N.M. Admin. Code § 6.50.1.7 - DEFINITIONS
The definitions listed below apply to all rules pertaining to the authority, the authority's risk-related and employee-benefit coverages and any rules issued by the authority concerning risk or loss prevention, except where other rules contain more specific definitions of the same term or additional terms.
A.
"Abatement" means the elimination of a recognized risk-related
hazard as the result of a recommendation by a risk management consultant or by
the authority.
B.
"Affidavit
of domestic partnership" means a sworn, written statement, in a form,
verified by the employer and approved by the authority, by which both members
of a domestic partnership affirm, solely for the purpose of obtaining employee
domestic partner benefits through the authority, that:
(1) the partners are in an exclusive and
committed relationship for the benefit of each other, and the relationship is
the same as, or similar to, a marriage relationship in the state of New
Mexico;
(2) the partners share a
primary residence and have done so for 12 or more consecutive months;
(3) the partners are jointly responsible for
each other's common welfare and share financial obligations;
(4) neither partner is married or a member of
another domestic partnership;
(5)
both partners are at least 18 years of age;
(6) both partners are legally competent to
sign an affidavit of domestic partnership; and
(7) the partners are not related by blood to
a degree of closeness that would prevent them from being married to each other
in the state of New Mexico.
C.
"Affidavit terminating domestic
partnership" means a sworn, written statement, in a form approved by the
authority, by which an employee notifies the authority that domestic partner
benefits should be terminated because the employee's domestic partnership
relationship is terminated.
D.
"Authority" means the New Mexico public school insurance
authority.
E.
"Board"
means the board of directors of the authority.
F.
"Change of status" means the
change of status of an eligible employee or eligible dependent by:
(1) death;
(2) divorce or annulment;
(3) loss of employment;
(4) loss of group or individual health
insurance coverage through no fault of the person having the insurance
coverage;
(5) birth;
(6) adoption or child placement order in
anticipation of adoption;
(7) legal
guardianship;
(8)
marriage;
(9) incapacity of a
child;
(10) establishment or
termination through affidavit of domestic partnership or affidavit terminating
domestic partnership; or
(11)
fulfilling the actively at work requirement and minimum qualifying number of
hours through promotion to a new job classification with a salary increase or
acceptance of a full-time position with a salary increase with the same
participating entity.
G.
"Charter school" means a school organized as a charter school
pursuant to the provisions of the 1999 Charter Schools Act, Section
22-8B-1 et seq., NMSA
1978.
H.
"Contract
period" when applied to employee benefit or risk-related coverages means
the established period of time over which the authority provides insurance to
participating entities. The contract period shall be specified by the board as
part of a memorandum of coverage, a group benefits policy, or administrative
services agreement. The contract period may be different for different
offerings, policies, or agreements.
I.
"Costs" means the direct and
indirect monetary and economic costs of insurance.
J.
"Coverage" means insurance
protection offered or provided by the authority to persons or entities entitled
to participate in the authority's offerings.
K.
"Critical hazard" means any
risk-related exposure, hazardous condition, or other circumstance having an
above average potential for immediate occurrence, but which is not immediately
life threatening. A critical hazard is of less severity than an imminent
hazard.
L.
"Deductible" means the dollar amount that will be deducted from
any payments made to or on behalf of a participating entity or employee or
covered individual.
M.
"Domestic partner" means an unrelated person living with and
sharing a common domestic life with an employee of an entity offering domestic
partner benefits, where the employee and the partner submit a properly executed
affidavit of domestic partnership and where the employee and the partner
presently:
(1) are in an exclusive and
committed relationship for the benefit of each other, and the relationship is
the same as, or similar to, a marriage relationship in the state of New
Mexico;
(2) share a primary
residence and have done so for 12 or more consecutive months;
(3) are jointly responsible for each other's
common welfare and share financial obligations; and
(4) are not married or in another domestic
partnership.
N.
"Domestic partner benefits" means dependent insurance coverage for
a domestic partner offered to an employee as a benefit of employment pursuant
to a written petition adopted by a member's governing body that:
(1) states that the member's governing body
has voted in an open, public meeting to offer domestic partner benefits to its
employees;
(2) sets forth the
percentage contribution, if any, the member will make toward an employee's
premium for domestic partner coverage;
(3) describes any evidence (documentation or
other) the member will require in support of an affidavit of domestic
partnership; and
(4) is received by
the authority at its offices before the effective date the coverage is to
begin.
O.
"Due
process reimbursement" means the reimbursement of a school district's or
charter school's expenses as defined in Section
22-29-3 NMSA 1978 which are
incurred as a result of a due process hearing as required pursuant to Section
22-29-12 NMSA 1978.
P.
