N.M. Admin. Code § 13.19.4.8 - ELIGIBILITY TO OPERATE
A.
Eligibility to operate as or offer coverage through a MEWA.
(1) Self-funded MEWA. A self-funded MEWA
shall be eligible to offer health benefits plans only after meeting the
requirements outlined in this section
(2) Fully-insured MEWA. A fully-insured MEWA
shall confirm that its offered coverage conforms with the requirements of this
section prior to the sale or delivery of any health benefits plan to MEWA
members.
B.
Eligibility for status as MEWA. A MEWA shall prove that it:
(1) is a bona fide association, which means
that the association:
(a) has membership
consisting solely of employers or union members:
(b) has been actively in existence for at
least five continuous years;
(c) is
engaged in substantial activities for its members, other than the sponsorship
of an employee welfare benefit plan, and provides business or professional
assistance and benefits to its members who share a common business interest and
are primarily engaged in the same trade or business:
(d) does not condition membership in the
association on any health status-related factor relating to an individual
(including an employee of an employer or a dependent of an employee) and
clearly so states in all membership and application materials:
(e) has within its membership the employers
who participate in and fund the arrangement;
(f) makes health benefits plan coverage
offered through the MEWA available to all members regardless of any health
status-related factor relating to such members (or individuals eligible for
coverage through a member) and clearly so states in all marketing and
application materials:
(g) does not
make health benefits plan coverage offered through the MEWA available other
than in connection with a member of the MEWA and clearly so states in all
marketing and application materials:
(h) provides and annually updates information
necessary for the superintendent to determine whether or not the MEWA meets the
definition of a MEWA before qualifying as a bona fide association for the
purposes of this rule; and
(i)
meets at least one of the following conditions:
(i) is a New Mexico entity;
(ii) includes a member that is a New Mexico
entity or who conducts business in New Mexico; or
(iii) has a participant who resides in New
Mexico;
(2)
shares a commonality of interests, which means that the employers or union
members are in the same trade, industry, line of business, or profession;
and
(3) does not charge employers
or union members membership fees solely to participate in the MEWA and no
membership fees are included in the premiums charged for health benefits plans.
C.
Limitations of
membership. A MEWA may only provide benefits to active or retired
owners, officers, directors, or employees (and the domestic partners and family
members of any of them) of participating employers or union members, except as
may otherwise be limited by provisions of ERISA.
D.
MEWAs formed for the purposes of
selling insurance, prohibited. No MEWA, shall be formed solely for the
purpose of selling insurance.
E.
Limitations on large group plans. A health benefits plan offered
by a MEWA shall not be considered a large group plan exempt from state and
federal laws governing individual or small group coverage solely because the
aggregate number of lives covered by the MEWA meets the definition of a large
group plan.
F.
Size of
MEWA A self-funded MEWA proposing to provide a health benefits plan to
fewer than 100 covered lives does not meet the criteria for eligibility under
this rule, shall not be registered as an authorized MEWA and shall not offer a
health benefits plan to any employees or union members.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.