2. Eligibility
The following individuals are eligible to receive any of the insurance benefits offered by the University:
2.1. Employees
The following employees are eligible:
- Staff employees who are full-time or part-time regular employees working twenty (20) hours or more per week (.50 FTE or greater).
- Faculty members who have a nine (9) month contract or more and who are full-time or part-time regular employees working fifty percent (50%) or more per week (.50 FTE or greater).
- Post Doctoral Fellows (PDFs) who have a contract of at least nine (9) months or more working at least .50 FTE are eligible for health, dental, life, and vision insurance only.
Insurance benefits are not available to:
- part-time employees working less than twenty (20) hours per week (less than .50 FTE);
- temporary employees; and
- on-call employees.
2.2. Eligible Dependents
Eligible employees as described in Section 2.1. herein may choose insurance coverage for eligible dependents. Dependents include the following:
- a legal spouse (must provide a copy of marriage certificate);
- a domestic partner (must provide UNM affidavit, see "Domestic Partners" Policy 3790, UBP);
- unmarried children to age twenty-three (23); or
- unmarried children over the age of twenty-three (23); if mentally or physically handicapped, provided extension of coverage is applied for within thirty-one (31) days of twenty-third birthday.
2.3. Retirees
Eligible faculty and staff employees retiring from the University may continue their group health, life, and dental insurance into retirement. To be eligible they must have:
completed a minimum of five (5) consecutive years of service immediately prior to retirement;
met the criterion for either the State of New Mexico Educational Retirement Act (ERA) or the Alternative Retirement Plan (ARP);
been covered by a local group health insurance policy for at least four (4) of the last five (5) years, and be currently enrolled in one of the available UNM health insurance plans for the last twelve (12) months of employment, prior to retirement; and
must be on UNM's payroll the month prior to retirement with active insurance.
2.3.1. Coverage
Coverage will be at the same level it was prior to retirement, until the retiree reaches sixty-five (65) when some coverage may change. If coverage is not elected at retirement, or if elected and later canceled, the retiree may not enroll in coverage at a later date.
2.3.2. Insurance Premiums
Insurance premiums are due and payable each month. Retirees can request the monthly premium be deducted from their NM Educators Federal Credit Union account or they can be billed monthly through the Bursar's Office. Failure to pay the monthly premium may result in cancellation of insurance coverage.
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3. Coverage Period
3.1. Coverage Begins
3.1.1. Initial Eligibility Period
If an employee enrolls in an insurance plan within sixty (60) calendar days from the date of hire or eligibility, coverage for the employee and dependents (if selected) will begin on the day the employee submits the signed enrollment form to the Benefits Office.
3.1.1.1. Late Enrollment for Health Insurance
If an employee does not enroll in health insurance within sixty (60) days of the initial eligibility period, the employee may enroll at any time during the year as a late enrollee in the PPO plan. Under the provisions of the Health Insurance Portability and Accountability Act (HIPAA), the employee will not be subject to medical underwriting; however, the employee and any eligible dependents will be subject to a twelve (12) month pre-existing conditions clause for the PPO plan. Please contact the Employee Benefits Office for further details. This late enrollment provision applies to health insurance only.
3.1.1.2. Special Events Enrollment for Health Insurance
Under the provisions of the Health Insurance Portability and Accountability Act (HIPAA), there are two special events which may allow the employee to add health insurance coverage if an employee has not elected health insurance coverage during the initial eligibility period or during open enrollment:
- The first special event is marriage, where the employee has opted out of health insurance, the employee may enroll in a health insurance plan and add the new spouse.
- The second special event is the birth or adoption of a child, where the employee has opted out of health insurance, at which time the employee may add a health plan and add the child.
In order to add a health insurance plan for either of the above special events, the employee must complete an enrollment form within thirty-one (31) days of the event. These provisions apply only to health insurance.
3.1.2. Open Enrollment
Periodically, open enrollment will be scheduled to allow employees to select or change insurance benefits. You may choose to enroll, disenroll, or make changes to insurance plans and/or to your Pre-Tax Insurance Premium Plan (PIPP). The Employee Benefits Office facilitates this enrollment and notifies employees in advance.
3.1.3. Birth of Child
If an employee is enrolled in an insurance plan, coverage for a newborn child will begin on the date of birth. The newborn must be added within sixty (60) days of birth.
3.2. Coverage While on Leave of Absence Without Pay
An employee on approved leave of absence without pay (LWOP) may elect to continue insurance coverage by paying the employee's portion of the monthly premiums. UNM will continue to pay its portion. Upon receiving notification from the Benefits Office, the employee must formally elect to continue coverage. Once continuation is elected, the employee will receive a monthly bill from the Bursar's Office. Failure to pay this bill may result in cancellation of coverage.
If an employee elects not to continue coverage while on LWOP, the employee must re-enroll within sixty (60) days after returning from LWOP or at the next available open enrollment.
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3.3. Coverage Terminates
3.3.1. Separation
Insurance benefits will terminate for the employee and dependents as of midnight on the separation date when separation results:
- from an employee's resignation;
- when an employee is relieved during the probationary period; or
- when an employee is discharged for unsatisfactory performance or misconduct.
