NO CHANGE ACTIVE ENROLLMENT 2024

This year’s annual Open Enrollment will require all benefit-eligible State and Local Public Body employees to actively examine the benefits offered for calendar year 2024. This is to ensure employees are making the appropriate decisions about the benefits that will best suite their own-and their families-needs.

During this enrollment employees are given the opportunity to Switch medical carriers, add/drop insurance, or remove/add eligible dependents.

The information provided below is intended to assist employees in submitting the request for NO CHANGES successfully.

IMPORTANT DATES

Open Enrollment Period:	October 1 - 31, 2023
Deadline to Confirm no changes:	October 31, 2023 11:59 PM

Steps:

Complete Online or Fillable NO CHANGE Form by clicking the blue “Proceed to no change enrollment form” button below or by submitting the Fillable no change form to Erisa Administrative Services.
Please be aware: The online NO CHANGE form will time out after 15 minutes of inactivity.
The form will need to be completed to its entirety.

Steps: Electronic Enrollment Form:
1. Review your important information, dates, and acknowledgements.
  
  Attention: Please follow the important guidance provided in each section of the enrollment form. Please take time to review.
2. Click the blue “Proceed to no change enrollment form” button.
3. Enter your current bio-graphics information to include current home and mailing addresses in SHARE. If you need assistance please see the provided link for directions.
  
  https://www.mybenefitsnm.com/documents/Manage_Personal_Information_and_Review_Your_Benefits.pdf
4. Submit and Print.
5. Upon submitting the NO CHANGE form, print two copies; one for your personal records and one to forward to your HR for your Personnel File.
6. Submit supporting documentation via E-mail: sonm@easitpa.com or Fax: 505-244-6009 to Erisa.
7. If using the Fillable Enrollment Form e-mail to sonm@easitpa.com or Fax: 505-244-6009. Remember to save proof of fax confirmation sheet.
  - Submit supporting documentation via E-mail: sonm@easitpa.com or Fax: 505-244-6009 to Erisa.

Questions: Please contact Erisa Administrative Services, Inc. (505) 244-6000 or toll free (855) 618-1800

I acknowledge that I reviewed the benefit plans offered to me by the State of New Mexico by attending virtual webinars and the mybenefitsnm.com website.

I confirm that NO CHANGES are needed at this time.

My current home and mailing address will be listed in the Employee Information section of this enrollment form and in SHARE.
https://www.mybenefitsnm.com/documents/Manage_Personal_Information_and_Review_Your_Benefits.pdf

My current E-Mail address will be listed in the Employee Information section of this enrollment form and in SHARE.
https://www.mybenefitsnm.com/documents/Manage_Personal_Information_and_Review_Your_Benefits.pdf

I will provide all supporting documentation for dependents whom I wish to continue coverage for calendar year 2023. The list of eligible Supporting documentation includes:

Exception: New Hires in 2023 are not required to submit proof of dependency.

List:

Adding a Spouse:
Marriage Certificate (must be court-filed and show filing date/acceptance; Marriage Licenses are not acceptable) Common-law marriages are not recognized under New Mexico statute; however, common-law marriages from states which do recognize them will also be recognized for benefit eligibility purposes
Adding a Domestic Partner:
Signed and notarized Domestic Partnership form (Note: must be 12 or more months since any prior identified documented or recorded termination of DP or marriage)
Adding a Dependent Child:
Birth Certificate Court Issued Guardianship/Kinship Papers Court Issued Custodial Papers (must not have expired) Adoption Papers
Adding your Domestic Partner's Children:
Birth Certificate or similar court-issued paperwork as described above identifying your domestic partner as the parent or legal guardian
Adding a Newborn:
A newborn may be added within 31 days of Date of Birth; proof of birth from the Hospital may be submitted in place of a Birth Certificate, but the BC must be submitted within 90 days of the DOB

Adding or Dropping Coverage Due to a Change in Other Coverage:
Documentation from the other provider clearly showing you and/or the dependent who is affected and whom you will be adding or dropping as the covered participant; must include the effective date in which your other coverage started or ended If the change is related to Medicaid please submit the full letter of notice from your Medicaid provider
Divorce or Separation:
A copy of the relevant pages showing the date of separation or divorce and the name of the ex-spouse; by Department of Labor rules this must be submitted within 30 days to your employer and administrator as the ex-spouse is eligible for COBRA
Dependent Turning 26:
Dependents turning 26 automatically drop at the end of the month in which their 26th birthday takes place and no documentation is required
Adult Disabled Dependents:
To receive plan coverage an adult disabled dependent must have been on your coverage prior to turning 26; a copy of the disabled dependent certification form must be filled out and submitted for approval by your medical carrier, then turned into Erisa for processing (forms at: https://www.mybenefitsnm.com)

I acknowledge the deadline to submit supporting documentation is 10/31/2023 11:59 PM.