Eligibility Requirements, BELIs and Examples · Eligibility Requirements, BELIs and Examples. Background. This supplement provides operational clarification to basic eligibility requirements

Group Insurance Regulations Administrative Supplement No. II-A

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Eligibility Requirements, BELIs and Examples

Background

This supplement provides operational clarification to basic eligibility requirements for health and welfare benefit packages (Full, Mid-level, and Core), outlines the Benefits Eligibility Level Indicators (BELIs) that control enrollments, and gives examples of initial employment appointments and the effects of appointment extensions, transfers, and re-hires on UC-sponsored health and welfare benefits. NOTE: The transactional instructions reference UC locations using the PPS system. Department of Energy laboratories and UCPath locations may have different codes to describe the same benefits eligibility rules. Check with the lab benefits office or UCPC for information.


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Initial Eligibility

In order to become initially eligible for benefits, the newly hired employee’s appointment is evaluated using the following several factors: appointment type, whether appointment is in Group A or Group B, membership in UCRP, appointment percentage and appointment duration. All factors are determined based on information entered into the payroll system upon hire. 1. The “appointment type code” is resident in the payroll system and is defined as follows:

Code Definition

1

Contract. A “Contract” appointment is a Group A Appointment Type (Code 1) that is eligible for health and welfare benefits (and eligible for membership in UCRP). It is different than an “independent contractor” or “independent consultant” or “non-employee consultant,” which are not eligible for benefits. Generally, Contract Appointments have a fixed duration and are not considered “career” status. A Contract employee signs a contract with UC which states the start and end dates of employment. For benefit purposes, this employee is treated the same as any other Group A employee.

2 Career, Group A 3 Limited, Group A

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Casual/Restricted (Students). A Casual/Restricted (Student) Appointment is a Group B Appointment Type (Code 4) that is eligible for health and welfare benefits, though limited to Core Benefits. However, Students are not eligible for membership in the UC Retirement Plan, nor are hours in Casual/Restricted appointments counted toward the accumulation of 1,000 hours in a 12- month period for UCRP/Full Benefits eligibility.

5 Academic, Group A unless in flat rate pay Appointment. Then in Group B

6

Per Diem. A Per Diem Appointment is a Group B Appointment Type (Code 4) that is eligible for health and welfare benefits, though limited to Core Benefits. However, Per Diems are not eligible for membership in the UC Retirement Plan, nor are hours in Per Diem appointments counted toward the accumulation of 1,000 hours in a 12- month period for UCRP/Full Benefits eligibility.

7 Partial Year/Career Appointment, Group A


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Initial Eligibility (cont.)

8 Floater. A Floater is a Group A Appointment Type (Code 8) that is eligible for health and welfare benefits. However, Floaters are not eligible for membership in the UC Retirement Plan, nor are hours in Floater appointments counted toward the accumulation of 1,000 hours in a 12- month period for UCRP/Full Benefits eligibility. Floaters are entitled to eligibility for Mid-level or Core benefits based on the percentage and duration of their appointment. If they are appointed at 100% time for 3 months or more, or at least 50% time for 12 months, they should be provided with Mid-level benefits. Floaters who are appointed at least 43.75% time for any duration are eligible for Core benefits

2. The “UCRP Membership” code is resident in the payroll system and is defined as follows:

U = 1976 Tier W = 2013 Tier

Note that eligibility for membership in UCRP is defined in UCRP Documents and Regulations and may differ from health & welfare benefits eligibility rules as defined here. In a few specifically defined situations, UC employees may be eligible to participate in UC health and welfare benefits while being enrolled in a non-UC retirement plan – see Admin Supplement II-B.

3. The “appointment percentage” is entered in the payroll system on EAPP screen

4. The “appointment duration” is entered in the payroll system on EAPP screen. If an appointment is intended to be indefinite or last for at least 12 months, but has an end date to reflect funding or visa restrictions, assign an Appointment Duration Code “B” or “V.”

“B” – the appointment end date is for “budget purposes only.” “V” – the appointment end date is for “visa purposes.”

This will instruct the payroll system to ignore the end date of the appointment and treat this appointment as indefinite when determining the Derived BELl. The Assigned BELI may be determined as though the appointment were indefinite.

5. A Lecturer who has variable appointments by quarter may attain eligibility for health & welfare benefits only (not UCRP) by averaging the appointments and determining the BELI based on the average. Status Qualifier Code 20 should be assigned and entered in the payroll system; see information on BELI Status Qualifier Codes below.

