New Mexico Administrative Code › Title 2 - PUBLIC FINANCE › Chapter 81 - RETIREE HEALTH CARE FUNDS › Part 6 - ELIGIBLE RETIREE SPOUSE, DOMESTIC PARTNER AND DEPENDENT BENEFIT COVERAGE ENROLLMENT › Section 2.81.6.8 - REQUIREMENTS FOR ENROLLMENT IN COVERAGES

Current through Register Vol. 35, No. 13, July 16, 2024
An eligible retiree, spouse, domestic partner or dependent
				  shall be enrolled pursuant to his/her actual status at the time of enrollment
				  or at any time thereafter when a change in status occurs. A retiree may add
				  eligible dependents at the time of acquiring them. A retiree may enroll
				  himself/herself only, and any eligible dependents, or no eligible dependents.
				  Each such enrollee's status must be the same for all lines of coverage (i.e.
				  single, two party or family). An eligible spouse, domestic partner or dependent
				  of a retiree may not be enrolled unless the eligible retiree is enrolled,
				  except as otherwise provided by court order pursuant to the Mandatory Medical
				  Support Act Sections
				  40-4C-1 to
				  14 NMSA 1978. A spouse, domestic partner or dependent of a deceased eligible
				  retiree receiving a survivor's pension benefit may enroll separately. Any
				  eligible retiree, spouse, domestic partner or dependent desiring to enroll for
				  coverages shall meet the following requirements:
A.
Spouse, domestic partner and
				dependent enrollment/medical insurability:
An eligible retiree, spouse,
				domestic partner or dependent may enroll without evidence of medical
				insurability only during an open enrollment period.
B.
Eligible retiree, spouse, domestic
				partner, dependent change in status/enrollment:
Where an eligible
				retiree, spouse, domestic partner or dependent was receiving or eligible to
				receive group health benefit coverages through a third party and because of a
				change in status they lose the coverage and become ineligible for the coverage
				the eligible retiree, spouse, domestic partner or dependent may be enrolled
				without evidence of medical insurability if enrolled during an open enrollment
				period. If the loss of coverage due to the change in status was not caused by
				any neglect or wrong doing by the eligible retiree, spouse, domestic partner or
				dependent, they may enroll at any time so long as they do so within 31 calendar
				days of the change of status. If an eligible retiree is employed by an employer
				offering its employees a basic plan of benefits, the coverage provided by the
				NMRHCA plan shall be secondary regardless of whether the retiree enrolls in his
				employer's plan.
C.
Domestic
				partner enrollment:
An eligible domestic partner may enroll upon the
				submittal of sworn statements of domestic partnership executed by both domestic
				partners on a form approved by the board.
D.
Prohibition against duplicate
				coverage:
An eligible retiree, spouse, domestic partner or dependent is
				prohibited from having duplicate coverage from the NMRHCA for any line of
				coverage. An eligible retiree, spouse, domestic partner or dependent is also
				prohibited from having retiree coverage and dependent coverage at the same time
				from the NMRHCA for any line of coverage.
E.
More than one eligible retiree in a
				family:
Where an eligible retiree, spouse, domestic partner or dependent
				are all three or two of them eligible retirees, either may enroll into coverage
				as the eligible retiree and the other be treated as an eligible spouse,
				domestic partner or dependent.
F.
Participation requirements for eligible retiree, spouse, domestic partner
				or dependent enrollment:
An eligible retiree, spouse, domestic partner
				or dependent is not permitted to enroll for a particular line of coverage
				unless the minimum participation level as determined by the NMRHCA is
				met.
G.
Switching
				coverage:
The eligible retiree, spouse, domestic partner or dependent
				shall all select the same line or lines of coverage and shall only be permitted
				to switch, add or delete coverages during an open enrollment period.
H.
Dropping coverage:
An
				eligible retiree, spouse, domestic partner or dependent (except for dental or
				vision coverages) may drop any line of coverage at any time at their
				discretion. If they drop a line of coverage, they cannot re-enroll except as
				this rule permits. Members of the same family shall not be allowed to carry
				different lines of coverage.
I.
Dental or vision/dropping coverage:
Once enrolled in dental or
				vision coverages an eligible retiree, spouse, domestic partner or dependent may
				drop such coverages any time after enrollment. However, once a NMRHCA
				participant drops dental or vision coverage, that individual may not reenroll
				in that line of coverage until the open enrollment period immediately following
				the fourth anniversary of such dropped coverage. The four year waiting period
				does not apply to an involuntary loss of coverage and such eligible retiree,
				spouse, domestic partner or dependent may reenroll in that line of coverage
				during the next open enrollment period.
