Group Insurance Eligibility Factsheet
University of California
Group Insurance Eligibility
Factsheet
for Employees and Eligible Family
Members
This booklet describes UC’s general rules about:
The information in this booklet is subject to change.
• employee eligibility for health and welfare benefits
This factsheet describes eligibility only. See the
• family member eligibility for UC-sponsored group
chart on page 3 for an overview of the plans that
insurance plans: medical, dental, vision, acciden-
apply to your benefits package.
tal death and dismemberment (AD&D), Basic and
Core life, dependent life, and legal.
Table of Contents
Before You Enroll ..................................................2
Enrollment ............................................................7
After You Have Enrolled .......................................2
– When to Enroll ..................................................7
Employee Eligibility .............................................3
– Other Enrollment Options ................................7
– Initial Requirements ...........................................3
– Medical Coverage Only ......................................8
– Health and Welfare Benefits Packages—Chart ....3
– Misuse of Plan ....................................................8
– Continuing Requirements ..................................3
– Loss of Eligibility ................................................8
Eligible Family Members ......................................4
– Verification of Family Member Eligibility ...........8
– Eligible Adult .....................................................4
Questions and Answers ........................................9
– Eligible Child .....................................................5
For More Information .........................................12
– No Duplicate UC Coverage ................................6
– Exclusion for Pre-Existing Conditions ................6
– Ineligible Family Members .................................6
Before You Enroll
Understand Your Benefits Options
Enrollment Deadlines
This factsheet describes eligibility only. Additional
Be sure to complete your enrollment or benefit
resources are available to help with health and welfare
change transactions by the specified deadline. If you
plan decisions. Your Group Insurance Plans provides
do not enroll, you will be automatically enrolled in
UC-sponsored plan information including plan
default coverage, based upon your benefits package.
options and coverage. Please refer to the Benefits for
See the “Period of Initial Eligibility” section on page 7
Domestic Partners booklet, if applicable to you.
for more details.
For more information on publications mentioned in
this factsheet, see page 12.
No Duplicate Coverage
The At Your Service website (atyourservice.ucop.edu;
UC rules do not allow duplicate coverage in UC-
see the “Health and Welfare” section) has detailed
sponsored plans. See “No Duplicate UC Coverage” on
information about UC-sponsored plans including UC
page 6 for more details.
plan summaries, links to plan websites, carrier tele-
phone numbers, plan costs and more information.
After You Have Enrolled
Confirm Your Choices
having a child) may affect your UC benefits. See “Life
Events (Benefits Checklists)” on page 12.
Confirm your enrollment on the At Your Service
website and review your pay statement to verify that
It is your responsibility to de-enroll any family
it reflects your benefit choices. Immediately notify
member who loses eligibility (see “Loss of Eligibil-
your Benefits or Payroll Office of any errors in your
ity” on page 8). UC and the plan reserve the right to
enrollment.
collect repayment for any employer contributions and
expenses incurred on behalf of the ineligible family
Keep Your Records Updated
member.
Make sure that UC always has your current address
Continuation
and phone number to correctly administer your
benefits and send you benefits information.
If you separate from UC employment, generally, your
UC-sponsored benefits will stop. If you retire from UC,
Use At Your Service Online (atyourservice.ucop.edu;
see the Group Insurance Eligibility Factsheet for Retirees
select “Sign in to My Accounts”) to update your per-
and Eligible Family Members (available on the At Your
sonal information, such as your home address, home
Service website) for more details.
telephone number, and income tax withholding.
Consolidated Omnibus Reconciliation Act of 1985
Please note: LBL employees cannot use At Your
(COBRA): If you or a family member lose eligibility
Service to update records.
for UC-sponsored medical, dental, vision coverage,
Moving Out of a Service Area
and/or Health Flexible Spending Account (HealthFSA),
you may be eligible to continue coverage under
If you move out of or return to an HMO, Anthem
COBRA. See “Loss of Eligibility” on page 8.
Blue Cross PLUS, or DeltaCare® USA service area,
Conversion Privileges: Within 31 days after UC spon-
see “Moving Out of a Service Area” on page 7.
sored coverage ends (if your participation has been
Life Changes
continuous), you may be able to convert your group
insurance coverage to individual policies. See “Loss of
Events in your personal life (such as getting married,
Eligibility” on page 8.
establishing a domestic partnership, getting divorced or
legally separated, terminating a domestic partnership or
2
Employee Eligibility
Most employees eligible for benefits are covered
Health and Welfare Benefits Packages
under one of three benefits packages—Full,
Mid-level, or Core.
