Administrative Policies and Procedures Manual - Policy 3600: Employee Benefit Plans

Date Originally Issued: 03-01-1987
Revised: 11-01-1991, 12-13-1991, 12-08-1999, 07-01-2001, 01-12-2005, 07-01-2007, 01-01-2008, 07-01-2011
Subject to Change Without Notice

Authorized by Regents' Policy 6.3 "Privileges and Benefits"
Process Owner: Vice President of Human Resources

Note:  The insurance plans in Section 4 of the previous version of the policy are being continued, the specific insurance plan information has been moved to the HR website.

1. General

The University provides a diversified package of Employee Benefit plans.  This policy describes general policies for participation in these plans.  For a more complete explanation of the Employee Benefit plans offered and enrollment procedures visit the University Division of Human Resources (HR) website.  

2. Eligibility

The following individuals are eligible to participate in any of the employee benefit plans offered by the University:

2.1. Eligible Employees

The following employees are eligible:

• Staff employees who are full-time or part-time regular employees scheduled to work twenty (20) hours or more per week (.50 FTE or greater).
• Term or contract staff employees who are full-time or part-time scheduled to work fifty percent (50%) or more per week. (.50 FTE or greater) and must have a minimum three (3) month initial term appointment or contract.
• 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 medical, dental, life, and vision insurance only.

Insurance benefits are not available to:

• part-time employees scheduled to work less than twenty (20) hours per week (less than .50 FTE);
• temporary employees; or
• 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 surviving spouse;
• a domestic partner (must provide UNM affidavit, see "Domestic Partners" Policy 3790, UBP);
• dependent children to age twenty-six (26) dependent children including natural, stepchildren, legally adopted children, children placed for adoption, and children who are under Legal Guardianship of the employee; or
• mentally or physically disabled dependent children over age twenty-six (26) if enrolled prior to turning twenty-six (26), provided extension of coverage is applied for within thirty-one (31) calendar days of the child's twenty-sixth birthday.  The University may require periodic recertification of disability.

2.2.1. Documentation

Documentation supporting dependent status such as a valid marriage certificate, birth certificate, or Affidavit of Domestic Partnership must be provided at the time of enrollment.

2.3. Retirees

Eligible faculty and staff employees retiring from the University may continue their group medical/dental plans and/or UNM group life insurance into retirement. To be eligible they must meet the following criteria:

• Must meet the criteria for either the State of New Mexico Educational Retirement Act (ERA) or the Alternative Retirement Plan (ARP); employees who qualify for disability retirement under the ERB’s rules qualify for the UNM retiree medical plan on the effective date of their disability retirement.
• Must be on UNM's payroll the month prior to retirement and actively enrolled in the UNM medical/dental and/or UNM group life insurance plan. 

In addition, employees hired on or after July 1, 2011:

• must have completed twenty (20) years of service with UNM immediately prior to retirement and be sixty (60) years of age, or completed seven (7) years of service with UNM immediately prior to retirement and be sixty-five (65) years of age; and .
• must have been enrolled in the UNM medical, dental, and/or life insurance plan for five (5) consecutive years immediately preceding retirement. 

In addition, employees hired prior to July 1, 2011:

• must have completed a minimum of five (5) consecutive years of service with UNM immediately prior to retirement; participants in the ARP must be fifty-nine and half (59 ½) (unless the employee is totally disabled and unable to continue employment) and must have applied for and continue the required systematic monthly withdrawal from the ARP vendor with which they are participating;
• must have been covered by a local group medical/dental insurance policy for at least four (4) of the last five (5) years, and be currently enrolled in one of the available UNM medical/dental and/or life insurance plans for the last twelve (12) months of employment, prior to retirement; and
• Employees retiring after July 1, 2016 must have been enrolled in the UNM medical, dental, and/or life insurance for five (5) consecutive years immediately preceding retirement.

2.3.1. Coverage

Employees who retire and are eligible to participate in UNM’s retiree medical plan must enroll within 60 days from their retirement date and maintain continuous coverage thereafter.  If coverage is not elected at retirement, or if elected and later canceled, the retiree may not enroll in coverage at a later date.  Retirees under age sixty-five (65) retain the same coverage as active employees.

When retirees reach age sixty-five (65), some coverage may change. Retirees and/or their dependents must elect a Medicare Senior Plan within sixty (60) calendar days from the date he or she reaches sixty-five (65) in order to remain covered under UNM medical benefits.  Failure to elect a Medicare Senior Plan will result in cancelation of UNM sponsored medical coverage.  If at the age of sixty-five (65), a retiree elects a Medicare Senior Plan offered through UNM, but not a Medicare Part D Prescription Drug Plan offered through UNM, the retiree cannot elect the Medicare Part D Prescription Drug Plan offered through UNM at a later date.  If a retiree begins collection of ERB retirement, and later rescinds his/her ERB retirement, the retiree will lose UNM retiree benefit privileges.  The retiree will not be eligible to enroll in any UNM Employee Benefit plan at the time of rescission or at any future date unless the retiree returns to active, Benefits Eligible service with UNM.

