New Mexico Statutes 59A-48-8. Membership coverage
A. Every member in a prepaid dental plan shall be issued a membership coverage form by the prepaid dental plan organization.
Terms Used In New Mexico Statutes 59A-48-8
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Contract: A legal written agreement that becomes binding when signed.
- member: means an individual who is enrolled in a group prepaid dental plan as a principal subscriber together with such person's dependents who are entitled to dental care services under the plan solely because of their status as dependents of the principal subscriber. See New Mexico Statutes 59A-48-2
- membership coverage: means any certificate or contract issued to a member setting out the dental coverage to which such member is entitled. See New Mexico Statutes 59A-48-2
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- prepaid dental plan: means any contractual arrangement whereby any prepaid dental plan organization undertakes to provide directly or to arrange for prepaid dental services and to pay or make reimbursement for any remaining portion of such prepaid dental services on a prepaid basis through insurance or otherwise. See New Mexico Statutes 59A-48-2
- prepaid dental plan organization: means any person who undertakes to conduct one or more prepaid dental plans providing only dental services. See New Mexico Statutes 59A-48-2
- prepaid dental services: means services included in the practice of dentistry as defined in the Dental Act [61-5-1 to 61-5-9, 61-5-11 to 61-5-22 N. See New Mexico Statutes 59A-48-2
B. Any contract applied for that provides family coverage shall, as to such coverage of individuals in the family, also provide that the benefits applicable for children shall be payable with respect to a newly-born child of the insured from the instant of such child’s birth to the same extent that such coverage applies to other individuals in the family. If payment of a specific premium is required to provide coverage for a child, the contract may require that notification of birth of a newly-born child and payment of the required premium shall be furnished to the insurer within thirty-one (31) days after the date of birth in order to have the coverage continue beyond the thirty-one-day period.
C. No membership coverage or amendment shall be issued or delivered to any person in this state until a copy of the form of the membership coverage or amendment has been filed with and approved by the superintendent.
D. A membership coverage shall contain a clear and complete statement of a contract, or a reasonably complete summary if a certificate of contract, of:
(1) the prepaid dental services or other benefits to which the member is entitled under the prepaid dental plan;
(2) any limitations of the services, kinds of services or benefits to be provided, including any deductible or copayment feature;
(3) where and in what manner information is available as to how services may be obtained; and
(4) the member’s obligation respecting charges for the prepaid dental plan.
E. A membership coverage shall contain no provisions or statements which are unjust, unfair, inequitable, misleading, deceptive or which encourage misrepresentation or which are untrue.
F. The superintendent shall approve any form of membership coverage if the requirements of Subsections D and E of this section are met and the prepaid dental plan is able in the judgment of the superintendent to meet its financial obligations under the membership coverage. It is unlawful to issue such form until approved. If the superintendent does not disapprove any such form within thirty (30) days after the filing, it shall be deemed approved. If the superintendent disapproves a form of membership coverage, the superintendent shall notify the prepaid dental plan organization, specifying the reasons for disapproval. The superintendent shall grant a hearing on such disapproval within fifteen (15) days after a request in writing is received from the prepaid dental plan organization.