Full Mid-level Core
Initial Requirements
Medical
•
•
or
or
Full Benefits
Medical—Core
•
•
•
You are eligible to enroll in Full Benefits if you are in
Dental
•
an eligible position and:
Vision
•
Short-Term Disability
•
• You are a member of a UC-sponsored retirement
Supplemental Disability
•
plan, which means UCRP or another defined benefit
Worker’s Compensation
•
•
•
plan to which UC contributes, such as the California
Basic Life
•
Public Employees’ Retirement System (CalPERS).
Core Life
•
•
Supplemental Life
•
•
There are two ways to qualify for UCRP membership:
Basic Dependent Life
•
•
1) You are appointed to work in an eligible position
Expanded Dependent Life
•
•
at least 50 percent time for a year or more1—or
AD&D
•
•
•
2) You have worked 1,000 hours in a 12-month
Business Travel Accident
•
•
•
period in an eligible position.
Legal
•
•
•
Automobile and Homeowner/
Members of the Non-Senate Instructional Unit qual-
Renter
•
•
ify for UCRP membership after working 750 hours
Health FSA
•
•
•
in an eligible position within a 12-month period.
DepCare FSA
•
•
•
TIP
•
•
•
Mid-level Benefits
You are eligible for Mid-level Benefits if:
Continuing Requirements
• You are not a member of a UC-sponsored retirement UC bases your ongoing eligibility for benefits on the
plan, which means UCRP or another defined benefit
number of regular hours you are paid by UC to work
plan to which UC contributes, such as the California each week. (Paid time excludes bonuses and overtime.)
Public Employees’ Retirement System (CalPERS),
and
To remain eligible for your benefit level, you must
maintain an average regular paid time of at least 17.5
• You are appointed to work at least 50 percent time
hours per week and remain in an eligible appointment.
for a year or more,1 or
If your average regular paid time drops below
• You are appointed to work 100 percent time for at
17.5 hours a week, you become ineligible for
least three months.
medical (including Core), dental and vision coverage
Core Benefits
as well as Basic and Core Life insurance, and Short-
You are eligible for Core Benefits if you are appointed
term Disability and Supplemental Disability cover-
to work at least 43.75 percent time in an eligible
age. You may still be eligible for Supplemental Life,
position.
AD&D, Health Flexible Spending Account, Depen-
dent Flexible Spending Account, legal, and Auto and
Homeowner/Renter coverage, as long as your earnings
cover the required premiums.
1 Or your appointment ending date is for funding purposes only
or for visa purposes only and your employment is intended to
continue for more than a year.
3
Eligible Family Members
Family members eligible for coverage under your
• a legal spouse, or
health and welfare benefits package (see page 3)
• a domestic partner who meets the requirements
may include one eligible adult and/or any eligible
noted in the chart below, or
children.
• an adult dependent relative (if enrolled by
Eligible Adult
12/31/03).
In addition to yourself, you may have only one
If you cover an adult dependent relative on your
eligible adult family member enrolled in your
medical, dental and vision plans, you may not enroll
UC-sponsored plans:
your spouse in any UC-sponsored insurance plan.
Reminder: Your family member(s) are only eligible for the plan(s) for which you are eligible
and in which you have enrolled (see “Health and Welfare Benefits Packages” on page 3).
gal
Eligible Adult
Medical
Dental
Vision
Le
AD&D
Dependent Life
Family Member
Eligibility
Must be
Legal spouse
Eligible
Legally married
• • • • • •
(same-sex/opposite-
sex)1, 2
Domestic partner Age 18 or older
• if opposite sex, either the employee or the domestic partner must be • • • • • •
(same-sex/opposite
age 62 or older and eligible to receive Social Security benefits based
sex)1
on age
• a domestic partnership registered with the State of California or
a substantially equivalent partnership established in another
jurisdiction (same-sex domestic partnership only) is a domestic
partnership for UC HR purposes. A domestic partnership that has
not been registered with the State of California must meet the following
criteria to be a domestic partnership for UC HR purposes:
– parties must be each other’s sole domestic partner in a long-term,
committed relationship and must intend to remain so indefinitely
– neither party may be legally married or be a partner in another
domestic partnership
– parties must not be related to each other by blood to a degree that
would prohibit legal marriage in the State of California
– both parties must be at least 18 years old and capable of consenting
to the relationship
– both parties must be financially interdependent
– parties must share a common residence
1 The surviving family members who are eligible for continuation of health and welfare benefits cannot enroll a spouse or domestic partner (or their
children/grandchildren).
2 A legally separated spouse is not eligible for UC-sponsored coverage.
4
Eligible Child
for other family members who must be claimed as
your tax dependent.
