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

Current through Register Vol. 35, No. 13, July 16, 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.