Questions and Answers

Contents:

If I decline medical coverage during my 31-day window of opportunity, may I enroll to NMPSIA medical coverage at a later date?
How often does NMPSIA have an open enrollment?
If I select a medical plan, will I have the opportunity to switch medical plans at a later date?
If I enroll in the NMPSIA Vision Plan, may I drop this Plan at any time?
How will I know that my application for NMPSIA benefits has been processed and that my enrollment has been accepted?
I am a new hire and am applying for family coverage (employee + spouse + natural child + natural child), but I have not been able to locate my marriage certificate and birth certificate for one of my children. Will you still cover my wife and both children?
Both my husband and I are employed with NMPSIA school districts. He carries family dental and vision coverage with his employing school district. Can I enroll in family dental and vision coverage with my employing school district to double cover my eligible dependents for dental and vision coverage?

Q. If I decline medical coverage during my 31-day window of opportunity, may I enroll to NMPSIA medical coverage at a later date?
A. If you do not turn in your application during your 31-day window of opportunity, you may enroll late to any of the medical plans. Late entrants are subjected to a maximum 18-month preexisting conditions limitation period.
You may have other opportunities to enroll within 31 days from involuntarily losing other coverage or within 31 days from the occurrence of a Federal HIPAA special event.

Q. How often does NMPSIA have an open enrollment?
A. A. NMPSIA offers an annual open enrollment for dental and vision coverage each fall to be effective January 1.
NMPSIA does not offer an open enrollment for medical coverage; however, you can enroll late to medical coverage with an 18-month pre-existing conditions limitation period (any prior creditable coverage may reduce this pre-existing conditions limitation period).
NMPSIA does not offer an open enrollment for voluntary life or long term disability coverage; however, you can enroll late (or enroll your spouse late) if Prudential approves the application through the medical underwriting process.
Contact your employer’s Benefits Specialist for further clarification.

Q. If I select a medical plan, will I have the opportunity to switch medical plans at a later date?
A. Yes, switch enrollment occurs once a year. Your employer establishes a switch period with NMPSIA. Your employer will notify you of its switch enrollment period and provide you with instructions. (This switch enrollment period will also allow you the opportunity to switch your option under the NMPSIA Dental Plan, if you are enrolled in Dental Plan at the time of switch enrollment.)

Q. If I enroll in the NMPSIA Vision Plan, may I drop this Plan at any time?
A. No. As a safeguard to protect the utilization of the Vision Plan, NMPSIA has a 2-year enrollment requirement under this plan. You and each member of your family have to fulfill the 2-year enrollment requirement before you can drop vision coverage. If you are enrolled in a Section 125 Plan, other rules may apply. Check with your employer's Benefits Specialist for clarification.

Q. How will I know that my application for NMPSIA benefits has been processed and that my enrollment has been accepted?
A. Upon receipt of your enrollment application, NMPSIA's Eligibility Administrator will mail you a Confirmation Notice or a Notice of Incomplete Enrollment. Review these notices carefully and immediately provide your employer's Benefits Specialist with any documentation requested to finalize your enrollment. Do this to avoid a delay or denial of coverage for your eligible dependents. You may contact your employer's Benefits Specialist for assistance or for clarification.

Q. I am a new hire and am applying for family coverage (employee + spouse + natural child + natural child), but I have not been able to locate my marriage certificate and birth certificate for one of my children. Will you still cover my wife and both children?
A. We will initially cover you and the one child for whom you have provided a birth certificate. We will cover your spouse and your other child effective on the first day of the month following the date you provide this missing documentation to your employer's Benefits Specialist. (We will not cover these dependents retroactive to your initial effective date.) You will be granted 61 days from your effective date of coverage to provide these missing documents. If you do not meet this deadline, your dependents will be considered late entrants.

Q. Both my husband and I are employed with NMPSIA school districts. He carries family dental and vision coverage with his employing school district. Can I enroll in family dental and vision coverage with my employing school district to double cover my eligible dependents for dental and vision coverage?
A. No, NMPSIA Rules do not permit double coverage within the NMPSIA Group Plan for medical, dental, vision, and voluntary life. You can have double coverage outside of the NMPSIA Group Plan.