N.M. Stat. § 59A-18-16
Continuation of coverage and conversion rights;
accident and health insurance policies; notice.
Subject to the provisions of the Health Insurance Portability Act:
A. every accident and health insurance policy that provides hospital, surgical and
medical expense benefits and that is delivered, issued for delivery or renewed in this
state on or after January 1, 1985 shall provide:
(1)
if an individual policy, covered family members the right to continue such
policy as the named insured or through a conversion policy upon the death of the
named insured or upon the divorce, annulment or dissolution of marriage or legal
separation of the spouse from the named insured; or
(2)
if a group policy:
(a) each member or employee of the group insured the right to continue such
coverage for a period of six months and thereafter through a conversion policy upon
termination of membership or employment with the group insured; and
(b) covered family members of an employee or member of the group insured
the right to continue such coverage through a converted or separate policy upon the
death of the member or employee of the group insured or upon the divorce, annulment
or dissolution of marriage or legal separation of the spouse from the member or
employee of the group insured.
Where a continuation of coverage or conversion is made in the name of the spouse
of the named insured or the spouse of the employee or member of the group insured,
such coverage may, at the option of the spouse, include coverage for dependent
children for whom the spouse has responsibility for care and support;
B. the right to a continuation of coverage or conversion pursuant to this section shall
not exist with respect to any member or employee of the group insured or any covered
family member in the event the coverage terminates for nonpayment of premium,
nonrenewal of the policy or the expiration of the term for which the policy is issued.
With respect to any member or employee of the group insured or any covered family
member who is eligible for medicare or any other similar federal or state health
insurance program, the right to a continuation of coverage or conversion shall be limited
to coverage under a medicare supplement insurance policy as defined by the rules and
regulations adopted by the superintendent;
C. coverage continued through the issuance of a converted or separate policy shall
be provided at a reasonable, nondiscriminatory rate to the insured and shall consist of a
form of coverage then being offered by the insurer as a conversion policy in the
jurisdiction where the person exercising the conversion right resides that most nearly
approximates the coverage of the policy from which conversion is exercised. Continued
and converted coverages shall contain renewal provisions that are not less favorable to
the insured than those contained in the policy from which the conversion is made,
except that the person who exercises the right of conversion is entitled only to have
included a right to coverage under a medicare supplement insurance policy, as defined
by the rules and regulations adopted by the superintendent, after the attainment of the
age of eligibility for medicare or any other similar federal or state health insurance
program;
D. at the time of inception of coverage, the insurer shall furnish to each covered
family member who is eighteen years of age or over and to each employee or member
of the group insured a statement setting forth in summary form the continuation of
coverage and conversion provisions of the policy;
E. the insurer shall notify in writing each employee or member, upon that
employee's or member's termination of employment or membership with the group
insured, of the continuation and conversion provisions of the policy. The employer may
give the written notice specified herein. The employer should notify the insurer of the
employee's or member's change of status and last known address. Under no
circumstances shall the employer have any civil liability under the conversion provisions
of the Insurance Code;
F. the eligible employee or member of the group insured or covered family member
exercising the continuation or conversion right shall notify the employer or insurer and
make payment of the applicable premium within thirty days following the date of the
notification given by the insurer pursuant to Subsection E of this section. There shall be
no lapse of coverage during the period in which conversion is available;
G. coverage shall be provided through continuation or conversion without additional
evidence of insurability and shall not impose any preexisting condition, limitations or
other contractual time limitations;
H. benefits otherwise payable under a converted or separate policy may be reduced
so they are not, during the first policy year of the converted or separate policy, in excess
of those that would have been payable under the policy from which conversion is
exercised. Benefits, if any, otherwise payable under a converted or separate policy are
not payable for a loss claimed under the policy from which conversion is exercised; and
I. any probationary or waiting period set forth in the converted or separate policy is
deemed to commence on the effective date of the applicant's coverage under the
original policy.