The definitions listed below apply to all rules pertaining to the authority, the authority’s risk-related and employee-benefit coverages and any rules issued by the authority concerning risk or loss prevention, except where other rules contain more specific definitions of the same term or additional terms.

1. A. “Abatement” means the elimination of a recognized risk-related hazard as the result of a recommendation by a risk management consultant or by the authority.

2. B. “Affidavit of domestic partnership” means a sworn, written statement, in a form, verified by the employer and approved by the authority, by which both members of a domestic partnership affirm, solely for the purpose of obtaining employee domestic partner benefits through the authority, that:

   1. (1) the partners are in an exclusive and committed relationship for the benefit of each other, and the relationship is the same as, or similar to, a marriage relationship in the state of New Mexico;
   2. (2) the partners share a primary residence and have done so for 12 or more consecutive months;
   3. (3) the partners are jointly responsible for each other's common welfare and share financial obligations;
   4. (4) neither partner is married or a member of another domestic partnership;
   5. (5) both partners are at least 18 years of age;
   6. (6) both partners are legally competent to sign an affidavit of domestic partnership; and
   7. (7) the partners are not related by blood to a degree of closeness that would prevent them from being married to each other in the state of New Mexico.
3. C. “Affidavit terminating domestic partnership” means a sworn, written statement, in a form approved by the authority, by which an employee notifies the authority that domestic partner benefits should be terminated because the employee’s domestic partnership relationship is terminated.
4. D. “Authority” means the New Mexico public school insurance authority.
5. E. “Board” means the board of directors of the authority.

6. F. “Change of status” means the change of status of an eligible employee or eligible dependent by:

   1. (1) death;
   2. (2) divorce or annulment;
   3. (3) loss of employment;
   4. (4) loss of group or individual health insurance coverage through no fault of the person having the insurance coverage;
   5. (5) birth;
   6. (6) adoption or child placement order in anticipation of adoption;
   7. (7) legal guardianship;
   8. (8) marriage;
   9. (9) incapacity of a child;
   10. (10) establishment or termination through affidavit of domestic partnership or affidavit terminating domestic partnership; or
   11. (11) fulfilling the actively at work requirement and minimum qualifying number of hours through promotion to a new job classification with a salary increase or acceptance of a full-time position with a salary increase with the same participating entity.
7. G. “Charter school” means a school organized as a charter school pursuant to the provisions of the 1999 Charter Schools Act, Section 22-8B-1 et seq., NMSA 1978.
8. H. “Contract period” when applied to employee benefit or risk-related coverages means the established period of time over which the authority provides insurance to participating entities. The contract period shall be specified by the board as part of a memorandum of coverage, a group benefits policy, or administrative services agreement. The contract period may be different for different offerings, policies, or agreements.
9. I. “Costs” means the direct and indirect monetary and economic costs of insurance.
10. J. “Coverage” means insurance protection offered or provided by the authority to persons or entities entitled to participate in the authority’s offerings.
11. K. “Critical hazard” means any risk-related exposure, hazardous condition, or other circumstance having an above average potential for immediate occurrence, but which is not immediately life threatening. A critical hazard is of less severity than an imminent hazard.
12. L. “Deductible” means the dollar amount that will be deducted from any payments made to or on behalf of a participating entity or employee or covered individual.

13. M. “Domestic partner” means an unrelated person living with and sharing a common domestic life with an employee of an entity offering domestic partner benefits, where the employee and the partner submit a properly executed affidavit of domestic partnership and where the employee and the partner presently:

    1. (1) are in an exclusive and committed relationship for the benefit of each other, and the relationship is the same as, or similar to, a marriage relationship in the state of New Mexico;
    2. (2) share a primary residence and have done so for 12 or more consecutive months;
    3. (3) are jointly responsible for each other's common welfare and share financial obligations; and
    4. (4) are not married or in another domestic partnership.

14. N. “Domestic partner benefits” means dependent insurance coverage for a domestic partner offered to an employee as a benefit of employment pursuant to a written petition adopted by a member’s governing body that:

    1. (1) states that the member’s governing body has voted in an open, public meeting to offer domestic partner benefits to its employees;
    2. (2) sets forth the percentage contribution, if any, the member will make toward an employee’s premium for domestic partner coverage;
    3. (3) describes any evidence (documentation or other) the member will require in support of an affidavit of domestic partnership; and
    4. (4) is received by the authority at its offices before the effective date the coverage is to begin.
15. O. “Due process reimbursement” means the reimbursement of a school district’s or charter school’s expenses as defined in Section 22-29-3 NMSA 1978 which are incurred as a result of a due process hearing as required pursuant to Section 22-29-12 NMSA 1978.

