As used in the Life and Health Insurance Guaranty Association Act:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

A. “account” means either of the two accounts maintained pursuant to Section 59A- 42-5 NMSA 1978;

B. “association” means the life and health insurance guaranty association created pursuant to Section 59A-42-5 N.M. Stat. Ann.;

C. “authorized assessment”, or the term “authorized” when used in the context of assessments, means that a resolution by the board has been passed whereby an assessment will be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed;

D. “benefit plan” means a specific employee, a union or an association of natural persons benefit plan;

E. “board” means the board of directors organized pursuant to Section 59A-42-6 N.M. Stat. Ann.;

F. “called assessment”, or the term “called” when used in the context of assessments, means that a notice has been issued by the association to member insurers requiring that an authorized assessment be paid within the time frame set forth within the notice. An authorized assessment becomes a called assessment when notice is mailed by the association to member insurers;

G. “contractual obligation” means an obligation under a policy or contract or a certificate under a group policy or contract, or portion thereof, for which coverage is provided pursuant to Section 59A-42-4 N.M. Stat. Ann.;

H. “covered policy” and “covered contract” means a policy or contract or portion of a policy or contract for which coverage is provided pursuant to Section 59A-42-4 N.M. Stat. Ann.;

I. “domiciliary state” means the state in which an insurer is incorporated or organized or, as to an alien insurer, the state in which at commencement of delinquency proceedings the larger amount of the insurer’s assets are held in trust or on deposit for the benefit of its policyholders and creditors in the United States;

J. “extra-contractual claims” includes claims relating to bad faith in the payment of claims, punitive or exemplary damages or attorney fees and costs;

K. “health benefit plan” means any hospital or medical expense policy or certificate or health maintenance organization subscriber contract or any other similar health contract. “Health benefit plan” does not include:

(1)     accident-only insurance;

(2)     credit insurance;

(3)     dental-only insurance; (4)     vision-only insurance;

(5)     medicare supplement insurance;

(6)     benefits for long-term care, home health care, community-based care or any combination thereof;

(7)     disability income insurance;

(8)     coverage for on-site medical clinics; or

(9)     specified disease, hospital confinement indemnity or limited benefit health insurance if the health benefit plans do not provide coordination of benefits and are provided under separate policies or contracts;

L. “impaired insurer” means a member insurer that, after the effective date of the Life and Health Insurance Guaranty Association Act, is not an insolvent insurer and is placed under an order of rehabilitation or conservation by a court of competent jurisdiction;

M. “insolvent insurer” means a member insurer that, after the effective date of the Life and Health Insurance Guaranty Association Act, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency;

N. “member insurer” means an insurer or health maintenance organization that is licensed or that holds a certificate of authority to transact in this state any kind of insurance or health maintenance organization business for which coverage is provided pursuant to Section 59A-42-4 N.M. Stat. Ann. and includes an insurer or health maintenance organization whose license or certificate of authority in this state may have been suspended, revoked, not renewed or voluntarily withdrawn, but does not include:

(1)     a health care plan, whether profit or nonprofit; (2)     a prepaid dental plan;

(3)     a fraternal benefit society;

(4)     a mandatory state pooling plan;

(5)     a mutual assessment company or other person that operates on an assessment basis;

(6)     an insurance exchange;

(7)     a charitable organization that is in good standing with the superintendent pursuant to Section 59A-1-16.1 N.M. Stat. Ann.;

(8)     any insurer that was insolvent or unable to fulfill its contractual obligations as of April 9, 1975; or

(9)     an entity similar to any of the above;

O. “Moody’s corporate bond yield average” means the monthly average corporates as published by Moody’s investors service, incorporated, or its successor;

P. “owner” of a policy or contract, “policy owner”, “policy holder” and “contract owner” means the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the member insurer. The terms “owner”, “policy owner”, “policy holder” and “contract owner” do not include persons with a mere beneficial interest in a policy or contract;

Q. “plan sponsor” means:

(1)     the employer in the case of a benefit plan established or maintained by a single employer;

(2)     the employee organization in the case of a benefit plan established or maintained by an employee organization; or

