Eligibility and Enrollment

Eligibility

Staff, faculty, and their dependents are eligible for insurance benefits if they meet the following criteria:

1. Staff must be:

  • Regular full-time or part-time employees,
  • Working at least 20 hours per week,
  • AND at an appointment percent of 50% or greater.

2. Faculty must be:

  • At least nine-month academic year contract,
  • Regular full-time or part-time employees,
  • AND at an appointment percent of 50% or greater.

3. Post-doctoral Fellows must be:

  • At least nine-month academic year contract,
  • Regular full-time or part-time employees,
  • AND at an appointment percent of 50% or greater.

Note: Note: Post-doctoral fellows are only eligible for medical, dental, and vision insurance; flexible spending accounts; life and accidental death & dismemberment insurance; and 403(b) and 457(b) supplemental insurance plans.

4. Eligible dependents are:

  • Your legal spouse.
  • Your domestic partner as defined and outlined in the UBPPM # 3790 (requires affidavit and 3 proofs of financial dependency).
  • Your unmarried children up to age 25.
  • Your unmarried children over the age of 25 if mentally or physically handicapped (an extension of coverage must be applied for within 31 calendar days of the 25th birthday).

Note: If a dependent no longer meets the listed eligibility requirements, employees must notify the Benefits Office in writing within 31 calendar days from the date that the dependent is no longer eligible.

Note: If your spouse and/or child has coverage as a UNM employee, he/she may not enroll as your dependent while he/she remains an employee. Likewise, if both you and your spouse/domestic partner work for UNM and are covered as employees, your child(ren) may only be enrolled as dependents under one employee.

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Enrollment

In order to have health insurance, you must enroll within 60 calendar days of your initial eligibility date or during Open Enrollment. There are no late enrollments.

For initial enrollment:

  • Coverage begins the first of the month after your enrollment form is received at the HR Service Center (must be date stamped by an HR Services Representative).
  • You may elect for your medical insurance to be effective the date your enrollment form is received and dated stamped by the HR Service Center. However, you will not receive a prorated premium for the month. You will pay a full month's employee portion of the premium regardless of the effective date of coverage.
  • You are not eligible for benefits before your date of hire or date of eligibility.

If you fail to enroll yourself/dependents within the initial eligibility period, you will not be able to enroll unless there is a qualifying status change or until Open Enrollment, which is in May. Enrollment during Open Enrollment will not become effective until the following July.

Dependent enrollment:

You can add dependents to your coverage provided you submit the necessary documentation to the HR Service Center. Initial dependent enrollment must be within 60 days of your initial eligibility (ideally at the same time as you enroll). See "Eligible dependents"in the previous section to determine if your dependent qualifies.

Proof of eligibility such as,

  • Marriage certificate,
  • Domestic partner certification affidavit,
  • Adoption records, or
  • Birth certificate

must be taken to the HR Service Center when dependents are enrolled. Family members for whom documentation is not received will be disenrolled retroactive to the coverage effective date, and you may be liable for any costs incurred for the invalid enrollment.

To add dependents after initial enrollment, they must meet the criteria for "Qualifying Change in Family Status events,"or "Special events under HIPPA."If criteria are not met, dependents are not eligible for enrollment until Open Enrollment in May.

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UNM's Contribution to the Cost of Insurance

UNM contributes a percentage of the premium for medical, dental, and basic life insurance as well as long-term disability. Once you enroll in any of the insurance plans, the premiums are automatically deducted from your paycheck. The percentage contributed by UNM is based on your salary and appointment percentage. Click here for UNM's contribution to insurance.

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Pre-Tax Insurance Premium Plan (PIPP)

Enrollment in PIPP allows for your premiums to be subtracted from your gross salary before computing taxes, reducing the amount you pay in federal, state, and social security taxes. This method of pre-tax payment generally increases your take-home pay.

The Pre-Tax Insurance Premium Plan (PIPP) is offered to all regular UNM employees who:

  • Are presently enrolled in a UNM-sponsored medical, dental, and/or vision insurance plan, and
  • Have premiums deducted through UNM payroll.

Note: If you elect this benefit, you may not use your medical, dental, and vision premiums as deductions when you file your federal and state income tax returns.

When you enroll in a medical, dental, vision, and/or FSA plan, you will be automatically enrolled in PIPP as well.

  • If you elect insurance coverage and do not want PIPP, you must complete a form declining participation in PIPP.

Advantages for Enrolling in PIPP

  • Most people receive no tax relief for what they have to pay for health care, but PIPP offers some assistance by reducing tax expenses. Current tax laws allow you to deduct your medical, dental, and/or vision premiums on your federal income tax form if all of your medical expenses for the year were greater than 7.5% of your income. It is unlikely that you will reach this 7.5% level unless your medical expenses for the year were very high or your income was low.
  • Enrolling in PIPP allows you to pay your medical, dental, and/or vision premiums prior to taxes being calculated.

