Every appeal of a coverage determination of the authority shall be initiated by mailing a petition for review, within 30 days of the mailing date of the determination, to the executive director of the New Mexico public school insurance authority by certified mail.

1. A. A petition for review must specify and include:

   1. (1) the name of the employee or member appealing, and, for institutional parties, the name, position, address and phone number of a person who will be responsible for receiving communications from the authority;
   2. (2) a full description of the coverage determination being appealed, including the date of the determination and, specifically, the substance of the determination that is being appealed;
   3. (3) a short, concise statement of the grounds for the appeal;
   4. (4) if the authority determination is in a writing, a copy of the writing must be attached to the notice;
   5. (5) copies of all documents, photographs or other tangible evidence that appellant contends provides support for appellant’s position; and
   6. (6) a memorandum stating the complete argument for overturning the determination of the authority, including a statement of relevant facts, an outline of controlling law, and the appellant’s argument.
2. B. An extension of up to 14 days to provide the items specified in Paragraphs (5) and (6) of Subsection A of 6.50.16.10 NMAC may be granted at the discretion of the authority upon written request of the appellant.

[6.50.16.10 NMAC - Rp, 6.50.16.10 NMAC, 09/01/2014]