New Mexico Administrative Code › Title 6 - PRIMARY AND SECONDARY EDUCATION › Chapter 50 - INSURANCE › Part 10 - EMPLOYEE BENEFIT COVERAGE ENROLLMENT POLICY › Section 6.50.10.10 - REQUIREMENTS FOR ENROLLMENT OF EMPLOYEE DEPENDENTS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Eligible employee participants may enroll
				their eligible dependents during the enrollment period established by the
				authority. If the employee is enrolled in family medical coverage, a newborn
				dependent of an employee parent is covered from the date of birth under the
				same lines of family coverage in which the employee parent is enrolled at the
				time of the newborn's birth. In cases where the employee is not enrolled in
				family medical coverage but has family coverage for other lines of employee
				benefits, the employee parent must enroll the newborn dependent within 31
				calendar days from the date of birth to be covered from the date of birth. In
				cases where there is a change of status in premium (i.e., single to two-party,
				single to family, or two-party to family) due to the addition of a newborn
				dependent, the employee parent must enroll the newborn dependent within 31
				calendar days from the date of birth to be covered from the date of birth.
				Certification of information from the official state publicly fled birth
				certificate or a state-fled birth certificate registration certification must
				accompany the enrollment form, or if the birth certificate or certification is
				not available, it must be submitted within 61 calendar days from the first day
				of the month following the newborn dependent's date of birth. Adopted
				dependents of an employee are eligible for coverage from the date of placement
				by a licensed state agency, a governmental agency or a court of competent
				jurisdiction. Supportive documentation of such placement is required with the
				change of status application within 61 calendar days of the date of
				placement.
B. The employee
				participant shall enroll the new eligible dependent within 31 calendar days of
				becoming an eligible dependent, except for newborns when family medical
				coverage is in effect at the time of the newborn's birth. Those persons
				considered to be a new eligible dependent are a newborn child, a new spouse, a
				domestic partner newly established by affidavit, a new legally adopted child,
				legal guardianship and other similar situations where the dependent becomes a
				new family member and is otherwise an eligible dependent. Supportive
				documentation in the form of copies of publicly filed marriage certificates,
				certificate of birth certificate information, guardianships, placement or
				adoption decrees and affidavits of domestic partnership shall be submitted
				along with the enrollment application.
C. An eligible dependent has no greater
				coverage than the eligible employee participant and the eligible dependent can
				maintain coverage only to the extent that the eligible employee participant
				maintains his coverage, except as otherwise specifically provided in this rule
				or to the extent federal law may grant broader rights.
D. An eligible employee participant may drop
				any line of coverage for their eligible dependent at any time at the employee's
				discretion. However, any provision with respect to prohibition against dropping
				any lines of coverage shall be enforced. If the employee drops the line of
				coverage, that employee cannot re-enroll the eligible dependent except as this
				rule permits. If the employee drops one dependent, the employee must drop
				coverage on all eligible dependents except an employee may drop a dependent 18
				years or above without dropping the other eligible dependents. 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's 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.
E. Proper documentation (together with
				application for coverage) including evidence of medical insurability where
				required, must be provided by the person seeking coverage within 61 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.
F. An eligible retired
				employee and eligible dependents shall be permitted to enroll in voluntary life
				only during the established enrollment period. The retiree shall be responsible
				for submitting paperwork prior to his retirement date to ensure no break in
				premium or coverage occurs. The retiree shall be responsible for premium
				payments for any monthly premiums.
G. The established enrollment period allowed
				by the authority for active participating entity board members and eligible
				dependents is 31 calendar days after the board member has taken oath.