N.M. Admin. Code § 6.50.10.8 - REQUIREMENTS FOR ENROLLMENT OF FULL TIME EMPLOYEES
A. An employee shall be enrolled pursuant to
their actual status at the time of enrollment. If a change in status of an
employee occurs they must notify the employer within 31 calendar days of the
change and complete any enrollment documents required by the
authority.
B. An employee may
enroll only them self. However, if the employee chooses to enroll one eligible
dependent, the employee shall enroll all eligible dependents unless one or more
eligible dependents have other coverage. If the dependent of an eligible
employee participant is enrolled in another medical plan, the eligible employee
participant may enroll in the authority's medical plan as a single and in the
two-party or family coverage for other lines. Evidence of the other coverage is
required.
C. New eligible employees
may enroll under the conditions set forth by the authority as follows:
(1) New eligible employees shall enroll
within 31 calendar days of hire or within 31 calendar days of being upgraded to
eligible employee. Evidence of upgrade is required.
(2) A new participating entity governing body
member or new participating authority board member shall enroll within 31 days
of being sworn in to office.
(3)
Coverage is effective on the first day of the month following the day the
employee applies, provided the employee authorizes in writing that the premium
is to be withheld from their payroll check, subject to the actively-at-work
provision, and for self-payers, the first day of the month following receipt of
the premium by the authority.
(4)
Where an employee is on a payroll option, the employer shall deduct and remit
from each payroll and shall remit the employer's contribution
simultaneously.
(5) Where an
employee seeks a transfer of benefits:
(a) the
employee is covered until the end of the month for which coverage was paid at
the school the employee is leaving;
(b) the employee shall enroll within 31
calendar days of hire at the school the employee is moving to; and
(c) participating entities shall coordinate
the effective date to ensure duplicate premiums are not paid on behalf of the
employee through the outgoing school as well as the incoming school.
(6) Eligible employees or
dependents who involuntarily lose benefits coverage have a 31-day window to
enroll in the authority. Supporting documentation showing the reason for the
involuntary loss of benefits coverage, the date benefits coverage was lost, who
was covered and what types of benefits coverage was lost must be submitted
within 31 days from the date of loss of coverage. The effective date of new
benefits coverage will be the first of the month following receipt by the
authority of the documentation required and the necessary application or
applications, provided that all enrollment rules of the authority are
met.
(7) Eligible employee
enrollment after the enrollment period shall be permitted to only enroll in the
authority's long-term disability plan and the voluntary life insurance plan
upon providing the required evidence of medical insurability and approval by
the disability and life carrier. Late enrollments shall not be permitted for
medical, dental or vision coverages.
(8) If an eligible employee participant
obtains dependent coverage for any eligible dependent from the authority, then
the employee is required to enroll all eligible dependents in such coverage
unless one or more eligible dependents have proof of other coverage. As an
example: If an eligible employee participant is divorced, and the divorce
decree states that medical coverage will be provided by the ex-spouse for one
or more dependents of the eligible employee participant, the employee is
permitted to enroll as a single in the medical and in the two party or family
coverage for other lines of coverage.
(9) An employee is prohibited from having
duplicate coverage from the authority for any line of coverage. An employee is
also prohibited from having employee coverage and dependent coverage at the
same time from the authority for any line of coverage. In the event of
duplicate coverage, only one benefit will be paid. In those cases where an
employee and their spouse or domestic partner are both eligible employees,
either one may enroll into the coverage and the other be treated as an eligible
dependent.
(10) An eligible
employee is not permitted to enroll for a particular line of coverage unless
the minimum participation level as determined by the authority is
met.
(11) The participant shall
only be permitted to switch from one plan to another plan within the same line
of coverage during an established switch enrollment period and then only under
the terms and conditions permitted by the authority. Open enrollment is allowed
annually to add a line of coverage under the terms and conditions provided by
the authority.
(12) An employee may
drop any line of coverage at any time at the employee's discretion, provided,
however, any provision with respect to prohibition against dropping any lines
of coverage shall be enforced as determined by the member. In divorce
situations, a divorced eligible employee may not drop eligible dependents based
on a change in status until a court-endorsed divorce decree is provided to the
member and processed by the authority. When a domestic partnership is
terminated, the employee may not drop eligible dependents based on a change in
status until the authority receives written notice from the employee that the
domestic partnership is terminated in the form of an affidavit terminating
domestic partnership provided to the member and processed by the authority. If
the employee drops the line of coverage(s), the employee cannot re-enroll
except as this part permits.
(13)
Proper documentation, including evidence of medical insurability where
required, must be provided by the eligible employee 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.
(14) Eligibility for
employee basic life requires the employee to be a benefits-eligible employee
working a minimum of 15 hours or more per week, or as determined by the
member.
Notes
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