"Eligible dependent" means a
person obtaining health care coverage from the authority based upon that
person's relationship to the eligible employee as follows:
(1) a person whose marriage to the eligible
employee is evidenced by a marriage certificate or who has a legally
established common-law marriage in a state that recognizes common-law marriages
and then moves to New Mexico;
(2) a
person who is the domestic partner of an eligible employee, employed by an
entity offering domestic partner benefits;
(3) a child under the age of 26 who is
either:
(a) a natural child;
(b) a legally adopted child pursuant to the
Adoption Act, Section
32A-5-1, et. seq. NMSA 1978 or by
adoptive placement order, court order or decree;
(c) a stepchild who is primarily dependent on
the eligible employee for maintenance and support;
(d) a natural or legally adopted child of the
eligible employee's domestic partner or a child placed in the domestic
partner's household as part of an adoptive placement, legal guardianship, or by
court order and who is living in the same household and is primarily dependent
on the eligible employee for maintenance and support;
(e) a child for whom the eligible employee is
the legal guardian and who is primarily dependent on the eligible employee for
maintenance and support, so long as evidence of the legal guardianship is
evidenced in a court order or decree (notarized documents, powers of attorney,
or conservatorships are not accepted as evidence);
(f) a foster child living in the same
household as a result of placement by a state licensed placement agency, so
long as the foster home is licensed pursuant to Section
40-7A-1, et. seq. NMSA,
1978;
(g) a child living in the
same household after a petition for adoption of that child has been filed
pursuant to the Adoption Act, Section
32A-5-1 et. seq. NMSA 1978 or a
pre-placement study is pending for purposes of adoption of the child pursuant
to Section
32A-5-1 et. seq. NMSA 1978;
or
(h) a dependent child pursuant
to a qualified medical support order;
(4) a dependent child over 26 who is wholly
dependent on the eligible employee for maintenance and support and who is
incapable of self-sustaining employment by reason of mental or physical
disability, provided that proof of incapacity and dependency, with proper
medical certification, must be provided within 31 days before the child reaches
26 years of age; any child who becomes so incapacitated while covered shall be
allowed to continue coverage thereafter during the period of incapacity, and
such times thereafter as may be authorized by the board;
(5) no provision in Paragraphs (1) through
(4) of Subsection P of
6.50.1.7 NMAC shall result in
eligibility of any person adopted by an eligible member pursuant to the adult
adoption provisions of Section
40-14-5 NMSA 1978;
(6) no provision in Paragraphs (1) through
(4) of Subsection P of
6.50.1.7 NMAC shall result in
eligibility of any person who has met the requirements of any such paragraph
for the primary purpose of obtaining eligibility under this chapter; any denial
of eligibility under this subsection may be submitted for dispute resolution to
the director of the authority pursuant to Subsection F of
6.50.10.13 NMAC, and the director's
decision may be appealed by following the procedures specified in 6.50.16 NMAC,
Administrative Appeal of Authority Coverage Determinations.
Q.
"Eligible participating
entity board member, entity governing body member or authority board
member" means an active participating entity board member, entity
governing body member or authority board member whose entity is currently
participating in the authority employee benefits coverages or who is eligible
as an active authority board member or as an eligible retiree (Subsection R of
6.50.1.7 NMAC).
R.
"Eligible retiree" means:
(1) a closed class: a "non-salaried eligible
participating entity governing authority member" who is a former board member,
who has served without salary as a member of the governing body of an employer
eligible to participate in the benefits coverages of the authority, and is
certified to be such by the director of the authority and has continuously
maintained group health insurance coverage through that member's governing
body; "eligible retiree" also includes former members of the authority board
who has continuously maintained authority group health insurance; with respect
to authority and participating entity board members who begin service after
January 1, 1997, may participate in the benefits coverages; coverage will end
at the request of the member, death or for non-payment;
(2) a "retired employee" who is drawing an
Educational Retirement Act pension or with respect to a retired authority
employee, a Public Employee Retirement Act pension, and desires to participate
in the authority's additional life coverage.
S.
"Eligible employee" means an
employee of an employer eligible to participate in the benefits coverages of
the authority including eligible participating entity board members, entity
governing body members and authority board members (Subsection Q of
6.50.1.7 NMAC), full-time employees
(Subsection X of
6.50.1.7 NMAC), or eligible
part-time employees (Subsection T of
6.50.1.7 NMAC).
T.
"Eligible part-time employee"
means a person employed by, paid by, and working for a participating entity
less than 20 hours but more than 15 hours per week during the academic school
term and is determined to be eligible for participation in authority employee
benefits coverages by an annual resolution which, prior to May 1 of the
previous year, is adopted by the participating entity governing body and
approved by the authority board.
U.
"Employee benefits minimum standards" means the minimum coverages,
minimum limits and other factors as specified in authority rules for which
insurance is offered.
V.
"Established enrollment period" means the period of time and the
dates for which an enrollment period is authorized by the authority.
W.
"Financial interest" means an
interest of ten percent or more in a business or exceeding $10,000.00 in any
business. For a board member, official, employee, agent, consultant or attorney
this means an interest held by the individual, their spouse, their domestic
partner, or their minor children.
X.
"Full-time employee" means a
person employed by, paid by and working for the participating entity 20 hours
or more per week during the academic school term or terms. A full-time employee
includes participating entity board members, entity governing body members and
authority board members as defined in Subsections SS and TT of
6.50.1.7 NMAC.
Y.
