Employers have no obligation under New Mexico law to offer long-term care insurance to their employees. However, if long-term care insurance is among the benefits offered, certain state law requirements limit how the plan may be designed. Under New Mexico's Long-Term Care Insurance Law, "long-term care insurance" is defined as any insurance coverage advertised, marketed, offered, or designed to provide coverage for at least 12 consecutive months for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services provided in a setting other than an acute care unit of a hospital (NM Stat. Sec. 59A-23A-4).
Preexisting condition limitations in long-term care insurance policies may not exclude coverage for more than 6 months after the effective date of coverage under the policy. Additionally, a “preexisting condition” cannot be defined more restrictively than as a condition for which medical advice or treatment was recommended by or received from a healthcare services provider within 6 months before the effective date of coverage (NM Stat. Sec. 59A-23A-7).
Long-term care insurance generally may not exclude coverage by type of illness, treatment, medical condition, or accident. However, policies may exclude:
• Preexisting conditions or diseases;
• Mental or nervous disorders (but not Alzheimer's disease);
• Alcoholism and drug addiction;
• Illness, treatment, or medical condition arising out of war or an act of war (whether declared or undeclared); participation in a felony, riot, or insurrection; service in the armed forces or auxiliary units; suicide (sane or insane), attempted ...