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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)

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 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 three months or greater

Faculty must be:

  • On at least a 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:

  • On at a 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:

  • Your legal spouse
  • Your domestic partner as defined and outlined in the UAPPM #3790 - Domestic Partners
    • For Surviving Spouses: Your surviving spouse requires new enrollment forms within 31 calendar days to continue current health benefits.
  • Maximum coverage period is 12-months
  • 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

    Proof of Dependency is required for all enrolled dependents.

    Dependent social security numbers are also required (when enrolled in a UNM Medical Plan) to meet IRS requirements. For more details, see "Collection of Dependent Social Security Numbers for Affordable Care Act (ACA) Reporting Purposes."

    Note: If a dependent no longer meets the listed eligibility requirements, you must unenroll 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

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 benefits elections. 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

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

  • For medical, dental and vision coverage enrollment:
    • Online enrollment is temporarily unavailable. Please complete the Medical/Dental/Vision Enrollment Form and fax it to 505-277-2278, or drop it off at the HR Service Center at 1700 Lomas Blvd NE, Suite 1400
  • For Life, Accidental Death & Dismemberment, and Long and Short-Term Disability coverage, enrollment is online: Time Login Instructions
  • For a Flexible Spending Account (FSA), enroll via paper form: Forms page
  • For a complete list of how to enroll for benefits offered through UNM, please see the Enrollment Table

For New Hires

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

For Current Employees Transitioning to a Benefits-Eligible Position

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

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 occurs annually each spring.

Enrollments or changes made during the Open Enrollment period are effective on July 1 of the Plan Year.

Dependent Enrollment

You can add dependents to your coverage, provided you submit the required dependent eligibility proof documentation when requested. Dependent enrollment must be elected during your designated 31 day enrollment period (ideally at the same time that you enroll). See "Eligible dependents" in the "Eligibility" section to determine if your dependent qualifies.

The Division of Human Resources partners with Aon Hewitt’s Dependent Verification Services to verify eligibility of all dependents enrolled in the UNM Medical Plan. All employees and pre-65 retirees with dependents (spouse/domestic partner and/or children) enrolling in a UNM Medical Plan will be required to provide documents to Aon Hewitt to prove dependent eligibility.

If you are adding a dependent to your Medical coverage, you will receive notification in the mail requesting that you submit proof documents to Aon Hewitt's Dependent Verification Center.

If you fail to submit the required proof documents, your dependent will be deemed ineligible for UNM coverage, which will result in cancellation of coverage for this dependent. Furthermore, you may be required to repay the total cost of any health care plan paid claims, and/or further action may be taken as deemed necessary.

Examples of Required Dependent Proof Documents

If you are enrolling dependents for Dental and/or Vision coverage only, copies of dependent eligibility proof documents must be provided to the HR Service Center within 31 days of your enrollment. You may either drop the documents off at the HR Service Center (1700 Lomas Blvd NE, Suite 1400), or fax them to 505-277-2278.

Proof Documents Submission Requirements

To add dependents after your initial enrollment, you must meet the criteria for a Qualifying Change in Status or Special Events Enrollment Under HIPAA. If the criteria are not met, dependents will not be eligible for enrollment until annual Open Enrollment in late 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 ten months will be double deducted in May and August to cover their June and July premiums.



Dependent Eligibility Verification

Beginning in early April, the Division of Human Resources is partnering with Aon Hewitt Dependent Verification Services to verify eligibility of all dependents enrolled in the UNM Medical Plan. All employees and Pre-65 retirees with dependents (spouse/domestic partner and/or children) enrolled in a UNM Medical Plan with any of the Third Party Administrators will be required to provide documents to prove dependent eligibility.



Employees will have an opportunity to proactively remove ineligible dependents during an amnesty period through the month of April. Aon Hewitt will begin requesting documents proving dependent eligibility in Mid-April. Any ineligible dependents who remain covered under an employee's medical plan after the verification period ends on May 16 will be canceled from coverage, and UNM may seek reimbursement for claims paid on behalf of the ineligible dependent.

Aon Hewitt will begin sending initial communications to home addresses on April 3, 2015. In order to make this process as efficient as possible, employees must respond to Aon Hewitt's documentation requests in a timely manner. It's a good idea to start gathering proof documents that will be requested by Aon Hewitt. Examples of proof documents Aon Hewitt will require include but are not limited to:

  • Marriage Certificate
  • Birth Certificate
  • Affidavit of Domestic Partnership and one proof of joint ownership
  • Recent Tax Return Documents
  • Court Documents supporting Legal Guardianship

Collection of Dependent Social Security Numbers for Affordable Care Act (ACA) Reporting Purposes

The Affordable Care Act (ACA), also referred to as Healthcare Reform, requires UNM to report to the IRS all individuals enrolled in any of the UNM Medical Plans. The IRS requires UNM to provide the Social Security Numbers (SSNs) of each individual enrolled in the UNM Medical Plans. In order to meet the new reporting requirements, Aon Hewitt’s Dependent Eligibility Verification Center will be soliciting dependent SSNs during the Dependent Verification process.

