New Mexico Administrative Code
Title 6 - PRIMARY AND SECONDARY EDUCATION
Chapter 50 - INSURANCE
Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY
Section 6.50.10.8 - REQUIREMENTS FOR ENROLLMENT OF FULL TIME EMPLOYEES
Universal Citation: 6 NM Admin Code 6.50.10.8
Current through Register Vol. 35, No. 18, September 24, 2024
A. An employee shall be enrolled pursuant to his actual status at the time of enrollment. If a change in status of an employee occurs he must notify the employer within 31 calendar days of the change and complete any enrollment documents required by the authority.
B. An employee may enroll just himself only. However, if the employee chooses to enroll one eligible dependent, the employee shall enroll all eligible dependents unless one or more eligible dependents have other coverage. If the dependent of an eligible employee participant is enrolled in another medical plan, the eligible employee participant may enroll in the authority's medical plan as a single and in the two-party or family coverage for other lines. Evidence of the other coverage is required.
C. New eligible employees may enroll under the conditions set forth by the authority as follows:
(1) New eligible employees shall
enroll within 31 calendar days of hire or within 31calendar days of being
upgraded to eligible employee. Evidence of upgrade is required.
(2) A new participating entity governing body
member or new participating authority board member shall enroll within 31 days
of being sworn in to office.
(3)
Coverage is effective on the first day of the month following the day the
employee applies, provided the employee authorizes in writing that the premium
is to be withheld from his payroll check, subject to the actively-at-work
provision, and for self-payers, the first day of the month following receipt of
the premium by the authority.
(4)
Where an employee is on a 12-month payroll option, the employer shall deduct
and remit from each payroll and shall remit the employer's contribution
simultaneously.
(5) Where an
employee seeks a transfer of benefits:
(a) the
employee is covered until the end of the month for which coverage was paid at
the school the employee is leaving;
(b) the employee shall enroll within 31
calendar days of hire at the school the employee is moving to; and
(c) participating entities shall coordinate
the effective date to ensure duplicate premiums are not paid on behalf of the
employee through the outgoing school as well as the incoming school.
(6) Eligible employee or
dependents who involuntarily lose benefits coverage have a 31 day window to
enroll in the authority. Supporting documentation showing the reason for the
involuntary loss of benefits coverage, the date benefits coverage was lost, who
was covered and what types of benefits coverage was lost must be submitted
within 31 days from the date of loss of coverage. The effective date of new
benefits coverage will be the first of the month following receipt by the
authority of the documentation required and the necessary application or
applications, provide that all enrollment rules of the authority are
met.
(7) Eligible employee
enrollment after the enrollment period shall be permitted to only in the
authority's long-term disability plan and the voluntary life insurance plan
upon providing the required evidence of medical insurability. Late enrollments
shall not be permitted for medical, dental or vision coverages.
(8) If an eligible employee participant
obtains dependent coverage for any eligible dependent from the authority, then
the employee is required to enroll all eligible dependents in such coverage
unless one or more eligible dependents have other coverage. If an eligible
employee participant is divorced, and the divorce decree states that medical
coverage will be provided by the ex-spouse for one or more dependents of the
eligible employee participant, the employee is permitted to enroll as a single
in the medical and in the two party or family coverage for other
lines.
(9) An employee is
prohibited from having duplicate coverage from the authority for any line of
coverage. An employee is also prohibited from having employee coverage and
dependent coverage at the same time from the authority for any line of
coverage. In the event of duplicate coverage, only one benefit will be paid. In
those cases where an employee and his or her spouse or domestic partner are
both eligible employees, either one may enroll into the coverage and the other
be treated as an eligible dependent.
(10) An eligible employee is not permitted to
enroll for a particular line of coverage unless the minimum participation level
as determined by the authority is met.
(11) The participant shall only be permitted
to switch from one plan to another plan within the same line of coverage during
an established switch enrollment period and then only under the terms and
conditions permitted by the authority.
(12) An employee may drop any line of
coverage at any time at the employee's discretion, provided, however, any
provision with respect to prohibition against dropping any lines of coverage
shall be enforced. In divorce situations, a divorced eligible employee may not
drop eligible dependents based on a change in status until a divorce decree is
filed with the authority. When a domestic partnership is terminated, the
employee, ex-domestic partner may not drop eligible dependents based on a
change in status until the authority receives written notice that the domestic
partnership is terminated in the form of an affidavit terminating domestic
partnership. If the employee drops the line of coverage(s), the employee cannot
re-enroll except as this part permits.
(13) Proper documentation, including evidence
of medical insurability where required, must be provided by the eligible
employee seeking coverage within 31 calendar days of the qualifying event.
Coverage may be rejected where adequate proof and documentation satisfactory to
the authority is not submitted in a timely manner.
(14) Eligibility for basic life is 15 hours
or more per week.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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