N.M. Admin. Code § 2.81.6.9

Current through Register Vol. 36, No. 1, January 14, 2025

Section 2.81.6.9 - ENROLLMENT AND ELIGIBILITY/ CONFLICT BETWEEN NMRHCA-CARRIER AGREEMENTS, NMRHCA RULES AND REGULATIONS, INDEMNITY POLICIES, HMO INDIVIDUAL SUBSCRIBER AGREEMENTS AND NMRHCA POLICY MISCOMMUNICATIONS

A.Carrier contracts: As to questions of enrollment and eligibility, in the event there is a conflict between the carrier contract with the NMRHCA and this rule the rule will prevail.

B.Miscommunication: As to questions of enrollment and eligibility, if miscommunication occurred, the party negligently communicating shall initiate action to correct the error.

C.Dispute resolution: As to questions of enrollment and eligibility, disputes not resolved between the retiree and the NMRHCA or its contractors shall be submitted to and resolved by the NMRHCA executive director. Any aggrieved person may within 30 days of the executive director's decision, appeal such to the NMRHCA board and its decision shall be final, except as otherwise provided by law.

N.M. Admin. Code § 2.81.6.9

6-15-98; 2.81.6.9 NMAC - Rn, 2 NMAC 81.6.9, 12-30-02, Adopted by New Mexico Register, Volume XXVII, Issue 24, December 30, 2016, eff. 1/1/2017