Disadvantages of Enrolling in PIPP

  • Once you select PIPP, the decision remains in effect for the fiscal year (July 1 through June 30) and you cannot make any changes to your medical, dental, and/or vision plans unless you experience a "qualifying change in status," as defined by the IRS (see Enrollment section for qualifying change in status events).
  • It could have a slight impact on your social security benefits.

PIPP Comparison

No PIPP PIPP
Annual Salary $33,000.00 $33,000.00
Pre-tax Deductions
Retirement $2,508.00 $2,508.00
Insurance $0.00 $2,952.96
 
Taxable Income $30,492.00 $27,539.04
 
Taxes $6,744.83 $6,091.41
Net Pay $23,747.17 $21,447.63
Insurance $ 2,952.96 $0.00
Net Spendable Income $ 20,794.21 $ 21,447.63
Annual Savings with PIPP = $ 653.42 (Your results may vary)

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Qualifying change in status

The UNM-sponsored group health plans have a pre-tax status and are therefore governed by IRS regulations. Once you in enroll in medical, dental, or vision insurance, or an FSA, you cannot make changes to these plans outside of Open Enrollment unless you experience a qualifying change in status. Changes to your plan must be made within 31 calendar days of the qualifying change in status event. You must submit an Enrollment/Change Form within the 31 day period along with the supporting documentation as applicable. If you are unable to provide documentation within the 31 days, please submit the change form along with an explanation that you are in the process of getting the required documentation.

Dental Change Form
Health Change Form
Vision Change Form

The requested change due to a qualifying change in status must be consistent with the qualifying event (e.g., marriage and adding a spouse; adding a newborn dependent to coverage).

Qualifying events include:

  • Birth or adoption.
  • Marriage.
  • Divorce, legal separation, or annulment.
  • Death of spouse or dependent.
  • The 25th birthday of your unmarried mentally or physically handicapped children (an extension of coverage must be submitted).
  • Employee or spouse employment change from part-time to full-time, or full-time to part-time.
  • Student status of dependent(s) changes from part-time to full-time, or full-time to part-time.
  • Employee or spouse residence or workplace change which places them outside of the health care service area.
  • Employee or spouse significant health insurance coverage change attributable to spouse's employment.
  • Employment termination or commencement for the employee, a spouse, or a dependent.

Change of coverage will begin the first of the month after the enrollment change request is received. The only exception:

  • In the event of birth, adoption, or placement for adoption of a child, coverage is effective retroactively to the date of birth, adoption, or placement for adoption.

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Loss of eligibility due to qualifying events for change of dependent status

A dependent loses eligibility to participate in UNM sponsored plans if any of the following qualifying events occur:

  • Dependent child turns 25.
  • Dependent child, who is under 25, becomes married.
  • Divorce of a spouse.
  • Dissolution of a domestic partnership.

You must disenroll your dependents and notify the HR Service Center within 31 calendar days of any of the above qualifying events. Otherwise, you may be liable for any plan expenses incurred by the ineligible dependent.

In most cases, a dependent may be eligible to continue insurance coverage through the provisions of COBRA.  Please contact the HR Service Center at 277-MYHR (6947) for information about COBRA.

Your responsibility

It is your responsibility to be sure that all of the dependents you enroll and continue to cover are eligible for the benefit in accordance with the terms and conditions of the plan. If you enroll a dependent who does not meet eligibility requirements, or if you do not drop a dependent who no longer meets eligibility requirements, you may be responsible for any expenses incurred. You MUST disenroll your ineligible dependent and notify the HR Service Center as soon as possible, or within 31 calendar days of any of the above qualifying events.To disenroll your dependent, you must submit an enrollment/change form to the Benefits Office. An eligible dependent's coverage ends on the last day of the month in which the event occured. If you do not notify the office and disenroll your dependent, it may result in paying higher premiums than is necessary.

Dental Change Form
Health Change Form
Vision Change Form

Other plan changes

Plan changes that do not meet the criteria for qualifying events can only be made during UNM's annual Open Enrollment- which traditionally occurs in May- for medical, dental, vision, and PIPP. Changes made during Spring Open Enrollment are effective July 1st of the following fiscal year. Open Enrollment for FSA occurs in November and changes will take place on January 1st.

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Special events enrollment under HIPAA

Under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), there are special events that may allow you to add health insurance coverage if you did not elect health insurance coverage for yourself and/or your dependents during your initial eligibility period or during Open Enrollment:

Loss of Other Coverage - If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health insurance coverage or group health plan coverage, you may be able to enroll yourself and/or your dependents if you or your dependents lose eligibility for that other coverage or if the employer stops contributing towards your or your dependent's coverage. To be eligible for this special enrollment opportunity you must request enrollment within 31 calendar days after your other coverage ends or after the employer stops contributing towards the other coverage.