(3)     the association, committee, joint board of trustees or other similar group of representatives of the parties who establish or maintain the benefit plan in the case of a benefit plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations;

R. “premiums” means amounts or considerations, by whatever name used, received on covered policies or contracts less returned premiums, considerations and deposits and less dividends and experience credits. “Premiums” does not include:

(1)     amounts or considerations received for policies or contracts or for the portions of policies or contracts for which coverage is not provided pursuant to Subsection E of Section 59A-42-4 N.M. Stat. Ann., except that assessable premiums shall not be reduced on account of Paragraph (3) of Subsection E of Section 59A-42-4 N.M. Stat. Ann., relating to interest limitations, or Paragraph (2) of Subsection F of Section 59A- 42-4 NMSA 1978, relating to limitations, with respect to one individual, one participant, one policy holder or one contract owner;

(2)     premiums in excess of five million dollars ($5,000,000) on an unallocated annuity contract not issued under a governmental retirement benefit plan, or its trustee, established pursuant to Section 401, 403(b) or 457 of the federal Internal Revenue Code of 1986; or

(3)     with respect to multiple non-group policies of life insurance owned by one owner, whether the policy holder or contract owner is an individual, firm, corporation or other person, and whether the persons insured are officers, managers, employees or other persons, premiums in excess of five million dollars ($5,000,000) with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner;

S. “principal place of business” means:

(1)     in the case of a plan sponsor or a person other than a natural person, the single state in which the natural person who establishes a policy for the direction, control and coordination of the operations of the entity as a whole primarily exercises that function, as determined by the association in its reasonable judgment by considering the following factors:

(a) the state in which the primary executive and administrative headquarters of the entity is located;

(b) the state in which the principal office of the chief executive officer of the entity is located;

(c) the state in which the board, or similar governing person or persons, of the entity conducts the majority of its meetings;

(d) the state in which the executive or management committee of the board, or similar governing person or persons, of the entity conducts the majority of its meetings;

(e) the state from which the management of the overall operations of the entity is directed;

(f) in the case of a benefit plan sponsored by affiliated companies comprising a consolidated corporation, the state in which the holding company or controlling affiliate has its principal place of business as determined using the factors in this subsection;

and (g) in the case of a plan sponsor, if more than fifty percent of the participants in the benefit plan are employed in a single state, that state shall be deemed to be the principal place of business of the plan sponsor; and

(2)     in the case of a plan sponsor of a benefit plan described in Paragraph (3) of Subsection Q of this section, the principal place of business of the association, committee, joint board of trustees or other similar group of representatives of the parties that establish or maintain the benefit plan that, in lieu of a specific or clear designation of a principal place of business, shall be deemed to be the principal place of business of the employer or employee organization that has the largest investment in the benefit plan in question;

T. “receivership court” means the court in the insolvent or impaired insurer’s domiciliary state having jurisdiction over the conservation, rehabilitation or liquidation of the member insurer;

U. “resident” means a person to whom a contractual obligation is owed and who resides in this state on the date of entry of a court order that determines a member insurer to be an impaired insurer or a court order that determines a member insurer to be an insolvent insurer. A person may be a resident of only one state, which, in the case of a person other than a natural person, shall be its principal place of business. Citizens of the United States that are either residents of foreign countries or residents of United States possessions, territories or protectorates that do not have an association similar to the association created by the Life and Health Insurance Guaranty Association Act shall be deemed residents of the state of domicile of the member insurer that issued the policies or contracts;

V. “structured settlement annuity” means an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant;

W. “structured settlement factoring transaction” means a transfer of structured settlement payment rights, including portions of structured settlement payments made for consideration by means of sale, assignment, pledge or other form of encumbrance or alienation;

X. “supplemental contract” means a written agreement entered into for the distribution of proceeds under a life, health or annuity policy or contract; and

Y. “unallocated annuity contract” means an annuity contract or group annuity certificate that is not issued to and owned by an individual, except to the extent of annuity benefits guaranteed to an individual by an insurer under the contract or certificate.