N.M. Admin. Code § 6.50.10.10 - REQUIREMENTS FOR ENROLLMENT OF EMPLOYEE DEPENDENTS
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
special enrollment. 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 filed birth certificate or a state-filed 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 to be verified by the employer,
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 pursuant to a court order. 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 as
determined by the employer. 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 from a line of coverage, 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 with
supporting documentation or proof of application. In divorce situations, a
divorced eligible employee may not drop eligible dependents based on a change
in status until a court-endorsed divorce decree or mutual written
court-endorsed stipulation is provided 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 employee for the person 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.
F. An eligible
retired employee and eligible dependents enrolled in a voluntary life plan
prior to retirement and the retiree is less than age 70, shall be permitted to
enroll in voluntary life prior to life coverage expiring. The retiree shall be
responsible for submitting enrollment paperwork and the first month's premium
prior to active coverage expiring to ensure no break in premium or coverage
occurs. The retiree shall be responsible for premium payments for any monthly
premiums. Retiree voluntary life coverage will extend through the last day of
the month the retiree reaches age 70.
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.
Notes
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