You may enroll eligible children shown in the chart
below.
Custody Arrangements
Note that your disabled child aged 23 or older is still
If you have a custody arrangement where you and the
considered to be your eligible child and not an adult.
other parent are responsible for 50 percent of a child’s
You may enroll your domestic partner’s child or
(stepchild or domestic partner’s child) support, only
grandchild even if you do not enroll your partner;
those children listed as tax dependents on the tax
however, your partner must be eligible for
return for you or your current spouse/domestic part-
UC-sponsored coverage and you must provide the
ner can be covered under UC-sponsored health plans.
appropriate documents to UC, if requested.
For example, if you and the other parent share in the
support of your stepson and stepdaughter and the
Tax Dependency
custody agreement states you may claim your stepson
In order to be eligible for UC-sponsored coverage,
and the other parent may claim your stepdaughter,
your stepchild, grandchild or step-grandchild
only your stepson can be covered by UC-sponsored
must be claimed as a tax dependent by you or
health plans. Even though you are responsible for a
your spouse. Your domestic partner’s child or
portion of the support for both children, only your
grandchild must be claimed as a tax dependent by
stepson may be covered under UC-sponsored plans.
you or your domestic partner. See the chart below
Reminder: Your family member(s) are only eligible for the plan(s) for which you are eligible
and in which you have enrolled (see “Health and Welfare Benefits Packages” on page 3).
Eligible Child
gal
Medical
Dental
Vision
Le
AD&D
Dependent Life
Family Member
Eligibility Must be
Natural or adopted To age 23 • unmarried
• • • • • •
child
Stepchild
To age 23 • unmarried
• • • • • •
• living with you
• supported by you or your spouse (50%+)
• claimed as a tax dependent by you or your spouse
Grandchild or
To age 23 • unmarried
• • • • • •
step-grandchild
• living with you
• supported by you or your spouse (50%+)
• claimed as a tax dependent by you or your spouse
Domestic partner’s To age 23 • unmarried
• • • • • •
child or
• living with you
grandchild1
• supported by you or your domestic partner (50%+)
• claimed as a tax dependent by you or your domestic partner
Legal ward
To age 18 • unmarried
• • • • • •
enrolled 1/1/95 or
• living with you
after
• supported by you (50%+)
• claimed as your tax dependent
Overage disabled
Age 23 or • unmarried
• • • • • •
child (except a
older
• living with you if not your natural or adopted child
legal ward) of
• enrolled in a group medical plan before age 23 with continuous coverage and
employee
the incapacity must have begun before age 23
• supported by you (50%+) and claimed as your dependent for income tax
purposes or eligible for Social Security income or Supplemental Security
Income as a disabled person. The overage disabled child may be working in
supported employment which may offset the Social Security or Supplemental
Security Income
• incapable of self-support due to a mental or physical disability incurred prior
to age 23
• must be approved before age 23 or by the carrier during the PIE for newly
eligible employees
1 Domestic partner must be eligible for UC-sponsored health coverage.
5
No Duplicate UC Coverage
Ineligible Family Members
UC rules do not allow duplicate coverage. This means
Certain family members are not eligible to participate
you may not be covered in UC-sponsored plans as
in UC-sponsored plans. Family members ineligible
an employee and as an eligible family member of a
for UC-sponsored plan coverage include but are not
UC employee or retiree at the same time. If you are
limited to: siblings, in-laws, cousins, nieces and neph-
covered as an eligible family member and then become
ews, legally separated spouses, former spouses, foster
eligible for UC coverage yourself, you have two
children, married children, great grandchildren and
options. You can either opt out of the automatic
your children’s and grandchildren’s spouses.
employee coverage and remain covered as another
Whenever a family member loses eligibility to
employee’s dependent or make sure the UC employee
participate in UC-sponsored plans, it is your respon-
or retiree who has been covering you de-enrolls you
sibility to de-enroll that family member by submitting
from his or her UC-sponsored plan before you enroll
an Enrollment, Change, Cancellation, or Opt Out—
yourself.
Employees Only Health and Welfare Plans form (UPAY
Family members of UC employees may not be
850). If you do not, you are liable for any excess UC
covered by more than one UC employee’s plan
costs and for any plan expenses incurred by the ineli-
coverage. For example, if a husband and wife both
gible family member.
work for UC, their children cannot be covered by
Making false statements about your family member(s)
both family members.
satisfying eligibility criteria, failing to notify the
If duplicate enrollment occurs, UC will cancel the
University of loss of eligibility within 31 days, or
later enrollment. UC and the plans reserve the right
failing to provide documentation when requested is
to collect reimbursement for any duplicate premium
considered misuse of the plan (see page 8).
payments and for any plan benefits provided due to
Former Spouse/Domestic Partner
the duplicate enrollment.