New Dependent as a Result of Marriage, Birth, Adoption, or Placement for Adoption - If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within calendar 31 days after the marriage, birth, adoption, or placement for adoption.

Medicaid Coverage Effective April 1, 2009
Beginning April 1, 2009, The Children's Health Insurance Program Reauthorization Act of 2009 (CHIP) added a special enrollment event under HIPAA. UNM will allow you and/ or your dependent who is eligible but not enrolled for coverage, to enroll if either of the following events occur:

  • TERMINATION OF MEDICAID OR CHIP COVERAGE- If you and/or your dependent is covered under a Medicaid plan or under a State child health plan (SCHIP) and your and/or your dependent's coverage under such a plan is terminated as a result of loss of eligibility.
  • ELIGIBILITY FOR EMPLOYMENT ASSISTANCE UNDER MEDICAID OR CHIP- If you and/or your dependent become eligible for premium assistance under Medicaid or SCHIP, including under any waiver or demonstration project conducted under or in relation to such a plan. This is usually a program where the state assists employed individuals with premium payment assistance for their employer's group health plan rather than direct enrollment in a state Medicaid program.

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Termination of coverage

The following plans terminate at midnight on the last day of the month of separation from employment:

  • Lovelace Insurance Company *
  • Presbyterian Insurance Company *
  • Delta Dental Plan *
  • Vision Service Plan *
  • FSA — Medical Reimbursement Account (check with the Benefits Office at 277-MyHR)
  • FSA — Dependant Care Spending Account
  • CIGNA Life, Long-term Disability, and Accidental Death and Dismemberment (may apply for conversion)

* You may elect to continue UNM's group health coverage in accordance with the federal guidelines of the Consolidated Omnibus Budget Reconciliation Act (COBRA). Refer to the next section on COBRA for additional information or contact the HR Service Center at 277-MyHR (6947) for detailed information and premium cost.

Also, you may decide to terminate one or more insurance plans during Open Enrollment in May. Termination during this time will be effective on June 30.

Dependent coverage termination

Dependent coverage terminates at the end of the month when the dependent is no longer eligible. Refer to the information in the section titled "Qualifying change in status"for further information.

Dependents who have lost their eligibility may elect to continue their medical, dental, and/or vision insurance coverage through UNM under the provisions of COBRA.

Certification of Creditable Coverage

When an employee or dependent terminates coverage for any reason, he or she will be sent a Certification of Creditable Coverage by his/her insurance carrier that outlines the type of health insurance plan, any deductibles, and the length of time the employee was enrolled in the plan at UNM. If the employee is leaving UNM and going to another employer, the certification can be presented to meet any pre-existing conditions clause a new employer may have with its plan.

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Consolidated Omnibus Budget Reconciliation Act (COBRA)

In accordance with the COBRA continuation provision, employees who separate from the University may elect to continue their medical, dental, and/or vision insurance for up to eighteen (18) months. The covered individual pays 102% of the premium costs.

Contact the HR Service Center at 277-MYHR or 277-6947 (MYHR) for detailed information.

Who is eligible for COBRA coverage?
  • Covered Employee who is (or was) covered under the University's group medical, dental, and/or vision plan at the time of the qualifying event.
  • Qualified Beneficiaries: Employee's legal spouse and/or dependent children provided each is (or was) insured under the plan on the day before the qualifying event occurred.
Qualifying events and continuation of coverage

Qualifying Event

Qualified Beneficiaries

Continuation Coverage

Covered employee's termination (for reasons other than gross misconduct) or reduction in hours of employment classification (from regular to temporary or on-call)

Covered employee
Spouse
Dependent child

18 months (may be extended due to disability)

Covered employee's termination with domestic partner election

Covered employee, domestic partner and domestic partner's dependents may be covered with employee

18 months (may be extended due to disability)

Death of covered employee

Spouse
Dependent Child

36 months

Covered employee's divorce or legal separation from spouse

Spouse
Dependent Child

36 months

Covered employee's entitlement to Medicare

Spouse
Dependent Child

36 months

Dependent child's ineligibility for benefits under plan

Dependent Child

36 months

Bankruptcy of retiree's covered employer

Covered retiree
Widows and Widowers

Until death

 

Employee's Responsibilities

If you enroll in medical, dental, or vision insurance programs, you will receive a COBRA Initial Rights Notification. This notification outlines your responsibilities if you experience a COBRA qualifying event that results in loss of insurance coverage. Please be sure to keep this notification for your files.

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