Aon Hewitt is the University of New Mexico’s Benefits Consultant. Please comply with the request for dependent SSNs, as UNM is subject to substantial penalty for failure to comply with the new reporting requirements.

Should you need assistance or have questions about Dependent Eligibility Verification, contact Aon Hewitt’s Dependent Verification Center at 1-800-725-5810.

Pre-Tax Benefit Plan Contributions

UNM Premium Only Plan (POP) for Pre-Tax Benefit Plan Contributions

When you enroll in medical, dental, and/or vision coverage, you can elect for your benefit plan contributions to be deducted from your gross salary before computing taxes, reducing the amount you pay in federal, state, and social security taxes. This method of pre-tax contributions generally increases your take-home pay over making benefit plan contributions on a post-tax basis.

The POP is offered to all regular UNM employees who:

  • Are presently enrolled in a UNM-sponsored medical, dental, and/or vision insurance benefit plan, and
  • Have benefit plan contributions deducted through UNM payroll
  • Review the Eligibility and Enrollment information on the HR Web site for additional eligibility details and enrollment procedures

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.

General Provisions of the POP

  • POP allows you to have your medical, dental, and/or vision benefit contributions deducted from your pay before income taxes are deducted, thus lowering your taxable income and reducing the amount you pay in taxes
  • Once you choose to enroll in the POP, you cannot make changes to your benefit plans unless you experience a Qualifying Change in Status event
  • You should consult a tax advisor for information on how the POP may impact Social Security benefits
  • POP does not include FSA - for information about FSA, review the FSA information on the HR Web site
  • Review UNM's Section 125 Plan Document for additional details

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 an 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.

If you are adding a dependent to your medical coverage, you will also be required to submit dependent proof documents and dependent social security numbers to Aon Hewitt’s Dependent Eligibility Verification Center.

If you are enrolling dependents for Dental and/or Vision coverage only, copies of dependent eligibility proof documents must be provided to the HR Service Center within 31 days of your enrollment. You may either drop the documents off at the HR Service Center (1700 Lomas Blvd NE, Suite 1400), or fax them to 505-277-2278.

Proof Documents Submission Requirements

Examples of Required Dependent Proof Documents

  • For medical, dental and vision coverage enrollment changes:
    • Online enrollment is temporarily unavailable. Please complete the Medical/Dental/Vision Enrollment Form and fax it to 505-277-2278, or drop it off at the HR Service Center at 1700 Lomas Blvd, NE, Suite 1400)
  • Make Flexible Spending Account (FSA) changes via the paper FSA Enrollment/Change Form
  • Make Life or Disability changes via the Standard Enrollment site

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
  • Employee or spouse significant health coverage change attributable to spouse's employment
  • Employment termination or commencement for the employee, a spouse, or a dependent
  • Gain or Loss of other health coverage (including HealthCare Exchange coverage)

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 unenroll 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 505-277-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 benefits 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 unenroll a dependent who no longer meets eligibility requirements, you may be responsible for any expenses incurred.

You MUST unenroll your ineligible dependent within 31 calendar days of any of the above qualifying events. To unenroll your dependent, you must submit election changes via the Enrollment/Change Form and provide supporting documentation.

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 late spring - for Medical, Dental, Vision, Life, Disability and Accidental Death & Dismemberment plans. Changes made during Open Enrollment are effective the beginning of the following Plan Year on July 1 (the Plan Year starts in the same calendar year that Open Enrollment is held).

Open Enrollment for Flexible Spending Accounts (FSA) occurs in late fall, and changes will take place on the beginning of the following Plan Year, January 1 (of the following calendar year in which FSA Open Enrollment is held).

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 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 coverage, you may be able to enroll yourself and/or your dependents if you or your dependents lose eligibility for that 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.

Proof Documents Submission Requirements

Examples of Required Dependent Proof Documents

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 are covered under a Medicaid plan or under CHIP, and your coverage 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.

If you are adding a dependent to your Medical, Dental, and/or Vision coverage, you are required to submit proof of your dependent’s eligibility. Refer to the Eligibility and Enrollment section for this information.

Proof Documents Submission Requirements

Examples of Required Dependent Proof Documents

Termination of coverage

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

  • UNM Health*
  • BlueCross BlueShield of New Mexico*
  • Presbyterian Health*
  • 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 505-277-MyHR (6947) for detailed information and premium cost.

Also, you may decide to terminate one or more Health, Life, or Disability plans during Open Enrollment in late spring. Termination during this time will typically be effective at the end of the current Plan Year.

Dependent coverage termination

Dependent coverage terminates at the end of the month in which 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 coverage through UNM under the provisions of COBRA. COBRA is not offered when dependents are deemed ineligible via UNM's Aon Dependent Eligibility Verification process.

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?

  • A 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 EventQualified BeneficiariesContinuation 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
(Ineligibility due to failing Dependent Eligibility Verification does not apply)
  • 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 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 health coverage. Please be sure to keep this notice for your files.