UC health and welfare eligibility rules do not allow
Exclusion for Pre-existing Conditions
for coverage of an ex-spouse/domestic partner. See
question 9 on page 10 for more details.
When you enroll in any UC-sponsored medical,
dental, or vision plan, you will not be excluded from
Adult Dependent Relative
enrollment based on your health, nor will your
Adult dependent relatives who are eligible for Medi-
premium or level of benefits be based on any pre-ex-
care are not eligible for coverage in UC-sponsored
isting health conditions. In fact, you will not be asked
health plans. Adult dependent relatives reaching age
for a statement of health. The same applies to your
65 will be automatically de-enrolled unless you
eligible family members.
submit a Medicare Declaration form (UBEN 126) and
However, enrolling in or increasing coverage for
documentation that proves they are ineligible for
Supplemental and Dependent Life insurance and
Medicare Part A.
Supplemental Disability insurance outside of a pe-
To notify UC that your adult dependent relative is
riod of initial eligibility (PIE) does require a statement
not eligible for Medicare, contact your local Benefits
of health. Pre-existing conditions may also limit the
Office before they turn age 65.
amount of benefits you can receive under Supplemental
Disability during your first year of coverage.
6
Enrollment
When to Enroll
Moving Out of a Service Area
Period of Initial Eligibility (PIE)
If you move out of an HMO, Anthem Blue Cross
PLUS, or DeltaCare® USA service area, you and/
A PIE is a time during which you or your eligible
or your eligible family members must transfer into a
family members may enroll in UC-sponsored health
medical plan and/or dental plan in your new location.
plans. A PIE starts on the first day of eligibility—for
If you return to the HMO, Anthem Blue Cross PLUS,
example, the day you are hired into a position that
or DeltaCare® USA service area, you may transfer
makes you eligible for medical coverage. For online
back. If you are returning from another HMO, you
enrollments, it ends 31 days later. For paper enroll-
may select any plan for which you are eligible.
ments, it ends 31 days later or on the last working
day of that 31-day period, whichever comes first.
Declined Enrollment
UC defines a working day as a normal business day—
You may decline (opt out of) enrollment in UC health
Monday through Friday, excluding holidays.
plans for yourself and/or your eligible family mem-
You may enroll your eligible family members during
bers because you have other medical insurance cover-
the 31-day PIE that begins on the first day the family
age or because of religious beliefs.
member meets all eligibility requirements. If your
If you decline due to having other health coverage
enrollment is completed during your PIE, coverage is
and you subsequently lose that coverage involuntarily,
effective the date the PIE began.
you may enroll yourself and/or your eligible family
If you are eligible for the Full Benefits package and
members in a UC-sponsored health plan.You must
don’t enroll, UC will automatically enroll you for
request the enrollment within 31 days after the other
self-only coverage in the Core medical plan, the Delta
coverage ends. Contact your local Benefits Office for
Dental plan, and the Vision Service plan.
more information.
If you are eligible for the Mid-level Benefits package
New Faculty Member
or the Core Benefits package but don’t enroll, UC will
If you are a newly appointed faculty member and
automatically enroll you for self-only coverage in the
don’t enroll when first eligible, a second PIE starts
Core medical plan.
on the first day of classes for the semester or quarter
Other Periods of Initial Eligibility
in which your appointment starts or the first day of
arrival to the campus, whichever occurs first.
If you are not enrolled in a UC-sponsored health and
welfare plan, and you have a newly eligible family
Other Enrollment Options
member, you may enroll yourself and your eligible
family member(s) when your family member becomes To be sure you get the coverage you want, sign up
eligible.
during your PIE. If you miss your PIE, however, you
may enroll in selected UC-sponsored plans as follows:
New Family Member
Open Enrollment
A newly eligible family member’s PIE starts the day
he or she becomes eligible (for example, the day you
Open Enrollment (usually held in the fall) is your
marry or your child is born). Enrollment is not
annual opportunity to transfer to a different medical
automatic; you must enroll the new family member.
or dental plan, add eligible family members, enroll in
or opt out of UC-sponsored medical, dental, vision
Adopted Child
plans, and/or opt in or out of TIP, and enroll or
The PIE for an adopted child begins on the earlier of
re-enroll in DepCare FSA and Health FSA. Changes
the date the child is placed in your physical custody
made during Open Enrollment are effective January 1
or the date you, your spouse, or domestic partner has
of the following year. If you have opted out of UC-
the legal right to control the child’s health care. If you
sponsored coverage, you may enroll yourself and your
do not enroll your child during this PIE, a second PIE
family members in a UC-sponsored medical, dental
begins with the date the adoption is final. Coverage
and/or vision plan during Open Enrollment.
