N.M. Admin. Code § 13.19.4.7

Current through Register Vol. 35, No. 20, October 22, 2024

Section 13.19.4.7 - DEFINITIONS

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

A."Association health plan or association or AHP" means any foreign or domestic association that provides a health benefits plan that covers the employees of multiple employers or union members. All association health plans are multiple employer welfare arrangements.

B."By laws" means the statements adopted by a MEWA that prescribe its purpose, government and administration.

C."Discretionary group" means a group that does not meet the standard, eligible group requirements under state or federal law, but have otherwise obtained insurance by the discretion of the superintendent to operate.

D."Employer" means:

(1) a person who is an employer as that term is defined in Section 3(5) of the federal Employee Retirement Income Security Act of 1974, and who employs two or more employees; and

(2) a partnership in relation to a partner pursuant to Section 59A-23E-17 NMSA 1978.

E."ERISA" refers to the Employee Retirement Income Security Act of 1974 (29 United States Code Section 1002(4)), and ERISAs implementing regulations, as currently enacted or subsequently amended;

(1) these rules incorporate the definitions in 29 U.S.C.A., § 1002, and in its implementing regulations, as currently enacted or subsequently amended.

(2) unless inconsistent with the definitions in 29 U.S.C.A., § 1002, or in its implementing regulations, these rules incorporate the definitions in the New Mexico Insurance Code.

F."Fully-insured multiple employer welfare arrangement" means that an authorized insurer is obligated to provide all of the benefits and services owed to a participant in, or beneficiary of, a MEWA and is directly liable to each participant or beneficiary for those services or benefits.

G."Insurance code" refers to the New Mexico Insurance Code and its implementing rules, as currently enacted or subsequently amended.

H."M-1 filing" means a Form M-l report that the federal department of labor requires a MEWA to file annually.

I."Multiple employer welfare arrangement" or "MEWA" refers to any foreign or domestic entity that administers a multiple employer welfare arrangement pursuant to 29 U.S.C.A., § 1002(40)(A) and these rules.

J."NAIC" means the national association of insurance commissioners.

K."Planadministrator or third-party administrator" means a person or entity engaged by a self-funded MEWA, to carry out the policies established by the trustees and to otherwise administer and provide day-to-day management of the health benefits plan;

L."Self-funded multiple employer welfare arrangement" refers to a MEWA that is not fully-insured. A fully-insured MEWA shall be deemed a self-funded MEWA, subject to all of the laws and regulations pertaining thereto, if, at any time, any of the obligations owed by the MEWA to a participant or beneficiary will not be provided by an authorized insurer.

M."Self-insure" means to assume primary liability or responsibility for certain risks or benefits, rather than transferring liability or responsibility to some other entity.

N."SERFF" means the system for electronic rates and forms filings.

N.M. Admin. Code § 13.19.4.7

13.19.4.7 NMAC - N, 05-01-02, Adopted by New Mexico Register, Volume XXX, Issue 16, August 27, 2019, eff. 8/27/2019, Amended by New Mexico Register, Volume XXXI, Issue 04, February 25, 2020, eff. 2/25/2020