Human Resources | Benefits | Eligibility and Enrollment
Eligibility and Enrollment
Eligibility
Staff, faculty, and their dependents are eligible for insurance
benefits if they meet the following criteria:
- Staff must be:
- Regular full-time or part-time employees,
- Scheduled to work at least 20 hours or more per week,
- AND at an appointment percent of 50% or greater.
- Term or Contract Staff must be:
- Regular full-time or part-time employees,
- Scheduled to work fifty percent (50%) or more per week
- AND at an appointment of (.50-1.00 FTE), for an initial period of
3 months or greater.
- 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.
- 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.
- Eligible dependents are:
- Proof of Dependency is required for dependents enrollment
- Your legal spouse.
- Your domestic partner as defined and outlined in the UBPPM #3790 - Domestic Partners.
- Your surviving spouse requires new enrollment forms within 31
calendar days to continue current health benefits. Maximum coverage
period is 12-months. See
Surviving Dependent Eligibility Criteria.
- Your children up to age 26. (Coverage ends at the end of the month
of your child's 26th birthday.)
- Your Children (mentally/physically disabled) over 26, may extend
coverage with application/certification within 31 days of turning age
26
Note: If a dependent no longer meets the listed
eligibility requirements, you must disenroll your ineligible dependent
within 31 calendar days from the date your dependent loses eligibility.
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. If the 60 calendar day
deadline falls on a weekend or holiday, you must submit your enrollment
forms prior to the weekend or holiday.
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 the
Spring. Enrollment during Open Enrollment will not become effective
until the beginning of the following Plan Year.
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 (claims) 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 the Spring.
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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.
Faculty who choose to receive their annual pay over 10 months will be
double deducted in May and August to cover their June and July premiums.
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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 Plan
Year 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) |
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, vision insurance, or 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 obtaining the
required documentation. If the 31 day deadline falls on a weekend or
holiday, your enrollment form must be received prior to the weekend or
holiday.
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 26th 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 26 (Coverage ends at the end of the month of
your child's 26 birthday)
- Divorce of a spouse
- Dissolution of a domestic partnership
You must disenroll your dependents within 31 calendar days of
any of the above qualifying events. Otherwise,
you may be liable for any claims 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 disenroll a
dependent who no longer meets eligibility requirements, you may be
responsible for any expenses incurred. You MUST disenroll your
ineligible dependent 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 ineligible dependent's
coverage ends on the last day of the month in which eligibility is lost.
If you do not notify the office and disenroll your dependent, you may be
responsible for any claims incurred by the ineligible dependent.
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 the Spring - for medical, dental, vision, and PIPP. Changes
made during Spring Open Enrollment are effective the beginning of the
following Plan Year. Open Enrollment for FSA occurs in the Fall and
changes will take place on the beginning of the following Plan Year.
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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. If the 31 day
deadline falls on a weekend or holiday, enrollment forms must be
received prior to the weekend or holiday.
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 31
calendar days after the marriage, birth, adoption, or placement for
adoption. If the 31 day deadline falls on a weekend or holiday,
enrollment forms must be received prior to the weekend or holiday.
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 the Children's
Health Insurance Program (CHIP) and your and/or your dependent's
coverage under such a plan is terminated as a result of loss of
eligibility.
- ELIGIBILITY FOR PREMIUM ASSISTANCE UNDER MEDICAID OR CHIP - If you
and/or your dependent become eligible for premium assistance under
Medicaid or CHIP, including under any waiver or demonstration project
conducted under or in relation to such a plan. This is usually a
program where the state provides employed individuals with premium
payment assistance for their employer's group health plan rather than
direct enrollment in a state Medicaid program.
Under CHIP, you have 60 calendar days to enroll in the UNM Medical
Plan if you experience either of the above Qualifying Change of Status
Events.
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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 — Dependent Care Spending Account
- Standard Short-term Disability
- Standard Life and Long-term Disability (portability or conversion may apply)
- UNUM - Long-term Care (conversion may apply)
* 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 Spring. Termination during this time will be
effective at the end of the current Plan Year.
Dependent coverage termination
Dependent coverage terminates at the end of the month the dependent
loses eligibility. 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.
Certificate of Creditable Coverage
When an employee or dependent terminates coverage for any reason, he
or she will be sent a Certificate 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 certificate can be presented to meet any pre-existing
conditions clause a new employer may have with his/her 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, FSA, or vision insurance programs,
you will receive a COBRA General Notice. 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 notice for
your files.
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