begins on the first day of the PIE in which you enroll
The legal plan is open to newly eligible employees or
the child.
during Open Enrollment only periods which specify
7
the plan is open.
continue coverage for 12 months by paying the
applicable premium directly to the carrier. Ineligible
Statement of Health
family members are not eligible for continuation
You may enroll in Supplemental and Dependent Life
coverage. See page 6.
insurance by submitting a statement of health to
the insurance company for approval. A statement of
Loss of Eligibility
health is also required to enroll in Supplemental Dis-
An enrolled family member’s coverage stops at the end
ability insurance or to reduce your waiting period.
of the month in which he or she no longer meets all of
The insurance company may or may not accept your
the eligibility requirements (see the charts on pages 4
enrollment based on the statement of health.
and 5).
You are responsible for canceling coverage for
Medical Coverage Only
family members who become ineligible. UC and the
If you get married, establish a domestic partnership,
plans reserve the right to collect repayment for any
or have a new child (through birth or adoption), you
expenses incurred due to the ineligible enrollment,
will have a new 31-day period of initial eligibility in
including the employer contribution.
which to enroll your new family member. During this
In certain situations, you and your family members
PIE you may also change your medical plan. You may
who lose eligibility may be able to continue group
also have an opportunity to enroll in a medical plan if
medical, dental, vision and/or Health FSA cover-
you opted out of UC coverage due to other coverage
age under COBRA (Consolidated Omnibus Budget
and employer contributions toward the other cover-
Reconciliation Act of 1985, as amended). See the At
age terminated, or if you or an eligible family member
Your Service website for additional information. The
reach your plan’s lifetime limit on all benefits.
legal plan may be converted to an individual policy.
90-Day Waiting Period
Contact your Benefits Office for details.
If you miss your PIE, you may enroll yourself or
eligible family members in medical coverage at any
Verification of Family Member Eligibility
time with a 90 consecutive calendar day waiting
UC and the insurance carriers reserve the right to
period that begins the day the completed enrollment
request documentation (marriage or birth certifi-
form is received by your local Benefits or Accounting
cates, verification of domestic partnerships, adop-
Office. Coverage is effective after the 90 days have
tion records, tax records, etc.) to verify eligibility for
elapsed. Your premiums may need to be paid on an
your enrolled family members. On an annual basis,
after-tax basis.
UC conducts a review of family members enrolled in
UC-sponsored health and welfare plans. Failing to
Misuse of Plan
provide documentation when requested will lead to
The University reserves the right to de-enroll employ-
de-enrollment of you and your family members for
ees and family members who misuse the plan. Misuse
12 months and possible legal action (see “Misuse of
of the plan includes enrolling individuals who are
Plan” at left). In addition, employees will be subject
ineligible.
to disciplinary action and will be responsible for any
employer contributions to and benefits paid by the
Employees who misuse the plan will be subject to
plan for the ineligible coverage. For additional infor-
disciplinary action and will be responsible for any
mation, see “Verification of Family Member” in Your
employer contributions to and benefits paid by the
Group Insurance Plans.
plan for the ineligible coverage.
Note: Please do not submit any documentation unless
In accordance with UC Group Insurance Regulations,
UC HR or your carrier asks you to do so.
ineligible enrolled family members who are identified
via the annual Random Audit of Family Member
Eligibility or through location audit efforts will be
permanently de-enrolled. The employee and eligible
family members will be de-enrolled for 12 months.
Subject to carrier approval, the employee and eligible
family members who are de-enrolled may be able to
8
Questions and Answers
Eligibility for a Spouse/Domestic Partner sored medical plan and also is covered as a dependent
under another plan, the UC-sponsored coverage pays
1. I am getting married. Can I add my new spouse to first for the employee. If the UC employee’s spouse
also has dual medical coverage, the non-UC plan
my UC-sponsored plans?
would be his/her primary coverage. The rules may be
Yes. Your spouse becomes eligible for coverage in your
different if you are covered under another plan as an
UC-sponsored plans on the date you marry if you
active employee and a retiree. Check your plan’s
enroll within 31 days. During the 31-day period of
booklet for details.
initial eligibility, you may choose a different medical
plan, if necessary.