J.
Proper documentation:
Proper
				documentation, including evidence of medical insurability where required, must
				be provided by the eligible retiree, spouse, domestic partner or dependent
				seeking coverage within thirty-one days of the application for coverage.
				Coverage may be rejected where adequate proof and documentation satisfactory to
				the NMRHCA is not submitted in a timely manner. In the event such documentation
				is not timely submitted, the coverage shall not be effective and any
				contribution paid by the retiree, spouse, domestic partner or dependent shall
				be returned without interest.
K.
Eligible spouse, domestic partner dependent/open enrollment:
During an open enrollment period of eligible spouses, domestic partners, and
				dependents may be enrolled without evidence of medical insurability. A new
				spouse, domestic partner or newborn dependent of an eligible retiree is
				eligible for coverage from date of birth, the date of marriage or date of
				submission of affidavit of domestic partnership, respectively, without
				providing evidence of medical insurability if the eligible retiree submits the
				required contribution and proper documentation within 31 calendar days of the
				birth, marriage or commencement of domestic partnership. Newly eligible
				dependents are also eligible for coverage from the date that a court order
				establishes their dependent status without providing evidence of medical
				insurability, if the eligible retiree submits the required contribution and
				proper documentation within 31 calendar days of the court order. In the event
				they fail to enroll within this period of time, they may not do so without
				providing evidence of medical insurability unless they subsequently enroll
				during an open enrollment period. Those persons considered to be a new eligible
				spouse, domestic partner or dependent are persons becoming related to the
				eligible retiree by marriage, establishment of a domestic partnership, the
				birth of a child, establishment of legal guardianship status and other similar
				situations where he or she becomes a new family member and is otherwise an
				eligible spouse, domestic partner or dependent under these rules.
L.
Eligible retiree, dependent,
				domestic partner or spouse/same coverage as eligible retiree:
The
				eligible spouse, domestic partner or dependent has no greater coverage than the
				eligible retiree participant and the eligible spouse, domestic partner or
				dependent can maintain coverage only to the extent that the eligible retiree
				participant maintains his/her coverage.
M.
Re-enrollment of eligible dependent
				student:
In those situations in which the eligible retiree maintains
				dependent coverage on an eligible dependent child under Paragraph (3) of
				Subsection F of Section 10-7 C -4 NMSA 1978 and the child student loses
				coverage because the child no longer qualifies as a full time student and at
				some later time the child again becomes a full time student and the student
				otherwise qualifies as an eligible dependent, the child may re-enroll at a time
				other than during an open enrollment period an eligible dependent, without
				evidence of medical insurability if notification and proper documentation is
				provided within 31 days of the change in status.
N.
Certificate of eligibility:
On certification by the executive director of the public schools insurance
				authority, the executive director of the public employees retirement
				association, the executive director of the educational retirement association
				or the certifying official designated by board rule of an independent public
				employer or other public entity, eligible retirees, spouses, domestic partners
				and dependents will be permitted to enroll in coverages within 31 days without
				proof of medical insurability. Certification shall be on a form approved by the
				executive director of the NMRHCA.
O.
Retirement documentation:
Employees contemplating retirement are responsible for submitting documentation
				prior to retirement so as to assure no break in coverage occurs.
P.
Prohibition of split
				coverages:
Retirees who have spouses or domestic partners who are
				employed by employers who offer or provide an employer benefits plan may choose
				to be covered by the spouses or domestic partner's employers' plan of benefits
				or the retiree may choose to be covered by the plan of benefits offered by the
				NMRHCA. Provided, however, the entire family shall be required to select to be
				covered under either the NMRHCA or the spouse's employer. Any responsibility
				for continued coverage under the Consolidated Omnibus Budget Reconciliation Act
				of 1985 (COBRA) shall be the responsibility of either the NMRHCA or the spouse
				or domestic partner employer coverage selected.
Q.
Coverage after marriage
				dissolution:
Where there is a dissolution of marriage by decree which
				results in either of the former spouses no longer being eligible for coverage,
				that spouse shall be eligible only for such continuation of coverage as is
				required by COBRA.
R.
Termination of domestic partnership:
Eligibility for benefit coverage
				shall terminate for the non-retiree member of the domestic partnership upon the
				termination of the domestic partnership. The retiree member must notify the
				NMRHCA of the termination of his/her domestic partnership in writing, which
				must include the name of the former domestic partner and the effective date of
				the termination of the partnership, within 31 days of the
				termination.