16. P. “Eligible dependent” means a person obtaining health care coverage from the authority based upon that person's relationship to the eligible employee as follows:

    1. (1) a person whose marriage to the eligible employee is evidenced by a marriage certificate or who has a legally established common-law marriage in a state that recognizes common-law marriages and then moves to New Mexico;
    2. (2) a person who is the domestic partner of an eligible employee, employed by an entity offering domestic partner benefits;

    3. (3) a child under the age of 26 who is either:

       1. (a) a natural child;
       2. (b) a legally adopted child pursuant to the Adoption Act, Section 32A-5-1, et. seq. NMSA 1978 or by adoptive placement order, court order or decree;
       3. (c) a stepchild who is primarily dependent on the eligible employee for maintenance and support;
       4. (d) a natural or legally adopted child of the eligible employee’s domestic partner or a child placed in the domestic partner’s household as part of an adoptive placement, legal guardianship, or by court order and who is living in the same household and is primarily dependent on the eligible employee for maintenance and support;
       5. (e) a child for whom the eligible employee is the legal guardian and who is primarily dependent on the eligible employee for maintenance and support, so long as evidence of the legal guardianship is evidenced in a court order or decree (notarized documents, powers of attorney, or conservatorships are not accepted as evidence);
       6. (f) a foster child living in the same household as a result of placement by a state licensed placement agency, so long as the foster home is licensed pursuant to Section 40-7A-1, et. seq. NMSA, 1978;
       7. (g) a child living in the same household after a petition for adoption of that child has been filed pursuant to the Adoption Act, Section 32A-5-1 et. seq. NMSA 1978 or a pre-placement study is pending for purposes of adoption of the child pursuant to Section 32A-5-1 et. seq. NMSA 1978; or
       8. (h) a dependent child pursuant to a qualified medical support order;
    4. (4) a dependent child over 26 who is wholly dependent on the eligible employee for maintenance and support and who is incapable of self-sustaining employment by reason of mental or physical disability, provided that proof of incapacity and dependency, with proper medical certification, must be provided within 31 days before the child reaches 26 years of age; any child who becomes so incapacitated while covered shall be allowed to continue coverage thereafter during the period of incapacity, and such times thereafter as may be authorized by the board;
    5. (5) no provision in Paragraphs (1) through (4) of Subsection P of 6.50.1.7 NMAC shall result in eligibility of any person adopted by an eligible member pursuant to the adult adoption provisions of Section 40-14-5 NMSA 1978;
    6. (6) no provision in Paragraphs (1) through (4) of Subsection P of 6.50.1.7 NMAC shall result in eligibility of any person who has met the requirements of any such paragraph for the primary purpose of obtaining eligibility under this chapter; any denial of eligibility under this subsection may be submitted for dispute resolution to the director of the authority pursuant to Subsection F of 6.50.10.13 NMAC, and the director’s decision may be appealed by following the procedures specified in 6.50.16 NMAC, Administrative Appeal of Authority Coverage Determinations.
17. Q. “Eligible participating entity board member, entity governing body member or authority board member” means an active participating entity board member, entity governing body member or authority board member whose entity is currently participating in the authority employee benefits coverages or who is eligible as an active authority board member or as an eligible retiree (Subsection R of 6.50.1.7 NMAC).

18. R. “Eligible retiree” means:

    1. (1) a closed class: a “non-salaried eligible participating entity governing authority member” who is a former board member, who has served without salary as a member of the governing body of an employer eligible to participate in the benefits coverages of the authority, and is certified to be such by the director of the authority and has continuously maintained group health insurance coverage through that member's governing body; “eligible retiree” also includes former members of the authority board who has continuously maintained authority group health insurance; with respect to authority and participating entity board members who begin service after January 1, 1997, may participate in the benefits coverages; coverage will end at the request of the member, death or for non-payment;
    2. (2) a “retired employee” who is drawing an Educational Retirement Act pension or with respect to a retired authority employee, a Public Employee Retirement Act pension, and desires to participate in the authority’s additional life coverage.
19. S. “Eligible employee” means an employee of an employer eligible to participate in the benefits coverages of the authority including eligible participating entity board members, entity governing body members and authority board members (Subsection Q of 6.50.1.7 NMAC), full-time employees (Subsection X of 6.50.1.7 NMAC), or eligible part-time employees (Subsection T of 6.50.1.7 NMAC).
20. T. “Eligible part-time employee” means a person employed by, paid by, and working for a participating entity less than 20 hours but more than 15 hours per week during the academic school term and is determined to be eligible for participation in authority employee benefits coverages by an annual resolution which, prior to May 1 of the previous year, is adopted by the participating entity governing body and approved by the authority board.
21. U. “Employee benefits minimum standards” means the minimum coverages, minimum limits and other factors as specified in authority rules for which insurance is offered.
22. V. “Established enrollment period” means the period of time and the dates for which an enrollment period is authorized by the authority.
23. W. “Financial interest” means an interest of ten percent or more in a business or exceeding $10,000.00 in any business. For a board member, official, employee, agent, consultant or attorney this means an interest held by the individual, their spouse, their domestic partner, or their minor children.
24. X. “Full-time employee” means a person employed by, paid by and working for the participating entity 20 hours or more per week during the academic school term or terms. A full-time employee includes participating entity board members, entity governing body members and authority board members as defined in Subsections SS and TT of 6.50.1.7 NMAC.
25. Y. “Fund” means the authority account or accounts in which the money received by the authority is held.