5. My spouse is covered under my UC medical plan. We
If your new spouse also works for UC and is enrolled
are receiving Social Security benefits and were recently
in UC coverage, he/she cannot be added to your
notified that we are eligible for Medicare. Even though
plans unless the current coverage is cancelled. Since
duplicate coverage is not allowed, he/she must
I’m stil working, are we stil eligible for UC-sponsored
choose whether to enroll as your family member or
medical coverage? Should we enrol in Medicare?
remain enrolled independently.
Yes. Your coverage through UC will continue under
the basic (non-Medicare) medical plan, and you will
2. My spouse and I do not live together. Is he still an automatically be enrolled in Medicare Part A. As long
eligible family member?
as you continue to work at UC, UC-sponsored medical
Yes. As your spouse, he is eligible. Please note that
coverage will be primary and Medicare Part A coverage
you and your spouse must be enrolled in the same
will be secondary. The same applies to your spouse as
plan. Be sure to verify your plan service area. If you
long as he/she remains covered on your plan.
become legally separated, divorce, or if the marriage
Once you retire from UC, you should contact Medi-
is annulled, he will no longer be eligible and you
care to sign up for Medicare Part B. You will also need
must de-enroll him from your UC-sponsored plans.
to complete UC’s Medicare Declaration form (UBEN
Eligibility stops at the end of the month in which the
126) and provide a copy of your Medicare card. (See
divorce/legal separation/annulment is final.
page 12 for a list of Medicare related publications.)
If you retire and do not enroll in Medicare Part B,
3. I am a UC employee with self-only UC-sponsored
you and any enrolled family members will be per-
health coverage. My spouse has lost his job and is
manently de-enrolled from UC-sponsored medical
losing his group benefit coverage. Can I enroll him in coverage. The UC Customer Service Center can help
when you retire.
my UC-sponsored plans?
Yes. If your eligible family member loses individual or
6. My same-sex partner and I were recently married,
group coverage involuntarily, you may add him/her to
do I need to make any changes to my benefits?
your UC-sponsored plans within 31 days of the loss
If your spouse is not currently covered, you have
of coverage and you may also choose a different
31-days from the date of the marriage to enroll your
medical plan. If you miss the PIE, you may add your
spouse. Complete the Enrollment, Change or Cancellation
spouse to your medical plan only after a 90-day
form (UPAY 850). If your spouse is currently enrolled
waiting period. (See “When to Enroll” on page 7 for
under your UC-sponsored coverage, you do not need to
additional information.) Proof of involuntary loss of
make any enrollment changes, but you may want to let
the individual or group coverage will be required.
your Benefits Office know about your change in status.
Additionally, you may add him/her to your plan
during any Open Enrollment.
Eligibility for a Domestic Partner
4. If my spouse and I are covered by my UC medical
7. My same-sex domestic partner and I are currently
plan and my spouse also has both of us covered under not registered as domestic partners with the State
her non-UC plan at work, which coverage pays first?
of California Domestic Partners Registry, nor are we
When a UC employee is covered under a UC-spon-
9
married. Can I still add my domestic partner to my
If a legal decree requires you to maintain health cover-
UC-sponsored plans?
age for your former spouse/domestic partner or any
other ineligible family member, you must make private
Yes. To add your domestic partner when he or she
arrangements for such coverage. You may not keep
becomes eligible, you must submit an Enrollment,
your former spouse/domestic partner or any other
Change, Cancellation, or Opt Out—Employees Only
ineligible family members on your UC plans. However,
Health and Welfare Plans form (UPAY 850). This form
your former spouse/domestic partner and any other
is available from the At Your Service website under
ineligible family members may be able to continue
“Forms & Publications.” You may also request a copy
medical, dental, or vision coverage through COBRA.
of the form from your local Benefits Office.
(Note: COBRA does not apply to those who have
8. May I add my domestic partner to my
never met UC’s eligibility requirements.) For informa-
tion about COBRA continuation privileges, see the At
UC-sponsored plans?
Your Service website or contact your Benefits Office.
Yes. You may add your domestic partner during your
31-day PIE when your domestic partner meets the
Eligibility for an Adult Dependent
UC eligibility requirements.
Relative
9. Does having my domestic partner enrolled in my
11. Can I cover my parent?
plan(s) affect my income tax?
No. You may not cover your parent as an adult
Under current Internal Revenue provisions, the value
dependent relative unless your parent was covered
of employer-paid medical coverage for anyone who
before January 1, 2004, and UC coverage has been
is not your tax dependent is considered imputed
continuous.
income and is subject to FICA (Social Security and
Medicare), federal income taxes, and any other
Eligibility for Child(ren)
required payroll tax.
12. My son lives with his mother in another town. Is
If you and your partner are registered with the State
of California and you have submitted UC’s form UPAY
he eligible for coverage under my UC-sponsored plans?
