N.M. Admin. Code § 13.10.11.27

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.11.27 - ENROLLMENT PERIODS

Applications must be received by the alliance office within the time period for enrollment specified above.

A. Timely enrollment. Employees and their dependents shall be entitled to enroll in an alliance plan during the following timely enrollment periods.

(1) New employees and their dependents may enroll in the plan within 31 days of completion of their employer's waiting period.

(2) An individual may enroll in the plan if:

(a) at the time the individual was first eligible to be covered under the small employer's plan, the individual was covered under another group health benefit plan;

(b) the individual's coverage under the other group plan terminates involuntarily except for cause; and

(c) the individual enrolls in the small employer's plan within 31 days of the effective date of termination of his or her coverage under the other group plan.

(3) A new dependent of an eligible or enrolled employee may enroll in the plan within 31 days of becoming eligible by virtue of marriage, birth, adoption or placement for adoption, or entry of a guardianship order. If the eligible employee is not then enrolled in the plan, he must also enroll in the plan within this period in order to obtain coverage for the dependent.

B. Late enrollment. Each approved health plan shall hold an annual open enrollment period for 30 days prior to an enrolled group's anniversary date, for coverage effective as of the anniversary date. Eligible employees or dependents who do not enroll within the time specified in subsection A shall be entitled to enroll during this open enrollment period without evidence of insurability. No late enrollments will be approved outside of a group's annual open enrollment period. The board of directors may require that all plans hold their annual 30-day open enrollment period at the same time, regardless of the group's anniversary date, in which case coverage shall be effective as of the first of the month following the close of the open enrollment period.

N.M. Admin. Code § 13.10.11.27

13.10.11.27 NMAC - N, 6-1-01