NM| The New Mexico Office of the Superintendent of Insurance Bulletin 2025-015 clarifies that for New Mexico insurers offering major medical, dental, or vision coverage, coordination of benefits (COB) provisions for minor dependents covered under more than one plan must align with Section 6(D)(2) of the NAIC Coordination of Benefits Model Regulation MO-120 (October 2013). It confirms that OSI will accept COB language that follows the NAIC order-of-benefits rules based on parental marital/living status, birthday rule, court decrees allocating responsibility, and custodial arrangements, and extends these rules to non-parent caregivers treating them as parents for COB purposes.
Key Points:
- For parents who are married or living together, the primary plan is determined by which parent’s birthday falls earlier in the calendar year, or if the same birthday, which plan has covered the parent longer.
- For divorced, separated, or not-cohabiting parents, the primary plan is driven first by any court decree assigning responsibility; if both or joint custody without specifics, the married/living-together birthday rule applies, and if no decree, priority follows custodial parent, custodial parent’s spouse, non-custodial parent, then non-custodial parent’s spouse.
- For dependent children covered under plans of non-parent individuals, the same ordering rules are applied as if those individuals were the child’s parents, and questions are directed to the OSI Life and Health Bureau.