New Mexico Administrative Code
Title 6 - PRIMARY AND SECONDARY EDUCATION
Chapter 50 - INSURANCE
Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY
Section 6.50.10.13 - ENROLLMENT AND ELIGIBILITY CONFLICTS
Current through Register Vol. 35, No. 18, September 24, 2024
A. In the event there is a conflict between a carrier's contract with the authority and this part regarding enrollment and eligibility, the carrier's contract shall prevail.
B. In the event there is a conflict between a carrier's contract with the authority and the policies of a participating entity regarding enrollment and eligibility, the carrier's contract shall prevail.
C. In the event there is a conflict between the policies of a participating entity policy and this part regarding enrollment and eligibility, this part shall prevail.
D. All disputes between a participating entity and an employee or part time employee in determining eligibility shall be resolved at the participating entity level.
E. As to questions of enrollment and eligibility, if miscommunication to an employee or part time employee by the participating entity has allegedly occurred, the participating entity shall provide a written statement to the authority indicating the party or parties who allegedly miscommunicated to the employee or part time employee and the circumstances in which the alleged miscommunication occurred.
F. As to questions of enrollment and eligibility, disputes not resolved between an employee or part time employee, the participating entity and the authority or its contractors shall be resolved according to the procedures of 6.50.16 NMAC of these rules.
G. As to all other conflicts between the authority and carriers, the relevant conflicts provisions of the agreements between them shall control with regard to conflict resolutions.
