1. A. An employer is eligible as a small employer if:

   (1) the employer, if a corporation, is incorporated in New Mexico or is authorized to do business in New Mexico; if a person or other organization, is a resident of this state or has its principal place of business in this state; and

   (2) at least 50 percent of all of its employees, eligible or not, live in New Mexico; and

   (3) on at least 50 percent of its working days during either of the two preceding calendar years, the employer had at least two and no more than 50 eligible employees.

   (a) If the employer has been in business for less than one calendar year, the determination of whether an employer is a small employer shall be based on the average number of employees that it is reasonably expected to employ on working days in the current calendar year.

   (b) A spouse or dependent of an employee, whether or not working in the business, may, at the employer's discretion, be counted as a separate employee for the sole purpose of determining the number of eligible employees. A spouse or dependent enrolling who is not employed in the business must still enroll for dependent coverage and need not complete an employee application; a spouse or dependent employed in the business has the option of enrolling as a dependent or an employee.

   (c) Any self-employed person and all employees who comprise the "two to 50 group" of eligible employees must work for the qualifying business a minimum of 20 hours per week on a regular basis.

   (d) Casual laborers and volunteers are not eligible.

   (e) An employee eligible or enrolled in medicare shall be considered an eligible employee for the sole purpose of determining whether an employer is a small employer, provided that that employee otherwise qualifies as an eligible employee.

2. B. Affiliated companies, or companies eligible to file a combined New Mexico tax return, must be considered one employer. Companies eligible to file a combined New Mexico tax return include two or more integrated corporations that are more than 50 percent owned and controlled by the same person or entity and for which at least one of the following conditions exists:

   (1) there is a unity of operations evidenced by central purchasing, advertising, accounting or other centralized services;

   (2) there is a centralized management or executive force and centralized system of operation; or

   (3) the operations of the corporation are dependent upon or contribute property or services to one another individually or as a group. Subsection R of Section 7-2A-2 and Section 7-2A-8.3 NMSA 1978.

3. C. The eligibility status of a small employer shall be determined as of the date of enrollment or renewal.
4. D. A small employer is not eligible for an alliance plan for three years after any termination of coverage issued to the employer through the alliance, if the termination was due to a failure to pay premiums timely, or to fraud, misuse of coverage, or violation of alliance policies. Any small employer applying for coverage under this paragraph within three years of the date of termination of its prior coverage through the alliance must complete a new application for coverage and be subject to all requirements, including preexisting condition requirements, that apply to a new employer group. All applications for coverage submitted by a small employer within three years of the date its prior coverage through the alliance has terminated must be approved by the executive director.
5. E. A small employer is not eligible for an alliance plan if it offers any other comprehensive group health insurance coverage to its employees, other than coverage sponsored by a recognized labor union. For purposes of this paragraph, comprehensive group health insurance coverage includes individual health insurance coverage if paid for or reimbursed by the employer, but excludes either individual or group coverage providing only a specific limited form of health insurance such as accident or disability income insurance coverage or a specific health care service such as dental care.
6. F. A small employer shall remit all premiums due for its employees and their dependents to the alliance.

[13.10.11.20 NMAC - N, 6-1-01]