Current through Register Vol. 35, No. 18, September 24, 2024
A. In
addition to continuation coverage under the act, other forms of continuation
coverage may be available under federal law or other provisions of state
law.Details of these other programs may be obtained from an employer, an agent,
or the insurance division. With respect to continuation of coverage provided
under the act:
(1) An employee is eligible
for continuation coverage under the act only if the employee has been
continuously covered under an alliance plan as an active employee
for at least six months, even if the employer group ceases to do business or
terminates its group coverage under the alliance. If the employee
has family coverage, this coverage would continue as well, provided other
conditions of eligibility continue to be met. An employee must apply for
continuation coverage through the alliance within 31 days of the
loss of his or her eligibility for group coverage through the
alliance.
(2) A
covered dependent is eligible for individual continuation coverage under the
Alliance Act only if the dependent has been continuously covered under an
alliance plan as a dependent of an active employee for at least
six months, and then only if the dependent applies for continuation coverage
within 31 days of:
(a) the death of the
employee;
(b) the divorce,
annulment or dissolution of marriage or legal separation of the spouse from the
employee;
(c) termination of the
employee's employment for any reason, including the termination of the
employer's group coverage or dissolution of the group; or
(d) for covered dependent children, upon
attainment of the limiting age of 26, as provided in Subsection C of
13.10.11.29 NMAC.
(e) a covered
dependent may not continue coverage if, at the time of the qualifying event
specified above, the employee himself is covered under continuation coverage;
provided that a spouse and any dependent children may continue coverage if the
qualifying event is the death of the continuee.
(3) No person is eligible to enroll or to
remain on continuation coverage if he or she resides outside of the United
States for a period of over six months or, if continuation coverage under this
section became effective after the effective date of this rule, he or she
either moves from the state of New Mexico or resides outside of the state of
New Mexico for a period of over six months.
(4) Continuation coverage under the act is
considered to be individual coverage for purposes of state and federal law.
Persons electing to continue coverage under the act shall be subject to the
provisions of 13.10.11.34 NMAC. Premiums for this continuation coverage shall
be calculated at individual coverage rates.
B. An individual who is eligible for and
elects COBRA continuation shall remain on the small employer's plan as required
by COBRA; COBRA rights shall be administered by the small employer who shall be
responsible for collecting premiums and submitting them to the
alliance. An individual who is eligible for state six-month
continuation may elect to remain on the group plan for the continuation period
provided that the plan itself continues and appropriate premiums are submitted
through the small employer. The alliance does not list bill. An
individual may move to an individual plan at any time during the continuation
period; provided, however, that any COBRA continuee who moves to an individual
plan after the effective date of this rule shall be deemed to be covered as an
individual and not as a COBRA continuee as of the date of his or her enrollment
in the individual plan.