850 indicating you and your partner are registered
Your unmarried natural or adopted children may be
and the filing date, you will not have imputed income
eligible for coverage up to age 23 whether or not they
for California income tax purposes. Any out-of-
live with you and regardless of how much of their
pocket premium cost for medical coverage of your
support you provide. If he is not claimed as your tax
partner (and/or your partner’s child/grandchild) will
dependent, you are subject to imputed income. For
be deducted from your pay on a pretax basis for Cali-
information on imputed income, see the At Your Ser-
fornia income tax purposes. For federal tax purposes,
vice website. If you are enrolled in an HMO medical
you will have imputed income and the out-of-pocket
plan or the DeltaCare® USA dental plan, your enrolled
premium cost must be paid on an after-tax basis.
family members must live in the plan’s service area.
If you claim your partner and/or your partner’s child
Contact your plan directly to confirm your options.
or grandchild as your tax dependent, you should not
13. If my children are covered by my UC medical
have imputed income.
plan and my spouse also covers our children under
Eligibility for a Former Spouse/Former
her non-UC plan, which plan will pay first for medical
Domestic Partner
services for our children?
10. Can my former spouse/domestic partner continue Generally, under the “birthday rule” provision, the
plan of the parent whose birthday falls earlier in the
coverage on my UC-sponsored plans?
year pays first. If one plan does not have a birthday
No. A former spouse/domestic partner is not eligible.
rule, the provisions of that plan determine the order
Eligibility stops on the last day of the month in which
of benefits.
a divorce, legal separation, annulment, or termina-
tion of partnership is final. Be sure to de-enroll your
14. My child goes to school in another state and lives
former spouse/domestic partner from all plans in
there for nine months of the year. Does this make
which he/she is enrolled.
him ineligible for coverage on my plans?
10
If your child’s permanent residence is your address,
process can take two to three months. If the medical
living away at school will not make him ineligible.
plan carrier approves continued coverage, your child
However, if you are enrolled in an HMO medical plan
may also remain enrolled in UC-sponsored dental,
or the DeltaCare® USA dental plan, your enrolled
vision, legal, Dependent Life and AD&D coverage.
family members can receive services only from con-
Contact your medical plan for information and the
tracted providers, except in emergencies. Call your
proper form. Note that UC and your medical plan
plan for more information.
have the right to periodically request proof of
continued disability in order to continue UC-spon-
15. My husband and I claim his children (my stepchil-
sored group coverage.
dren) on our tax return and we pay for most of their
support. They live with us part of the year. Are they
Eligibility for Stepchild(ren)
eligible for coverage under my UC-sponsored plans?
19. I cover my stepson on my UC-sponsored plans.
To satisfy UC eligibility requirements, their perma-
Next year, my husband and I want to file separate
nent residence must be the same address as yours.
tax returns. Will my stepson still be eligible for
(UC eligibility requirements include, but are not the
same as, those of the IRS.)
UC-sponsored coverage?
Yes, as long as he meets all eligibility requirements.
Eligibility for a Legal Ward
UC eligibility requirements specify that a stepchild
must be claimed as a tax dependent either by you
16. Why does eligibility for a legal ward end at
or your spouse for the tax year corresponding to the
age 18 when it continues to age 23 for other
coverage.
children?
20. My stepdaughter lives with my wife and me. The
California law stipulates that legal guardianship ends
divorce settlement from my wife’s previous marriage
when a child reaches age 18. Consistent with the law,
group insurance for legal wards will stop at the end of
provides for the child’s father to claim my stepdaugh-
the month in which the child turns 18.
ter as a dependent for tax purposes. Can I cover her
on my UC-sponsored plans?
17. My legal ward will soon turn age 18 and will no
longer be eligible for coverage on my UC-sponsored
No. To qualify for coverage, your stepdaughter must
be claimed as your (or your wife’s) tax dependent.
plans. Is she eligible for health coverage under
COBRA?
Eligibility for Other Enrollees
Yes. COBRA allows enrolled family members to
21. I am the legal guardian for a child who does not
continue coverage for a limited time after they lose
eligibility for UC-sponsored group coverage. (Note:
live with me. Is this child eligible for coverage on my
COBRA does not apply to those who have never met
UC-sponsored plans?
UC’s eligibility requirements.) For information about
If the child was enrolled before January 1, 1995, and
continuing coverage under COBRA and/or converting
coverage has been continuous, living with you is not a
to an individual policy, refer to the At Your Service
requirement for a legal ward. If the child was enrolled
website or call your Benefits Office for more
on or after January 1, 1995, however, you cannot
information.
enroll him or her as a legal ward unless he or she is
living with you. See the chart on page 5 for details.
