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A. Every insurer, fraternal benefit society, multiple employer welfare arrangement, health maintenance organization or nonprofit health care plan that provides primary health insurance or health care coverage insuring or covering major medical expenses shall, in determining the initial year's premium charged for an individual, use only the rating factors of age, geographic area of the place of employment and smoking practices, except that for individual policies the rating factor of the individual's place of residence may be used instead of the geographic area of the individual's place of employment.
B. Separately for an insurer's individual and group policies, no person's rate shall exceed the rate of any other person with similar family composition by more than two hundred fifty percent of the lower rate, except that the rates for children under nineteen years of age or children nineteen to twenty-five years of age who are full-time students may have rates that are lower than the bottom rates in the two hundred fifty percent band. The rating factor restrictions shall not prohibit an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from offering rates that differ depending upon family composition. For the purposes of this subsection, “family composition” refers only to whether coverage covers an individual or a family.
C. The provisions of this section do not preclude an insurer, multiple employer welfare arrangement, fraternal benefit society, health maintenance organization or nonprofit health care plan from using health status or occupational or industry classification in establishing the amount a large group health benefits plan may be charged for coverage.
D. As used in Subsection C of this section, “health status” does not include genetic information.
E. The superintendent shall adopt regulations to implement the provisions of this section.
Cite this article: FindLaw.com - New Mexico Statutes Chapter 59A. Insurance Code § 59A-18-13.1. Adjusted community rating - last updated May 06, 2021 | https://codes.findlaw.com/nm/chapter-59a-insurance-code/nm-st-sect-59a-18-13-1/
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