18.9.1
Pre-existing conditions
18.9.1
Creditable coverage
18.9.1
Renewability
12.6 Medical Savings Accounts (MSAs), Flexible Savings
Accounts (FSAs), Health Savings Accounts (HSAs), Health
Reimbursement Accounts (HRAs)
18.9.1
Definition
22.6, 22.7, 22.8
Eligibility
22.6, 22.7, 22.8
Contribution limits
22.6, 22.7, 22.8
22.6, 22.7, 22.8
13.0 Group Health Insurance 6%
13.1 Characteristics of Group Insurance
18.3
Group contract
18.3.1
Certificate of coverage
18.3.2
Experience rating versus community rating
18.3.3
13.2 Types of Eligible Group
18.4
Employment-related groups (§59A-23-3A.1)
18.4
Individual employer groups
Multiple-Employer Trusts (METs) or Welfare Arrangements
(MEWAs) (Reg
13.9.4)
18.4
Associations (alumni, professional, other) (§59A-23-3A.2)
18.4
Customer groups (depositors, creditor-debtor, other)
18.4
13.3 Marketing Considerations
18.6
Advertising
18.6.1
Regulatory jurisdiction/place of delivery
18.6.2
13.4 Employer Group Health Insurance
18.5
Insurer underwriting criteria
18.5.1
Characteristics of group
18.3
Plan design factors
18.5.1
Persistency factors
18.5.1
Administrative capability
18.5.1
Eligibility for insurance
18.5.2
Annual open enrollment
18.5.2.4
Employee eligibility
18.5.2.1
Dependent eligibility
18.5.2.2
Coordination of benefits provision
18.5.3
Subrogation
18.6.2
Change of insurance companies or loss of coverage
18.7
Coinsurance and deductible carryover
18.7.1
No-loss no-gain
18.7.2
Events that terminate coverage
18.7.3
Extension of benefits (Reg 13.10.5.10)
Continuation of coverage under COBRA and New Mexico specific
rules (59A-18-16)
State Supplement
Conversion privilege (59A-18-16)
State Supplement
18.4
State Supplement
13.5 Small Employer Medical Plans
Definition of small employer (59A-23C-3(N))
State Supplement
Rate and renewability (59A-23C-6)
State Supplement
Pre-existing condition exclusion (§59A-23E3)
State Supplement
14.0 Dental Insurance 2%
14.1 Types of Dental Treatment
19.3
Diagnostic and preventive
19.3
Restorative
19.3.1
Oral surgery
19.3.1
Endodontics
19.3.1
Periodontics
19.3.1
Prosthodontics
19.3.1
Orthodontics
19.3.1
14.2 Dental Plan Types
19.3.2
Indemnity plan features
19.3.3.1
Indemnity vs. expense based plans
19.3.3.1
Choice of providers
19.3.2.1
Scheduled versus nonscheduled plans
19.3.2.2
Benefit categories
19.3.2.4
Diagnostic/preventive services
19.3.2.4
Basic services
19.3.2.4
Major services
19.3.2.4
Deductibles and coinsurance
19.3.2.4
Combination plans
19.3.2.3
Exclusions
19.3.2.6
Limitations
19.3.2.4
Predetermination of benefits
19.3.2.5
14.3 Employer Group Dental Expense
19.3.3
Integrated deductibles versus stand-alone plans
19.3.3.1
Minimizing adverse selection
19.3.3.2
15.0 Insurance for Senior Citizens and Special Needs
Individuals 6%
15.1 Medicare
20.3
Nature, financing and administration
20.3.1
Part A — Hospital insurance
20.3.2
Individual eligibility requirements
20.3.2.1
Enrollment
Coverages and cost-sharing amounts
20.3.2.1
20.3.2.2, 20.3.2.3,
20.3.2.4, 20.3.2.5
Part B — Medical insurance
20.3.3
Individual eligibility requirements
20.3.3.1
Enrollment
20.3.3.1
Coverages and cost-sharing amounts
20.3.3.2, 20.3.3.3
Exclusions
20.3.5
Claims terminology and other key terms
20.3.4
Part C — Medicare Advantage
20.3.6