Eligibility for Disabled Child(ren)
22. My 15-year old niece lives with me off and on,
18. My child is 22 years old and disabled. How can I but I am not her legal guardian. She is not currently
continue to cover her on my UC-sponsored plans?
enrolled. Can I enroll her next year?
Assuming that all eligibility requirements are met (see
A niece is not an eligible child. To become your legal
the chart on page 5), you must obtain approval from
ward (and therefore eligible) you would need to be
your medical plan before your child’s 23rd birthday
appointed as your niece’s legal guardian by the court.
and notify your local Benefits Office. Be sure to call
as soon as possible prior to your child’s birthday; the
11
For More Information
The following publications are available online from
Medicare
At Your Service (atyourservice.ucop.edu) or from
• Medicare Factsheet
your Benefits Office.
• Medicare Declaration (UBEN 126)
Health and Welfare Benefits
• Medicare Universal Enrollment Request Form
• Your Group Insurance Plans
• Medicare Advantage Prescription Drug Plan
• Health Flexible Spending Account (Health FSA)
Disenrollment Form (UBEN 101)
Summary Plan Description
Life Events (Benefits Checklists)
• Dependent Care Flexible Spending Account (DepCare
• Family Changes
FSA) Summary Plan Description
• Family and Medical Leave
• Evidence of Coverage booklets
• Furlough
• Health FSA/DepCare FSA Enrollment, Change, or
Cancellation Salary Reduction Agreement (UPAY 919)
• Indefinite Layoff
• Disability Factsheet
• Leave Without Pay
• Disability Benefits Information for Faculty
• Military Leave
• Pregnancy and Newborn Child Factsheet for Employees
• Paid Leave
with Sick Leave
• Sabbatical Leave
• Tax Savings on Insurance Premiums (TIP) Summary
• Temporary Layoff
Plan Description
• Termination of Employment
• Group Insurance Eligibility Factsheet for Retirees and
UC Retirement
Eligible Family Members
• UCRP summary plan descriptions
• Benefits for Domestic Partners
• UC Retirement Handbook
• The UCRP Buyback Booklet
To find Benefits Office phone numbers, select
“Directories and Contacts” under “Quick Links” on
the UC HR website (atyourservice.ucop.edu).
By authority of the Regents, University of California Human Resources, located in Oakland, administers all benefit plans in accordance with applicable
plan documents and regulations, custodial agreements, University of California Group Insurance Regulations, group insurance contracts, and state and
federal laws. No person is authorized to provide benefits information not contained in these source documents, and information not contained in these
source documents cannot be relied upon as having been authorized by the Regents. Source documents are available for inspection upon request (1-800-
888-8267). What is written here does not constitute a guarantee of plan coverage or benefits—particular rules and eligibility requirements must be met
before benefits can be received. The University of California intends to continue the benefits described here indefinitely; however, the benefits of all
employees, retirees, and plan beneficiaries are subject to change or termination at the time of contract renewal or at any other time by the University or
other governing authorities. The University also reserves the right to determine new premiums, employer contributions and monthly costs at any time.
Health and welfare benefits are not accrued or vested benefit entitlements. UC’s contribution toward the monthly cost of the coverage is determined
by UC and may change or stop altogether, and may be affected by the state of California’s annual budget appropriation. If you belong to an exclusively
represented bargaining unit, some of your benefits may differ from the ones described here. Contact your Human Resources Office for more information.
The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) provides for continued coverage for a certain period of time at applicable
monthly COBRA rates if you, your spouse, or your dependents lose group medical, dental, or vision coverage because you terminate employment (for
reasons other than gross misconduct); your work hours are reduced below the eligible status for these benefits; you die, divorce, or are legally separated;
or a child ceases to be an eligible dependent. Note: The continuation period is calculated from the earliest of these qualifying events and runs concur-
rently with any other UC options for continued coverage. See your Benefits Representative for more information.
In conformance with applicable law and University policy, the University is an affirmative action/equal opportunity employer. Please send inquiries
regarding the University’s affirmative action and equal opportunity policies for staff to Director of Diversity and Employee Programs, University of
California Office of the President, 300 Lakeside Drive, Oakland, CA 94612 and for faculty to Director of Academic Affirmative Action, University of
California Office of the President, 1111 Franklin Street, Oakland, CA 94607.
Website address: atyourservice.ucop.edu
University of California
Human Resources
P.O. Box 24570
Oakland, CA 94623-1570
2005-E W10/09
