2023 New Mexico Statutes › Chapter 59A - Insurance Code › Article 23E - Health Insurance Portability › Section 59A-23E-8 - Group health plan; group health insurance; special enrollment periods for individuals losing other coverage.

A. group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan shall permit an employee who is eligible but not enrolled for coverage under the terms of the plan, or a dependent of the employee if the dependent is eligible but not enrolled for coverage, to enroll for coverage under the terms of the plan if:
(1) the employee or dependent was covered under a group health plan or had health insurance coverage at the time coverage was previously offered to the employee or dependent;
(2) the employee stated in writing at the time coverage was offered that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or issuer required such a statement at the time and provided the employee with notice of that requirement and the consequences of the requirement at the time;
(3) the employee's or dependent's coverage described in Paragraph (1) of this subsection was:
(a) under a COBRA continuation provision and the coverage under that provision was exhausted; or
(b) not under a COBRA continuation provision and either the coverage was terminated as a result of loss of eligibility for the coverage, including as a result of legal separation, divorce, death, termination of employment or reduction in the number of hours of employment, or employer contributions toward the coverage were terminated; and
(4) under the terms of the plan, the employee requested enrollment not later than thirty days after the date of exhaustion of coverage described in Subparagraph (a) of Paragraph (3) of this subsection or termination of coverage or employer contribution described in Subparagraph (b) of Paragraph (3) of this subsection.
B. A group health plan or a health insurance issuer offering group health insurance plan coverage shall permit an eligible enrollee to enroll for coverage under the terms of the plan if either of the following conditions is met:
(1) the eligible enrollee's medical assistance provided pursuant to the Public Assistance Act is terminated; or
(2) the eligible enrollee becomes eligible for medical assistance, with respect to coverage under the group health plan or health insurance plan, under such medicaid plan or state child health plan, including under any waiver or demonstration project conducted under or in relation to such a plan, if the employee requests coverage under the group health plan or health insurance plan not later than sixty days after the date the employee or dependent is determined to be eligible for such assistance.
C. As used in this section, "eligible enrollee" means an employee or dependent of an employee who is eligible, but not enrolled, for coverage under the terms of an employer's group health plan.
History:
Laws 1997, ch. 243, § 8; 1998, ch. 41, § 12; 2019, ch. 259, § 9.
ANNOTATIONS
The 2019 amendment,
effective June 14, 2019, provided that a group health plan or a health insurance issuer offering group health insurance plan coverage must allow an eligible enrollee to enroll for coverage if the individual's medical assistance is terminated or if the individual becomes eligible for medical assistance; added new subsection designation "A." and redesignated former Subsections A through D as Paragraphs A(1) through A(4), in Paragraph A(3), after "described in", added "Paragraph (1) of this", and after "subsection", deleted "A of this section", and redesignated former Paragraphs "(1)" and "(2)" as Subparagraphs A(3)(a) and A(3)(b), in Paragraph A(4), after "described in", deleted "Paragraph (1)" and added "Subparagraph a", after "of", deleted "Subsection C" and added "Paragraph (3)", and after the next occurrence of "described in", deleted "Paragraph (2) of Subsection C of this section" and added "Subparagraph (b) of Paragraph (3) of this subsection"; and added new Subsections B and C.
The 1998 amendment,
effective March 6, 1998, substituted "Group health plan; group health insurance" for "Special enrollment periods for individuals losing other coverage" in the section heading, inserted "was" at the end of Subsection C, and deleted "was" following "under" and "not under" in Paragraphs C(1) and (2), respectively.