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.
[13.10.34.7 NMAC - Rp, 13.10.34.7 NMAC, 07/01/2023]