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Human Resources  |  Benefits  |  Eligibility and Enrollment

Eligibility and Enrollment

Eligibility and Enrollment

This information applies to new employees and current employees transitioning to a benefits-eligible position.

Use the tabs below to learn more about benefits eligibility and enrollment for UNM employees. If you have additional questions, contact Human Resources at (505) 277-MyHR (6947)

Benefit Plan Eligibility Waiting Period for Faculty and Staff New Hires

In order to ensure compliance with the Affordable Care Act Summary of Benefits and Coverage (SBC) provisions, the UNM HR Benefits Office has a 15-day benefits eligibility waiting period for all employees hired into a benefits-eligible position, effective September 1, 2013.

Once the employee has satisfied the 15-day eligibility waiting period, he/she will have 31 days to enroll in coverage, with coverage becoming effective the first of the month following the date of enrollment. For those hired from July 1, 2013 - August 31, 2013 new hires will be eligible to enroll in benefits on their date of hire. These new hires will have 60 days to enroll in benefits, making their effective date the date in which they enroll (this follows current practice).

For New Hires Hired July 1, 2013 through August 31, 2013:

  • The SBC must be provided on the first date of eligibility to enroll in benefits
  • In order to provide the SBC on the first date of eligibility to enroll in benefits, employees hired July 1, 2013 - August 31, 2013:
    • Must complete and submit all new hire paperwork to the appropriate Employment Area or HR Service Center three days prior to their hire date
    • Must set up a NetID and password prior to their hire date
  • Example:
    • Hire date: August 1, 2013
    • First day employee is eligible to enroll in benefits: August 1, 2013
      • Employee must enroll in benefits within 60 days
    • Employee enrolls August 1, 2013, and elects for benefits to be effective on August 1, 2013; coverage begins August 1, 2013

For Current Employees Transitioning to a Benefits-Eligible Position on/after September 1, 2013:

  • There is a 15-day benefit eligibility waiting period
  • Example:
    • Transition effective date (i.e., from .25 FTE to .50 FTE): September 1, 2013
    • Eligibility Waiting Period: September 1, 2013 - September 15, 2013
    • First day employee is eligible to enroll in benefits: September 16, 2013
      • Employee must enroll in benefits within 31 days
    • Employee enrolls September 16, 2013 - September 30, 2013; coverage is effective October 1, 2013
    • Employee enrolls October 1, 2013 - October 16, 2013; coverage is effective November 1, 2013

For New Hires Hired on or after September 1, 2013:

  • There is a 15-day benefit eligibility waiting period
  • Example:
    • Hire date: September 1, 2013
    • Eligibility Waiting Period: September 1, 2013 - September 15, 2013
    • First day employee is eligible to enroll in benefits: September 16, 2013
    • Employee must enroll in benefits within 31 days
  • Employee enrolls September 16, 2013 - September 30, 2013; coverage is effective October 1, 2013
  • Employee enrolls October 1, 2013 - October 16, 2013; coverage is effective November 1, 2013

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,
    • Scheduled to work at least 20 hours or more per week,
    • AND at an appointment percent of 50% or greater.
  2. 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.
  3. 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.
  4. 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.
  5. Eligible dependents are:
    • Proof of Dependency is required for dependents enrollment
    • Your legal spouse.
    • Your domestic partner as defined and outlined in the UAPPM #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.

Enrollment - For New Hires/Newly Benefits-Eligible Employees on/after September 1, 2013

In order to have health coverage you must meet the benefits eligibility requirements and satisfy a 15-day waiting period before you are eligible to elect benefits. Upon completion of the 15-day waiting period, you will have 31 calendar days to make your benefit elections online. After your initial 31 days to elect benefits as a new hire or newly benefits-eligible employee, you will only be able to make changes or elections to your benefit coverage during Open Enrollment periods, or if you experience a Qualifying Change in Status event.

For Initial Enrollment:

  • Coverage begins the first of the month after your online benefit elections have been elected and confirmed.
  • You are not eligible for benefits before your date of hire or date of eligibility.

For New Hires Hired on or after September 1, 2013:

  • There is a 15-day benefit eligibility waiting period
  • Example:
    • Hire date: September 1, 2013
    • Eligibility Waiting Period: September 1, 2013 - September 15, 2013
    • First day employee is eligible to enroll in benefits: September 16, 2013
      • Employee must enroll in benefits within 31 days
    • Employee enrolls September 16, 2013 - September 30, 2013; coverage is effective October 1, 2013
    • Employee enrolls October 1, 2013 - October 16, 2013; coverage is effective November 1, 2013

For Current Employees Transitioning to a Benefits-Eligible Position on/after September 1, 2013:

  • There is a 15-day benefit eligibility waiting period
  • Example:
    • Transition effective date (i.e., from .25 FTE to .50 FTE): September 1, 2013
    • Eligibility Waiting Period: September 1, 2013 - September 15, 2013
    • First day employee is eligible to enroll in benefits: September 16, 2013
      • Employee must enroll in benefits within 31 days
    • Employee enrolls September 16, 2013 - September 30, 2013; coverage is effective October 1, 2013
    • Employee enrolls October 1, 2013 - October 16, 2013; coverage is effective November 1, 2013

If you fail to enroll yourself/dependents within the initial eligibility period, you will not be able to enroll unless you have a Qualifying Change of Status Event or until Open Enrollment, which is annually in the Spring. Enrollment during Open Enrollment will not become effective until the beginning of the following Plan Year, on July 1.

Dependent Enrollment

You can add dependents to your coverage provided you submit the necessary documentation to the HR Service Center. Dependent enrollment must be elected during the 31 days of your initial benefit eligibility (ideally at the same time as you enroll). See "Eligible dependents" in the "Eligibility" section to determine if your dependent qualifies.

Proof of eligibility such as:

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

must be taken to the HR Service Center when dependents are enrolled. Family members for whom supporting documentation is not received will not be enrolled in benefit coverage.

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

For information on where to enroll for benefits offered thorough UNM please see the Enrollment Table.

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.

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. Learn more by exploring UNM's Contribution to Insurance and the Benefits Deductions Worksheet.

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.

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 coverage for medical, dental, vision, or a Flexible Spending Account (FSA), you cannot make changes to these plans outside of Open Enrollment period unless you experience a Qualifying Change in Status Event (Also known as a Qualifying Life Event.). Changes to your plan must be made within 31 calendar days of the Qualifying Change in Status Event. You must submit election changes online within the 31 day period along with submitting the applicable supporting documentation to the HR Service Center. If you are unable to provide documentation within the 31 days, please submit an explanation that you are in the process of obtaining the required documentation.

The requested change due to a Qualifying Change in Status Event must be consistent with the qualifying event (e.g., marriage and adding a spouse; birth and 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.

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 26th 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 election changes online and provide supporting documentation. An ineligible dependent's coverage ends on the last day of the month in which eligibility is lost. If you do not disenroll your dependent online by making the election changes to have him/her disenrolled , 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.

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.

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.

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.