THIS BULLETIN SUPERSEDES AND REPLACES BULLETIN 2018-006 – INTEREST RATE APPLICABLE TO UNPAID CLAIMS

# STATE OF NEW MEXICO ## OFFICE OF SUPERINTENDENT OF INSURANCE DEPUTY SUPERINTENDENT Robert E. Doucette, Jr.  DEPUTY SUPERINTENDENT Andy Romero SUPERINTENDENT OF INSURANCE John G. Franchini  Insurance Bulletin 2019-010 June 27, 2019 This Bulletin supersedes and replaces Bulletin 2018-006. TO: INSURANCE COMPANIES AUTHORIZED TO TRANSACT BUSINESS OF INSURANCE IN NEW MEXICO RE: INTEREST RATE APPLICABLE TO UNPAID CLAIMS 45 DAYS AFTER REQUIRED PROOF OF LOSS HAS BEEN FURNISHED THE FOLLOWING BULLETIN is issued pursuant to NMSA 1978, § 59A-2-8, and 13.1.2.8 NMAC, et seq. The New Mexico Insurance Code, at NMSA 1978, § 59A-16-21(B), provides: Notwithstanding any provision of the Insurance Code, any insurer issuing any policy, certificate or contract of insurance, surety, guaranty or indemnity of any kind or nature which fails for a period of forty-five days, after required proof of loss has been furnished, to pay to the person entitled the amount justly due shall be liable for the amount due and unpaid with interest on that amount at the rate of one and one-half times the prime lending rate as determined by the superintendent, for New Mexico banks per year during the period the claim is unpaid. The New Mexico Administrative Code, at 13.10.22.12(O) NMAC, provides: Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2019-010 Page | 2 r year during the period the claim is unpaid. The New Mexico Administrative Code, at 13.10.22.12(O) NMAC, provides: Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2019-010 Page | 2 Each contract shall provide that a MHCP failing to pay a health care professional or failing to pay a covered person for out of pocket covered expenses within forty-five days after a clean claim has been received by the MHCP shall be liable for the amount due and unpaid with interest on that amount at the rate of one and one half times the rate established by a bulletin entered by the superintendent in January of each calendar year. For the purposes of this section, “clean claim” means a manually or electronically submitted claim that contains all the required data elements necessary for accurate adjudication without the need for additional information from outside of the MHCP’s system and contains no deficiency or impropriety, including lack of substantiating documentation currently required by the MHCP, or particular circumstances requiring special treatment that prevents timely payment from being made by the MHCP. Due to the recent change in the prime lending rate, commencing July 1, 2019, the interest rate applicable to the referenced statute and rule is 8.25%. This rate shall remain in effect until superseded by a subsequent bulletin specifying a different rate. The Superintendent intends to publish an interest rate bulletin at least once per year. The Superintendent may publish interest rate bulletins more frequently if the prime lending rate materially fluctuates, or less frequently if the prime lending rate remains stable. statute and rule is 8.25%. This rate shall remain in effect until superseded by a subsequent bulletin specifying a different rate. The Superintendent intends to publish an interest rate bulletin at least once per year. The Superintendent may publish interest rate bulletins more frequently if the prime lending rate materially fluctuates, or less frequently if the prime lending rate remains stable. An insurer who owes interest pursuant to the referenced statute or rule shall use the rate specified in the rate bulletin in effect 45 days after the insurer was furnished a proof of loss or claim. Please direct your questions regarding this bulletin to Anna Krylova at (505) 827-4529, or via e-mail at anna.krylova@state.nm.us. DONE AND ORDERED this June 27, 2019. John G. Franchini JOHN G. FRANCHINI Superintendent of Insurance Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us