2.3.2. Non-insurance Benefits

Retirees who meet the criteria of Section 2.3. herein, are eligible for Education Benefits subject to the provisions of University Policy 3700 and other non-insurance related benefits. Retirees may participate in non-insurance related benefits without participating in insurance related benefits. 

2.3.3 Layoff

Employees who are laid off during their career and reemployed while eligible for Reemployment Rights based on the provisions of University Policy 3225 will retain time for service and coverage that was accrued prior to Layoff to meet the requirements under the provisions of Section 2.3., herein.  Employees will not accrue service and coverage to meet the provisions of Section 2.3., herein, while eligible for Reemployment Rights due to Layoff status.

2.3.3.1.  Employees Eligible to Retire

Employees who are eligible to retire and are laid off will be considered to have met the provisions of Section 2.3., herein, while the employee remains eligible for Reemployment Rights based on the provisions of University Policy 3225, provided the employee would have otherwise met the provisions of Section 2.3, herein. 

2.4.  Premiums

Insurance premiums are due and payable each pay period. Active employees are automatically deducted the employee portion of the premium from their pay.  Retirees are billed for the retiree portion of premiums on a monthly basis. Failure to pay the monthly premium may result in cancellation of insurance coverage.  Retirees whose coverage is canceled due to non-payment of premiums will not be eligible for reinstatement of coverage.

2.4.1. University/Active Employee Contribution Split

Premium costs are shared by the employee and the University for certain Employee Benefit plans.   The University contributes a percentage of the premium based on the employee’s annualized salary and FTE. 

2.4.2 University/Retiree Contribution Split

Premium costs are shared by the retiree and the University for certain Employee Benefit plans The University contributes a percentage of the premium based on an under age sixty-five (65) retiree’s annualized salary.  The University contributes a fixed percentage of the premium for over age sixty-five (65) retirees.

3. Enrollment

3.1.  Initial Eligibility Period

To obtain coverage, an eligible employee must enroll in an insurance plan within sixty (60) calendar days from the date of hire or eligibility. If an employee does not enroll within sixty (60) calendar days of the date of eligibility, the employee must wait until the next open enrollment period as described in Section 3.2. herein, unless the employee experiences a Qualifying Change of Family Status.  In these cases the employee may make the changes described in Sections 3.3 herein.  Late enrollments will not be accepted.

3.2. Open Enrollment

Periodically, open enrollment will be scheduled to allow employees to select or change Employee Benefit plans.  The Division of Human Resources facilitates open enrollment and notifies employees in advance.

3.3.  Qualifying Change of Family Status and HIPAA Special Enrollment Events

Certain events such as such as marriage, birth of a child, change in spouse’s employment, or divorce may allow an employee to make a change in benefits outside of an open enrollment period. Changes in benefit elections must be consistent with the Qualifying Change in Status Event,  and made within thirty-one (31) calendar days from the date of the Qualifying Change of Status event.  Supporting documentation must accompany the benefit enrollment form when provided to HR.

3.4. Coverage While on Leave of Absence Without Pay

An employee on approved leave of absence without pay (LWOP) may continue insurance coverage by paying the employee's portion of the monthly premiums. Employees on approved LWOP will automatically be billed by the Bursar's Office for premiums while on LWOP.  If the employee wishes to cancel insurance benefits while on LWOP, the employee must notify the Employee Benefits Office in writing within thirty-one (31) calendar days from the date LWOP begins.  Coverage will terminate at the end of the month that the cancelation form is received and date stamped by HR.

If an employee cancels insurance while on LWOP, he or she must re-enroll within thirty-one (31) calendar days after returning from LWOP or at the next available open enrollment, subject to the provisions of each Benefit Plan.  If the employee does not elect to re-enroll within thirty-one (31) calendar after returning to pay status and waits until the next open enrollment period, the employee will not have coverage until elections made during Open Enrollment become effective.

3.5. Coverage Terminates

3.5.1. Separation or Employee Eligibility Ceases

Coverage will terminate for the employee and dependents as of midnight on the last day of the month in which the separation date occurs or an employee’s eligibility ceases.  The employee will be responsible for the full month's premium through payroll deduction.  If the employee's paycheck is not enough to cover the full premium, the employee will be billed for the difference.  Employees who separate employment or whose eligibility ceases may be able to continue coverage through COBRA provisions (see Section 3.5.3. herein).

3.5.2. Dependent Eligibility Ceases

Employees must notify HR when a dependent loses eligibility for coverage.  When a dependent is no longer eligible for coverage as described in Section 2.2. herein coverage will terminate as of midnight on the last day of the month eligibility ceases.  Dependents whose eligibility ceases may be able to continue coverage through COBRA continuation provisions (see Section 3.5.3. herein).

3.5.3. Consolidated Omnibus Budget Reconciliation Act (COBRA)

Some plans may be continued in accordance with the federal guidelines of the Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation provisions. If a COBRA a qualifying event occurs, an employee covered under the University's group medical, dental, vision plan and/ or FSA plan may elect to continue coverage for a specified duration based on COBRA continuation provisions.

3.5.4. Policy Conversion

Most plans may be converted to an individual policy in accordance with the guidelines of each contract.

4. Related Information

The Division of  Human Resources website has additional information, enrollment forms, and details about the benefit plans offered by the University.