N.M. Admin. Code § 6.50.10.13 - ENROLLMENT AND ELIGIBILITY CONFLICTS
A. In the event there is a conflict between a
carrier's contract with the authority and this part regarding enrollment and
eligibility, the carrier's contract shall prevail.
B. In the event there is a conflict between a
carrier's contract with the authority and the policies of a participating
entity regarding enrollment and eligibility, the carrier's contract shall
prevail.
C. In the event there is a
conflict between the policies of a participating entity policy and this part
regarding enrollment and eligibility, this part shall prevail.
D. All disputes between a participating
entity and an employee or part-time employee in determining eligibility shall
be resolved at the participating entity level.
E. As to questions of enrollment and
eligibility, if miscommunication to an employee or part-time employee by the
participating entity has allegedly occurred, the participating entity shall
provide a written statement to the authority indicating the party or parties
who allegedly miscommunicated to the employee or part-time employee and the
circumstances in which the alleged miscommunication occurred.
F. As to questions of enrollment and
eligibility, disputes not resolved between an employee or part-time employee,
the participating entity and the authority or its contractors shall be resolved
according to the procedures of 6.50.16 NMAC of these rules. Paid premiums are
to be determined by the employer.
G. As to all other conflicts between the
authority and carriers, the relevant conflict provisions of the agreements
between them shall control with regard to conflict resolutions.
Notes
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