N.M. Admin. Code § 13.10.35.7

Current through Register Vol. 35, No. 21, November 5, 2024

Section 13.10.35.7 - DEFINITIONS

For definitions of terms contained in this rule, refer to 13.10.29 NMAC, unless otherwise noted below.

A."Domestic co-insured" means a spouse or domestic partner insured under the same plan or certificate.

B."Earned premiums" for a reporting year means the premium received up to the loss ratio measurement date that provided coverage during that reporting year.

C."Incurred claims" for a reporting year means the claims for which services were provided in the reporting year. This includes such claims that were paid in the reporting year plus unpaid claims reserves for such reporting year.

D."Loss ratio" means the incurred claims divided by earned premiums, calculated pursuant to Subsection D of 13.10.35.9 NMAC.

E."Loss ratio measurement date" means the date as of which the incurred claims and earned premiums for each reporting year are determined for the reporting required in Subsection M of 13.10.35.9 NMAC of this rule.

F."Preferred provider" means a dental or vision care provider, or group of providers, who contracts with a dental or vision insurance carrier to provide dental or vision services to a covered person.

G."Reporting year" means a calendar year during which group or individual dental coverage is provided by a policy, contract or certificate covering dental services.

H."Schedule of benefits" means any form that is part of an insurance policy filed with and approved by the superintendent that contains any of the following information: coverage levels, cost sharing features, covered services, benefit maximums and exclusions.

I."Unpaid claim reserves" for a reporting year means reserves and liabilities established as of the applicable loss ratio reporting year but were paid after the reporting year.

N.M. Admin. Code § 13.10.35.7

Adopted by New Mexico Register, Volume XXXII, Issue 11, June 8, 2021, eff. 1/1/2022, Amended by New Mexico Register, Volume XXXIII, Issue 24, December 27, 2022, eff. 1/1/2024