26. Z. “Governing body” means the elected board or other governing body that oversees and makes the policy decisions for a school district, charter school or other educational entity. (See also Subsection UU of 6.50.1.7 NMAC)

    1. (1) common law relationships of the same or opposite sex which are not recognized by New Mexico law unless domestic partner benefits are offered by the employee’s entity;

    AA. “Imminent hazard” means those conditions or practices which exist requiring suspension of activities or operations so as to avoid an occurrence which could reasonably be expected to result in death or serious physical harm immediately or before the imminence of such danger can be eliminated through the recommended abatement.

    BB. “Ineligible dependents” means:

27. (2) parents, aunts, uncles, brothers and sisters of the eligible employee;

    1. (3) grandchildren left in the care of an eligible employee without evidence of legal guardianship; or

    2. (4) any other person not specifically referred to as eligible.

       CC. “Insider information” means information regarding the authority which is confidential under law or practice or which is not generally available outside the circle of those who regularly serve the authority as board members, officials, employees, agents, consultants or attorneys.

       DD. “Insurance” means basic insurance, excess insurance, re-insurance, retrospectively rated insurance, self-insurance, self-insured retention and all other mechanisms to provide protection from risks assumed by the authority.

       EE. “Insurance policy” means one or more basic insurance policies, excess insurance policies, reinsurance policies, retrospectively rated insurance policies, or other insurance policies sought or obtained by the authority from one or more insurance companies to provide contractual protection against one or more risks or perils or which provide health related services.

       FF. “Line” means insurance protection which protects against a specific category or set of perils.

       GG. “Loss prevention” means a system for identification and reduction of risk-related exposures, hazardous conditions or other circumstances likely to produce a loss.

       HH. “Risk management consultant (RMC)” means the employee of the contracted risk-related agency or the authority charged with the responsibility of providing loss prevention services to the authority.

       II. “Memorandum of coverage” means the document which lists all terms and conditions of risk-related coverages.

       JJ. “Member” and “members” means all public school districts and charter schools mandated by the New Mexico Public School Insurance Authority Act, Section 22-29-9 et seq. NMSA 1978 to be members of the authority and all other educational entities voluntarily participating in the authority.

       KK. “Occurrence” means continuous and repeated exposures to substantially the same general harmful conditions, accidents or events. All such exposures to substantially the same general condition shall be considered as arising from one occurrence.

       LL. “Offering” refers to any single line offering, multi-option or package offering made available by the authority.

       MM. “Other educational entity” means an educational entity as defined in Section 22-29-3, NMSA 1978 which is an authority member pursuant to Section 22-29-9E NMSA 1978.

       NN. “Package offering” means combining together of two or more lines of risk-related insurance.

       OO. “Participant” means a person receiving employee benefit coverage from the authority.

       PP. “Participating entity” means a school district, charter school or other educational entity receiving authority coverage.

       QQ. “Participating authority board member” means a person that is appointed to serve and is serving as a member of the authority board.

       RR. “Participating entity board member” or “participating entity governing body member” means a person that is elected or appointed to serve and is serving as a member of the governing board of a participating entity.

       SS. “Participating entity governing board” means the elected or appointed board or other governing body that oversees and makes the policy decisions for the school board, charter school or educational entity.

       TT. “Part-time employee” means a person employed by, paid by and working for the participating entity less than 20 hours per week during the academic school term or as determined by the employer.

       UU. “Public official” means a person serving the authority as board member, official, employee, agent, consultant or attorney or as a member of an ad hoc or standing authority advisory committee.

       VV. “Recommendation” means a method or means of risk-related corrective action suggested to a participating entity to eliminate a designated hazard.

       WW. “Request for waiver” means a request for waiver of participation.

       XX. “Review board” means the risk-related loss prevention review board. In the event a risk-related loss prevention review board is not designated by the authority board, “review board” means the risk advisory committee of the board.

       YY. “RFP” means a request for proposals and consists of all papers including those attached to or incorporated by reference in a document used to solicit proposals for insurance policies or professional services.

       ZZ. “Risk-related coverage” means any coverage required under the Tort Claims Act, Section 4-41-1 et seq. NMSA 1978, or any other state mandate and any coverage provided at the authority’s discretion.

       AAA. “School district” means any school district as defined in Section 22-29-3 NMSA 1978.

       BBB. “Self-insured retention” means that dollar amount from the first dollar of loss up to a maximum amount for which the risk of loss is retained as determined by the authority.

       CCC. “Special events” mean events that permit enrollment in employee-benefits coverages.

       DDD. “State” means the state of New Mexico.

       EEE. “Waiver” or “waiver of participation” means a written document issued by the authority to a school district or charter school excusing the school district or charter school from participation in an authority offering. A school district or charter school may submit a request for waiver of participation for each authority offering.

[6.50.1.7 NMAC - Rp, 6.50.1.7 NMAC, 9/1/2014; A, 12/10/2024]