New Mexico Register / Volume XXXV,
Issue 23 / December 10, 2024
This is an amendment to
6.50.7 NMAC, Sections 8, 9, 12 and 14, effective 12/10/2024.
6.50.7.8 WAIVER OF PARTICIPATION: School districts and charter schools shall
participate in and accept all authority offerings, unless the school district
or charter school has applied for and been granted a waiver for an individual
line of coverage by the authority board.
If a waiver is granted for an individual line of coverage, the school
district or charter school will not be provided any insurance protection or
coverage by the authority for the perils covered by that individual line of
coverage. The school district or charter
school receiving the waiver accepts the obligation to obtain its own insurance
protection for the perils covered by the individual line of coverage for which
the waiver is granted. A school district
or charter school that has been granted a waiver for an individual line of
coverage shall be prohibited from participating in that individual line of
coverage during the contract period, provided, however, the district or charter
school may, if the authority contract period exceeds four years, again seek
participation. [However, a school
district or charter school may, if the authority contract period exceeds four
years, again seek participation as if it were an other
educational entity pursuant to 6.50.4.8 NMAC.]
[6.50.7.8 NMAC -
Rp, 6 NMAC 50.7.8, 09/01/2014; A, 12/10/2024]
6.50.7.9 RESPONSIBILITIES OF SCHOOL
DISTRICTS AND CHARTER SCHOOLS WHICH WAIVE PARTICIPATION IN AUTHORITY COVERAGES:
A. A school district
or charter school may waive participation in either the risk related or group
health insurance or both. Pursuant to
Subsections C and D of Section 22-29-9, a school district or charter school
must waive all risk-related or all group health insurance coverages or must
petition for participation in the remaining coverages
offered by the authority in that particular
individual line of coverage.
B. Should a school
district or charter school waive participation in an individual line of
coverage, the school district or charter school shall be responsible for the
following charges:
(1) For [risk related] risk-related coverages, the
school district or charter school shall forfeit to the authority any right to
any return premiums or reserves and shall be responsible to pay to the
authority on demand the cost of any prior losses in excess of
premium and all the appropriate expenses of the authority in defending,
settling and administering any such losses;
(2) For
group health insurance, the school district or charter school shall forfeit to
the authority any right to any return premium or reserves it may be entitled
to. The school district or charter
school shall also pay to the authority any funds paid for prior incurred claims
of the school district or charter school in excess of
premium paid by the school district or charter school and shall pay to the
authority all the appropriate expenses of the authority in defending, settling
and administering such claims.
C. Any school
district or charter school waiving participation in an individual line of
coverage shall pay to the authority any sums determined by the authority to be
due in order to hold safe and harmless all other
members of the authority from any adverse financial impact caused by the waiver
of coverage. An accounting of funds and
amounts owed by the school district or charter school shall not be due from the
authority until two years after the waiver of participation has taken effect.
[6.50.7.9 NMAC -
Rp, 6 NMAC 50.7.9, 09/01/2014; A, 12/10/2024]
6.50.7.12 APPROVAL
OR DISAPPROVAL OF REQUEST FOR WAIVER OF PARTICIPATION: The authority board shall approve or
disapprove a waiver of participation based on the documentation submitted by
the school district or charter school. The board shall grant a waiver to a
school district or charter school that shows evidence to the satisfaction of
the board that:
A. In the event the
waiver is with regard to group health insurance:
(1) that
the school district or charter school has secured a valid written enforceable
commitment from an insurer to provide group health insurance;
(2) that
the coverage committed to the school district or charter school and the plan
benefits for their employees is at least as beneficial as the plan being
procured by the authority;
(3) that
there are no more exclusions from coverage and the exclusions are not broader
than those set out in the authority’s request for proposals;
(4) that
the deductibles, stop loss, out of pocket costs, etc.,
if any, result in no more costs to the employees than would occur pursuant to the authority’s
request for proposals;
(5) that
any cost containment features not result in any higher
costs or burdens on the employees than would result under the authority’s
request for proposals;
(6) that
the prospective insurer of the school district or charter school have the same
or greater rating as that required in the authority’s request for proposals;
(7) that
the notice of intent to request a waiver has been timely filed;
(8) that
the request for waiver of participation has been timely filed;
(9) that
all the data required to be included in the request for waiver of
participation has been timely supplied;
(10) that
the proposed insurer for the school district or charter school has
satisfactorily demonstrated to the school district or charter school and to the
authority that the insurer in its proposal to the school district or charter
school has adequately accounted in its rates for such items as school district
or charter school experience, incurred but not reported losses, medical
inflation trends and other relevant factors for the purpose of allowing the
school district or charter school and
the authority to determine the future viability of the plan, if rates
are under-quoted at inception and whether the proposed insurer for the school
district or charter school meets the minimum financial standards of the
authority; and
(11) that
the total group health insurance offering available in that school district or
charter school compares favorably in all respects with the authority’s request
for proposals;
B. In the event the
waiver is with regard to risk-related insurance:
(1) that
the school district or charter school has secured a valid written enforceable
commitment from an insurer to provide risk-related insurance;
(2) that
there are no more exclusions from coverage and the exclusions are not broader
than those in the authority’s request
for proposal;
(3) that
the deductibles, [self insured] self-insured
retention, etc., if any, are no higher or result in any more costs to the
school district or charter school than would occur
pursuant to the authority’s request for proposal;
(4) that
any cost containment features not result in any higher
costs or burdens on the school district or charter school than would result
under the authority’s request for proposals;
(5) that
the prospective insurers of the school district or charter school provide coverages as broad as is required in the authority’s request
for proposals;
(6) that
the prospective insurers of the school district or charter school have the same
or greater rating as required in the authority’s request for proposals;
(7) that
the notice of intent to request a waver has been timely filed;
(8) that
the request for waiver of participation has been timely filed;
(9) that
all the data required to be included in the request for waiver of participation
has been included; and
(10) that
the proposed insurer for the school district or charter school has
satisfactorily demonstrated to the school district or charter school and to the
authority that the insurer in its proposal to the school district or charter
school has adequately accounted in its rates for such items as school district
or charter school experience, incurred but not reported losses, the nature of
existing coverage(claims made or occurrence) and other relevant factors for the
purpose of allowing the school district or charter school and the authority to
determine the future costs of coverages, to determine if rates are under-quoted
at inception and whether the proposed insurer for the school district or
charter school meets the minimum financial standards of the authority.
[6.50.7.12 NMAC -
Rp, 6 NMAC 50.7.12, 09/01/2014; A, 12/10/2024]
6.50.7.14 AUTOMATIC
WAIVER ALLOWED: School districts and charter schools are
entitled to an automatic waiver for any line of authority coverage where
the employee pays the full amount of the premium. If the school district or charter school
desires insurance protection for a particular line of employee-pay-all
coverage, the school district or charter school must affirmatively petition the
authority for coverage. In granting the
coverage the board shall first determine that the school district or charter
school meets the minimum participation requirements as established by the board
[from time to time] as necessary, that the school district or
charter school will carry the coverage through the end of the contract period
and that approval will not jeopardize the stability of the fund.
[6.50.7.14 NMAC -
Rp, 6 NMAC 50.7.14, 09/01/2014; A, 12/10/2024]