Revised September 2020
Please read the NMPSIA Program Guide (provided to you by
your employee benefits office) as you complete this change
card.
NMPSIA’s Program Guide outlines the NMPSIA Eligibility Rules
and administrative guidelines for enrollment. If you do not have
this Guide, you can obtain a copy from your school district/entity
benefits office or at https://nmpsia.com.
ELIGIBILITY
If you are reporting a change in status, you must turn in this form
within 31 days from your qualifying event.
Contractors are not eligible to participate in NMPSIA
coverage, except for one-bus owners. Fleet bus owners and
their employees are not eligible to participate in NMPSIA
coverage.
To be eligible for NMPSIA Group Coverage, you must work the
minimum number of hours per week established by your
employer. In most cases employees are eligible for all other lines
of coverage when they work a minimum of 20 hours per week.
Variable hour employees should confirm eligibility for benefits
with their Employee Benefits Office.
Subject to the actively at work provision, the effective date for all
your other lines of coverage is determined by your employer.
This effective date can never be made retroactive (prior to the
date you officially apply).
SALARY INFORMATION
NMPSIA records your base annual salary. Your employer will not
prorate your salary if you begin after the school year AND your
employer will not include salary increments for other duties, such
as coaching, department head, yearbook, etc.
ENROLLMENT
You may only apply for the lines of NMPSIA coverage offered by
your employer.
Please keep the following in mind:
● If you decline medical coverage within 31
days of becoming
eligible, you may apply to enroll in NMPSIA medical coverage
within 31 days from a qualifying event or special enrollment
event, or enroll during open enrollment for medical coverage in
the fall with an effective date of January 1st.
●
You may enroll as employee only for any line of NMPSI
A
coverage.
● If you enroll in vision coverage, you and each of your enrolled
dependents must meet the 24-month enrollment requirement
before you can cancel this coverage.
● If you decline dental and/or vision coverage, you may not
enroll late to either of these plans unless you apply within 31
days from involuntarily losing other dental and/or vision
coverage, or enroll during the open enrollment for dental/vision
in the fall with an effective da
te of January 1st.
Indicate the status (employee only, two-party, or family) for each
line of coverage. If you enroll one eligible dependent, you must
enroll all eligible dependents, unless one or more dependents
have other coverage. When enrolling dependents, you may
exclude a dependent from a particular line of NMPSIA coverage
only if you provide evidence that the dependent you are excluding
has that particular line of coverage elsewhere. In this case,
evidence of the other coverage is required (i.e., letter of insurance
verification, insurance ID card with dependent’s name listed, etc.).
If you are excluding a dependent and do not provide this
evidence, the dependents you are enrolling will suffer a delay in
coverage until such evidence is provided. There is a 61-day
deadline from your effective date of coverage to provide such
evidence.
If both you and your spouse work for the same employer or for
another NMPSIA affiliated employer, you and your spouse cannot
double insure each other and your dependents under the
NMPSIA Group Plan for any line of NMPSIA coverage. (i.e., You
work for Las Cruces Public Schools and carry family medical,
dental, vision, additional life insurance coverage for yourself, your
spouse, and your children. Your spouse who is employed with
Deming Public Schools cannot apply for family coverage to insure
him, you and your children for these lines of NMPSIA coverage
since you already carry this NMPSIA coverage at Las Cruces
Public Schools.
To enroll your spouse and/or your married or unmarried children
(who are up to 26 years old) for any line of NMPSIA coverage
offered by your employer, you will be required to present your
employee benefits office with copies of the supportive
documentation to prove eligibility for your dependents.
To enroll your spouse, present your official state publicly filed
marriage certificate (from the County Clerk’s Office). You may
provide a chapel marriage certificate, but NMPSIA reserves the
right to request the official state copy at any time. If you divorce,
you must report this within 31 days and cancel coverage for your
ex-spouse effective the last day of the month the divorce is final.
You will be required to provide copies of certain pages of your
final divorce decree. Covering an ex-spouse is considered
misrepresentation.
To enroll your married or unmarried children (who are up to 26
years old) for any line of NMPSIA coverage offered by your
employer, present their official state publicly filed birth
certificates (from the Bureau of Vital Statistics). You may
provide hospital birth certificates, but NMPSIA reserves the right
to request the official state copy at any time.
Coverage for your dependents will begin on your effective date of
coverage when you provide your employee benefits office with
the appropriate supportive documentation at the time of
application or prior to your coverage going into effect. You have
61 days from your effective date of coverage or 61 days from
your qualifying event to provide the appropriate supportive
documentation for your dependents, but their effective date of
coverage will be on the first day of the month following the date
your employee benefits office receives this documentation.
Coverage for your dependents will not be made retroactive. If
you do not provide this information within 61 days, you may apply
to cover your dependents during the established open enrollment
period in the fall for coverage that will become effective on
January 1.
Medical and Prescription Drug Coverage – If you enroll in the
medical plan, you are automatically enrolled in the Prescription
Drug Program. You will receive a separate ID card from the
NMPSIA Prescription Drug Manager to purchase your
prescription drugs.
CONFIRMATION OF ENROLLMENT
Once your enrollment has been processed, the NMPSIA Eligibility
Administrative Office will email you or mail you a Confirmation of
Enrollment Notice to your home (and to your employer). Please
review this confirmation notice carefully and report any
discrepancies to your Employee Benefits Office or to the NMPSIA
Eligibility Administrative Office at 1 (800) 233-3164.
If you do not provide your employer with all of the appropriate
documentation necessary to finalize your enrollment request, you
will be contacted for the appropriate documentation. Please be
sure to adhere to all deadlines associated with this request.
