A. For a policy or certificate that has been in force for less than six months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
B. For a policy or certificate that has been in force for at least six months but less than two years an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.
C. After a policy or certificate has been in force for two years it is not contestable upon the grounds of misrepresentation alone. Such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
D. No long-term care insurance policy or certificate may be field issued based on medical or health status. For purposes of this subsection, "field issued" means a policy or certificate issued by an agent or a third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer.
E. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
History: 1978 Comp., § 59A-23A-8, enacted by Laws 1993, ch. 126, § 12.
Repeals and reenactments. — Laws 1993, ch. 126, § 12 repealed former 59A-23A-8 NMSA 1978, as enacted by Laws 1989, ch. 136, § 8, relating to the continuation of coverage and conversion, and enacted a new section, effective June 18, 1993. For provisions of former section, see the 1992 NMSA 1978 on NMOneSource.com.
Am. Jur. 2d, A.L.R. and C.J.S. references. — Rescission or cancellation of insurance policy for insured's misrepresentation or concealment of information concerning human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) or related health problems, 15 A.L.R.5th 92.
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