New Mexico Administrative Code

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 …

This part applies to all school districts, charter schools, other educational entities, eligible employees, eligible retired employees, eligible dependents, eligible participating entity governing body members, and persons or entities authorized to participate in the authority's …

Subsection D of Section 22-29-7 NMSA 1978 directs the authority to promulgate necessary rules, regulations and procedures for the implementation of the New Mexico Public School Insurance Authority Act, Section 22-29-1 et seq. NMSA 1978.

Permanent.

September 1, 2014 unless a later date is cited at the end of a section.

The objective of this part is to establish the enrollment policy for all persons or entities authorized to participate in the authority's employee benefits coverage.

A. "Actively at work" for life and disability coverage, means performing the material duties of your own occupation at your employer's usual place of business. You will also meet the actively at work requirement if you were absent from active work because of a regularly scheduled…

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 emplo…

A. Part-time employees who work less than 20 hours a week but 15 hours per week or more are eligible for employee benefits if the member has passed a part-time resolution agreeing to provide employee benefits to part-time employees. A part-time resolution must be renewed in May o…

New Mexico Public School Insurance Authority.

This part applies to all school districts, charter schools, other educational entities, eligible employees, eligible retired employees, eligible dependents, eligible participating entity governing body members, and persons or entities authorized to participate in the authority's …

Subsection D of Section 22-29-7, NMSA 1978, directs the authority to promulgate necessary rules, regulations and procedures for the implementation of the New Mexico Public School Insurance Authority Act, Section 22-29-1 et seq. NMSA 1978.

Permanent.

September 1, 2014 unless a later date is cited at the end of a section.

The objective of this part is to protect those persons that have obtained employee benefits coverage from the authority in the past and may no longer be entitled to coverage under other provisions of this chapter.

[RESERVED]

To the extent the adoption of Title 6, Chapter 50 purports to withdraw employee benefits coverage from any individual, group or class of persons currently receiving coverage from the authority, the authority intends by this savings clause (grandfather clause) to allow the authori…

New Mexico Public School Insurance Authority.

A. The LPRB shall consider and act upon: (1) requests by the RMC that a member be required to implement a specific recommendation; (2) requests by a member that a recommendation by the RMC be vacated; (3) any other matter with regard to the enforcement of the authority's loss pre…

When considering a request as specified above, the LPRB chairperson shall: A. provide notification to all LPRB members, the RMC, and the affected member; B. conduct the meeting allowing the RMC and the member representative the opportunity to present arguments and justifications …

The responsibility for enforcement of LPRB decisions shall be vested in the authority board which may act as it sees fit to protect the integrity of the authority. These actions may include but are not limited to issuing a notice of no coverage, premium increase, or fines to the …

An aggrieved member may appeal any final determination of the authority under this part by following the procedures specified in 6.50.16 NMAC, Administrative Appeal of Authority Coverage Determinations. Review of any final decision or order of the authority under this part can on…

This part applies to all school districts, charter schools, other educational entities and persons or entities authorized to participate in the authority's coverage on matters involving risk-related coverages.

Subsection D of Section 22-29-7 NMSA 1978, directs the authority to promulgate necessary rules, regulations and procedures for the implementation of the New Mexico Public School Insurance Authority Act, Section 22-29-1 et seq. NMSA 1978.

Permanent.

September 1, 2014 unless a later date is cited at the end of a section.

The objective of this part is to establish a loss control and a loss prevention management system for the purpose of reducing claims and costs.

[RESERVED]

A. The loss prevention program is hereby created to provide a mechanism for the identification and abatement of hazards relating to all lines of coverage provided by the authority. B. The loss prevention program is a service provided to the member school districts, charter school…

A. The LPRB is hereby created to provide a mechanism for the review of loss prevention activities within the authority's jurisdiction. The LPRB is appointed by the board at the annual board meeting and, except as provided in Subsection B of this section, its membership shall be m…

New Mexico Public School Insurance Authority.

This part applies to all school districts, charter schools, other educational entities and persons or entities authorized to participate in the authority's risk-related coverages.

Subsection D of Section 22-29-7 NMSA 1978, directs the authority to promulgate necessary rules, regulations and procedures for the implementation of the New Mexico Public School Insurance Authority Act, Section 22-29-1 et seq. NMSA 1978.

Permanent.

September 1, 2014 unless a later date is cited at the end of a section.

The objective of this part is to establish a policy for settling claims against authority insureds.

[RESERVED]

The authority retains the right at its sole discretion to decide the terms and conditions of settlement of any claim against any authority insured. The authority or its third-party administrator will not settle a claim against an authority insured for an amount in excess of $50,0…

New Mexico Public School Insurance Authority.

In the event of a conflict between this part and the Workers' Compensation Act, Sections 52-1-1 et seq. NMSA 1978, the provisions of the act shall prevail.

No school district, charter school or educational entity has the authority to accept or acknowledge liability for any workers' compensation claim. There is no liability for a workers' compensation claim until liability is acknowledged in writing by an authorized employee of the a…

In any case where an insured under the authority's workers' compensation program is eligible to receive workers' compensation benefits for an injury, the exclusive remedy for such injury is workers' compensation benefits. Such injured insured shall have no claim for additional be…

This part applies to all school districts, charter schools and other educational entities authorized to participate in the authority's workers' compensation program.

Subsection D of Section 22-29-7 NMSA 1978, directs the authority to promulgate necessary rules, regulations and procedures for the implementation of the New Mexico Public School Insurance Authority Act, Section 22-29-1 et seq. NMSA 1978.

Permanent.

September 14, 2014 unless a later date is cited at the end of a section.

The objective of this part is to direct school districts, charter schools and other educational entities to adopt a policy in order to establish the particular entity's procedure for the selection of health care providers, for use of sick leave and for payment of insurance premiu…

[RESERVED]

All school districts, charter schools, other educational entities and any other entities participating in the authority's workers' compensation coverages shall adopt a workers' compensation claim policy for its employees substantially in the form as set forth in Subsections A thr…

All entities participating in the authority workers' compensation coverage shall adopt a policy substantially in the following form, selecting one of two options available for the selection of health care providers, for use of sick leave and for payment of insurance premiums whil…