New Mexico Public Schools Insurance Authority (NMPSIA)

Employee Benefits Rules and Regulations Summary: Change of Status

If you (or in some cases, your dependents) have a change of status due to the following qualifying events, you must report this change in status to your employer’s benefits office within 31-days from the qualifying event:

Qualifying Events:

  • Birth

  • Death

  • Divorce or Annulment (not a legal separation)

  • Marriage

  • (Court Order)

  • Adoption of a child or child placement order in anticipation of adoption

  • Full-time student status

  • Incapacity of a child

  • Legal guardianship of a child

  • Promotion with a salary increase, or employment status change from a part-time position to a full-time position with a salary increase (provided you are fulfilling the active-at-work requirement and meeting the minimum number of hours worked)

  • Loss of employment (including retirement)

  • Loss of group or individual coverage through no fault of the person having the group or individual insurance coverage (includes loss of medical insurance, dental insurance, vision insurance, Medicaid, exhaustion of COBRA, etc.)

Special Enrollments:

Special enrollments mandated by state and federal laws permit you to enroll in medical coverage (Non-HMO Plan or HMO Plan) within 31 days from the occurrence of a special event.  The late enrollment provisions will not apply to special enrollments provided you meet this 31-day timeline.  Special enrollments are for the purpose of applying for only medical coverage; no other line of NMPSIA employee benefits coverage is available under the special enrollment provision.  Further, employees may be selective in enrolling dependents.

If you meet eligibility requirements and are not enrolled in the NMPSIA Medical Plan, you may enroll yourself and any of your eligible dependents for NMPSIA medical coverage within 31 days from the occurrence of the following special events:

  • You suffer a loss of coverage because coverage of your spouse or child under another plan is terminated as a result of divorce, death, termination of employment, reduction in hours, legal separation, or termination of employer contributions
  • You become married
  • A child is born to you or your spouse
  • You adopt a child or a child is placed for adoption in your family

If you are enrolled in the NMPSIA Medical Plan, you may enroll you r eligible dependents for NMPSIA medical coverage within 31 days from the occurrence of the following:

  • Your spouse or child suffers a loss of coverage
  • You become married
  • A child is born to you or your spouse
  • You adopt a child or a child is placed for adoption in your family

A change of status due to a qualifying event or a special event will only be recorded by the insurance carrier(s) when you complete the appropriate application and provide supportive documentation to your employer’s benefits office within 31 days from the date of the qualifying event or the special event.  If you do not make application for coverage within these 31 days, the late enrollment provisions of the NMPSIA Rules will apply.

Further, if you do not report a change of status that causes your spouse or dependent child to become ineligible either within 60 days from the qualifying event or within 60 days from the day coverage would end, your spouse or dependent child will not be eligible for COBRA continuation coverage.  When a spouse or children become ineligible, coverage under the NMPSIA Group Plan ends for them on the last day of the month that they become ineligible.  (Even though you have 60 days to report this change as it pertains to COBRA continuation coverage, NMPSIA Rules require that you report this change of status within 31 days from the qualifying event.  This alerts NMPSIA to notify the carriers about your dependent’s ineligibility to avoid unnecessary claim payments.  This also allows your employer to make the necessary premium adjustments, if any, to your payroll check.)

Example #1: You divorce on July 12th; this causes your ex-spouse to become ineligible; immediately visit your employee benefits office to drop your ex-spouse from the NMPSIA Group Plan (provide this office with a copy of your divorce decree and a “signed” record change card); coverage for your ex-spouse ends July 31st; your ex-spouse may apply for COBRA continuation coverage provided that you report this change of status within the timeframe listed above.  (REMINDER: Review your beneficiary designation and make any changes you wish.)

Example #2: Your 20-year-old child is certified as a full-time student and is covered under your NMPSIA Group Plan; your child marries on August 25th; this causes your child to become ineligible and NMPSIA Group coverage will end for your child on August 31st; your child may apply for COBRA continuation coverage provided that you report this change of status within the timeframe listed above.

When you are electing NMPSIA Group coverage, you will be required to sign the appropriate application.  In the event of a dependent enrollment, your employer’s benefits office is required to view the original state publicly filed supportive documentation you have presented.  Copies of these documents are then forwarded to the NMPSIA Eligibility Administrator.  Without the appropriate supportive documentation, your dependent’s effective date of coverage will be delayed.  If supportive documentation is not provided by the established deadline, your dependent will fall under the provisions for late enrollment.