Part D — Prescription Drug Insurance
15.2 Medicare Supplements (Reg 13.10.25,
§59A-24A)
20.3.7
Purpose
20.4
Open enrollment
20.4.1
Standardized Medicare supplement plans
20.4.1
Core benefits
20.4.1
Additional benefits
20.4.1
New Mexico regulations and required provisions
State Supplement
Advertising
State Supplement
Standards for marketing
State Supplement
Permitted compensation arrangements
State Supplement
Suitability for recommended purchase
State Supplement
Required disclosure provisions
State Supplement
Outline of coverage (59A-24A-9)
State Supplement
Right to return (free look) (59A-24A-10)
State Supplement
Replacement
State Supplement
State Supplement
Benefit standards
State Supplement
Pre-existing conditions (59A-24A-4(B))
State Supplement
Guaranteed issue
State Supplement
Prohibited provisions (59A-24A-4)
State Supplement
Medicare SELECT (Reg 13.10.8.26)
State Supplement
15.3 Other Options for Individuals with Medicare
20.4
Employer group health plans
20.3.8
Disabled employees
20.3.6.2
Employees with kidney failure
20.3.6.2
Individuals age 65 and older
20.3.8
Medicaid
20.5
Eligibility
20.5
Benefits
20.5
15.4 Long-Term Care (LTC) insurance
21.1
Eligibility for benefits
21.4
Levels of care
21.5
Skilled care
21.5
Intermediate care
21.5
Custodial care
21.5
Home health care
21.5
Adult day care
21.5
Respite care
21.5
Benefit periods
21.6.1
Benefit amounts
21.6.2
Optional benefits
21.6.4
Guarantee of insurability
21.6.4
Return of premium
21.6.4
Qualified LTC plans (state and federal)
21.8
Exclusions
21.7
Underwriting considerations
21.1
New Mexico regulations and required provisions
State Supplement
Advertising (59A-23A-11; Reg 13.10.15.36)
State Supplement
Standards for marketing (Reg 13.10.15.36, .49–.53)
State Supplement
Prohibited marketing practices (Reg 13.10.15.38)
State Supplement
Suitability of recommended purchase (Reg 13.10.15.40, .52)
State Supplement
Required disclosure provisions (Reg 13.10.15.19, .50–.53)
State Supplement
Outline of coverage (Reg 13.10.15.45, .46)
State Supplement
Shoppers guide (Reg 13.10.15.47)
State Supplement
Right to return (free look) (59A-23A-6(E))
State Supplement
Replacement (Reg 13.10.15.25, .42)
State Supplement
Policy standards (59A-23A-6)
State Supplement
Benefit triggers (Reg 13.10.15.44)
State Supplement
Pre-existing conditions (59A-23A-7)
State Supplement
Inflation protection (Reg 13.10.15.24)
State Supplement
Nonforfeiture benefit offer (Reg 13.10.15.43)
State Supplement
Unintentional lapse (Reg 13.10.15.17)
State Supplement
Penalties (Reg 13.10.15.48)
State Supplement
16.0 Federal Tax Considerations for Health Insurance 3%
16.1 Personally-Owned Health Insurance
Disability income insurance
22.3
Medical expense insurance
22.3
Long-Term care insurance
22.3
16.2 Employer Group Health Insurance
22.3
Disability income (STD, LTD)
22.3
Medical and dental expense
22.3
Long-Term care insurance
22.3
Accidental death and dismemberment
16.3 Medical Expense Coverage for Sole Proprietors and
Partners
22.3
16.4 Business Disability Insurance
22.5
Key person disability income
22.5
Buy-sell policy
16.5 Medical Savings Accounts (MSAs), Flexible Savings
Accounts (FSAs), Health Savings Accounts (HSAs), Health
Reimbursement Accounts (HRAs)
22.5
22.4
22.6, 22.7, 22.8