"Fund" means the authority
account or accounts in which the money received by the authority is
held.
Z.
"Governing
body" means the elected board or other governing body that oversees and
makes the policy decisions for a school district, charter school or other
educational entity. (See also Subsection UU of
6.50.1.7 NMAC)
AA.
"Imminent hazard" means
those conditions or practices which exist requiring suspension of activities or
operations so as to avoid an occurrence which could reasonably be expected to
result in death or serious physical harm immediately or before the imminence of
such danger can be eliminated through the recommended abatement.
BB.
"Ineligible dependents"
means:
(1) common law relationships of the
same or opposite sex which are not recognized by New Mexico law unless domestic
partner benefits are offered by the employee's entity;
(2) parents, aunts, uncles, brothers and
sisters of the eligible employee;
(3) grandchildren left in the care of an
eligible employee without evidence of legal guardianship; or
(4) any other person not specifically
referred to as eligible.
CC.
"Insider information" means
information regarding the authority which is confidential under law or practice
or which is not generally available outside the circle of those who regularly
serve the authority as board members, officials, employees, agents, consultants
or attorneys.
DD.
"Insurance" means basic insurance, excess insurance, re-insurance,
retrospectively rated insurance, self-insurance, self-insured retention and all
other mechanisms to provide protection from risks assumed by the
authority.
EE.
"Insurance
policy" means one or more basic insurance policies, excess insurance
policies, reinsurance policies, retrospectively rated insurance policies, or
other insurance policies sought or obtained by the authority from one or more
insurance companies to provide contractual protection against one or more risks
or perils or which provide health related services.
FF.
"Line" means insurance
protection which protects against a specific category or set of
perils.
GG.
"Loss
prevention" means a system for identification and reduction of
risk-related exposures, hazardous conditions or other circumstances likely to
produce a loss.
HH.
"Risk
management consultant (RMC)" means the employee of the contracted
risk-related agency or the authority charged with the responsibility of
providing loss prevention services to the authority.
II.
"Memorandum of coverage"
means the document which lists all terms and conditions of risk-related
coverages.
JJ.
"Member" and
"members" means all public school districts and charter schools mandated
by the New Mexico Public School Insurance Authority Act, Section
22-29-9 et seq. NMSA 1978 to be
members of the authority and all other educational entities voluntarily
participating in the authority.
KK.
"Occurrence" means continuous and repeated exposures to
substantially the same general harmful conditions, accidents or events. All
such exposures to substantially the same general condition shall be considered
as arising from one occurrence.
LL.
"Offering" refers to any single line offering, multi-option or
package offering made available by the authority.
MM.
"Other educational entity"
means an educational entity as defined in Section
22-29-3, NMSA 1978 which is an
authority member pursuant to Section 22-29-9E NMSA 1978.
NN.
"Package offering" means
combining together of two or more lines of risk-related insurance.
OO.
"Participant" means a person
receiving employee benefit coverage from the authority.
PP.
"Participating entity" means
a school district, charter school or other educational entity receiving
authority coverage.
QQ.
"Participating authority board member" means a person that is
appointed to serve and is serving as a member of the authority board.
RR.
"Participating entity board
member" or "participating entity governing body member"
means a person that is elected or appointed to serve and is serving as a member
of the governing board of a participating entity.
SS.
"Participating entity governing
board" means the elected or appointed board or other governing body that
oversees and makes the policy decisions for the school board, charter school or
educational entity.
TT.
"Part-time employee" means a person employed by, paid by and
working for the participating entity less than 20 hours per week during the
academic school term or as determined by the employer.
UU.
"Public official" means a
person serving the authority as board member, official, employee, agent,
consultant or attorney or as a member of an ad hoc or standing authority
advisory committee.
VV.
"Recommendation" means a method or means of risk-related
corrective action suggested to a participating entity to eliminate a designated
hazard.
WW.
"Request for
waiver" means a request for waiver of participation.
XX.
"Review board" means the
risk-related loss prevention review board. In the event a risk-related loss
prevention review board is not designated by the authority board, "review
board" means the risk advisory committee of the board.
YY.
"RFP" means a request for
proposals and consists of all papers including those attached to or
incorporated by reference in a document used to solicit proposals for insurance
policies or professional services.
ZZ.
"Risk-related coverage"
means any coverage required under the Tort Claims Act, Section
4-41-1 et seq. NMSA 1978, or any
other state mandate and any coverage provided at the authority's
discretion.
AAA.
"School
district" means any school district as defined in Section
22-29-3 NMSA 1978.
BBB.
"Self-insured retention"
means that dollar amount from the first dollar of loss up to a maximum amount
for which the risk of loss is retained as determined by the
authority.
CCC.
"Special
events" mean events that permit enrollment in employee-benefits
coverages.
DDD.
"State" means the state of New Mexico.
EEE.
"Waiver" or "waiver
of participation" means a written document issued by the authority to a
school district or charter school excusing the school district or charter
school from participation in an authority offering. A school district or
charter school may submit a request for waiver of participation for each
authority offering.
Notes
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