In accordance with the COBRA continuation provision, an employee who separates from the University may elect to continue health, dental, and/or vision insurance through the University (see Section 3.3.5. herein).
3.3.2. Layoff
When an employee is laid off, the employee may continue his or her insurance coverage for three (3) months as long as the employee pays his or her share of the premiums. After three (3) months, the employee's insurance benefits will terminate as of midnight on the last day of the month following ninety (90) days on the layoff roster. The laid off employee may continue coverage for an additional fifteen (15) months under COBRA (see Section 3.3.5. herein).
3.3.3. Employee Eligibility Ceases
If an employee is no longer eligible for coverage, insurance benefits for the employee and dependents will terminate as of midnight on the last day of eligible employment. This would apply to employees whose assignment:
- is reduced to less than 1/2 time; or
- changes from regular to temporary or on-call.
3.3.4. Dependent Eligibility Ceases
When a dependent is no longer eligible for coverage as described in Section 2.2. herein, insurance benefits will terminate as of midnight on the last day of the month eligibility ceases. In accordance with the COBRA continuation provision, ineligible dependents may elect to continue their health, dental, and/or vision insurance through the University (see Section 3.3.5. herein).
3.3.5. Consolidated Omnibus Budget Reconciliation Act (COBRA)
Some insurance packages may be continued through UNM in accordance with the federal guidelines of the Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provision. If a qualifying event occurs, an employee who is (or was) covered under the University's group health, dental, and/ or vision plan at the time may continue coverage through the University's insurance plans for eighteen (18) months. The covered individual pays 102% of the premium costs. Contact the Employee Benefits Office for detailed information.
3.3.6. Policy Conversion
Most of the insurance plans may be converted to an individual policy in accordance with the guidelines of each insurance contract. Contact the Employee Benefits Office for detailed information.
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The above chart applies to full time employees. For part time employees, the base salary is figured on the full-time equivalent and the University's contribution is reduced by the percentage (%) multiple.
The University's insurance program offers health, dental, and vision coverage. Both individual and dependent coverage are available. Payroll deductions for health, dental, and vision premiums can be made on a pre-tax basis, thereby reducing social security, federal, and state income taxes.
The Pre-Tax Insurance Premium Plan (PIPP) allows health, dental, and/or vision insurance premiums to be subtracted from the gross salary before computing taxes. This reduces the employee's amount paid in federal, state, and FICA (social security) taxes. This method of pre-tax payment generally increases the employee's take-home pay. If this method is used, the employee may not deduct health, dental, and vision premiums when filing federal and state income tax returns. Additionally, the employee may have a slight reduction at the time the employee qualifies for social security income benefits. When an employee enrolls in any insurance plan, the employee is enrolled automatically in PIPP. If the employee elects insurance coverage and does not want PIPP, a form must be completed declining the PIPP election. The PIPP election is valid through June 30 of each year and may only be changed during open enrollment or as the result of an Internal Revenue Service (IRS) defined "change in status."
Term life insurance is available to all eligible employees, their dependents, and retired employees under age sixty-five (65). The Basic Life insurance is available to employees and is 100% of the employee's base annual salary, with a minimum available coverage level of $25,000 and a maximum of $80,000. Supplemental coverage is available in increments of one (1), two (2), and three (3) times the employee's annual salary, up to a maximum increment of $100,000 per year of annual salary. The maximum total coverage available is $380,000. Employees may also purchase coverage for their spouse, domestic partner, and dependents.
At age sixty-five (65), retirees' basic life insurance coverage decreases to $4,000. If the retiree had additional/supplemental life insurance coverage, the retiree may elect to continue the coverage; however, the additional/supplemental coverage decreases to $2,000 for those that had an increment of one(1) and $6,000 for those that had an increment of two (2) or three.
Accidental death & dismemberment benefits are payable only when a death or dismemberment results from an accident. Coverage is available in increments, provided it is not more than ten (10) times the employee's actual salary. A separate policy can be purchased to obtain additional coverage for the employee and his or her dependents coverage.
Long term disability insurance is available to those eligible employees whose base annual salary is $10,000 or more. After six (6) continuous months of a covered disability, an employee may qualify for a disability income benefit. The benefit is equal to sixty percent (60%) of the base monthly UNM earnings to a maximum salary protection of $8,333 per month (such as the maximum benefit available is $5,000). If an employee is eligible for income from other group sources because of the disability, the benefit will be reduced by the amount of that income.
Long term care insurance covers some or all of the costs of custodial care of an individual who is no longer capable of caring for him/herself. Custodial care in a residential facility or private home is not covered by either health insurance or Medicare. Full-time employees must have worked at UNM longer than one (1) year to be eligible for this coverage.
Eligible employees are automatically enrolled in the program with guaranteed coverage. Effective July 1, 1999, the University pays for $1,000 per month benefit. Starting July 1, 2000, the University will pay for $2,000 per month benefit and employees may purchase additional long term care coverage up to $4,000 per month benefit.
An employee, full-time or part-time, can purchase coverage for themselves, a spouse, domestic partner, parents (in-laws), and grandparents (in-laws). The coverage is subject to underwriting and does not have a guaranteed issue.