Once eligibility is determined, the responsible department manager assigns a BELI (Benefits Eligibility Level Indicator) code to employees. These codes range from 1-5 and are entered into the location’s payroll system. It is the Assigned BELI that controls access to benefits. PPS also derives a BELI code and produces edit reports which compare the Assigned BELI and Derived BELI. Derived BELI codes range from 1-9, although the derived codes 5-9 have all been incorporated into Assigned BELI 5. The appropriate manager at each location reviews these reports and ensures that any discrepancies are adjusted (see page 7 of this Supplement for more details on BELI discrepancy audits). For Senior Management Eligibility, see Section 5002.A.1. of the Group Insurance Regulations.


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Continuing Eligibility

UC bases your ongoing eligibility for benefits on your average hours of service over a 12-month, standard measurement period (SMP). Average Hours of Service includes:

PAID TIME Any and All paid time, for example: regular pay, summer salary pay, paid time for vacation, paid holiday, paid illness, paid jury duty, paid military duty, or paid leave of absence, paid sabbatical, etc. UNPAID TIME Unpaid FMLA Unpaid USERRA Unpaid Jury Duty Unpaid Hours during “special employment breaks” of at least 4 weeks (501 hours max)

If your hours during the SMP meet the threshold to be offered coverage, then that coverage must be offered, and if accepted, will be provided during the subsequent stability period, regardless of your number of hours during the stability period (as long as you remain employed). UC’s standard stability period for all employees is Jan. 1–Dec. 31. If your hours during the SMP do not meet the threshold, then all coverage ends on Dec. 31. The required average hours of service threshold is: • For Group A (Career, Academic, Limited, Partial-Year Career, Contract, Floater): 17.5 hours

per week • For Group B (Per Diem, Casual/Restricted (students), By Agreement or other flat-dollar

payments, Seasonal): 30 hours per week

The threshold applied is the one applicable to the type of appointment held at the time of measurement. Eligible Employees who take any approved Leave of Absence are exempt from any continuing eligibility requirements.


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Transfers and Rehires

If an employee is transferred from a position with benefits to a position which is in an “ineligible group” with or without a break in service, then the employee becomes a BELI 5 and all health & welfare benefits stop. If a former employee is rehired following a break in service, initial eligibility as a rehire is evaluated differently depending on whether the break was less than 26 week or more than 26 weeks, using the regular factors (appointment type, UCRP membership, percent, duration), as well as considering both the number of hours the employee has accumulated in the “Hours Towards Benefits Eligibility” field and whether the employee is still in a prior stability period. Rehires following separation of less than 26 weeks

At the time the rehire appointment is approved, evaluate and award new benefits package as appropriate;

1. Evaluate appointment percentage & duration; if not eligible, then 2. Evaluate for 1,000/750 hours; if not eligible then 3. Evaluate for stability period; if in an active stability period, award Core and

measure at next SMP. Rehire stays in same measurement and stability cycle. At new appointment for which benefits are awarded, provide a beginning benefits eligibility

period Rehires following separation of 26 weeks or more At the time the rehire appointment is approved, evaluate and award new benefits package as

appropriate; 1. Evaluate appointment percentage & duration; if not eligible, then 2. Evaluate for 1,000/750 hours; if not eligible then 3. Assign BELI 5 and IMP

At new appointment for which benefits are awarded, provide beginning benefits eligibility period

Due to Medicare Secondary Payer laws, retirees with Medicare who are rehired should carefully consider their appointment levels and the impact of those appointments on their eligibility for employee benefits. For Transfers In and Out of Senior Management Appointments, see Section 5003.A.5. of the Group Insurance Regulations. 1,000/750

Hour Rule An employee with a limited appointment which would normally not qualify for benefits due to the percent and duration of the appointment – e.g., 40% for 12 months – but who worked for UC in the last 12 months and has 1,000 hours in “hours toward benefits eligibility” as of the beginning of the month of rehire, is eligible for Full Benefits. Additionally, an employee with a limited appointment which would normally not qualify for benefits due to the percent and duration of the appointment – e.g., 40% for 12 months – may qualify for benefits prospectively upon working 1,000 hours within the 12 month period. Note that employees hired or rehired into positions covered by the Unit 18 contract need only have 750 hours in “Hours Towards Benefits Eligibility” to qualify for Full Benefits

For example, a lecturer is appointed 60% from 10/1/16 – 6/30/17. He should be assigned BELI 4 on 10/1/16. However, as of the month of May 2017, he has accumulated 750 hours. On the first of the next month (6/1/17), he is eligible for UCRP membership and his BELI will change to a BELI 1.


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Rehired Retirees

Generally rehired at 43% or less (not eligible for benefits) Recalled/rehired individuals who are enrolled, or eligible for enrollment, in a UC retiree

medical plan do not need to be offered “employee” coverage “R” code (found in Retirement/Savings Programs screen IRTR in PPS) keeps rehires out of

1,000 hour process


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BELIs and Associated Health & Welfare Benefits

Full Benefits (BELI 1)

Full Benefits include: • Medical • Dental • Vision • Basic Life • Supplemental Life • Senior Management Life (only

Employees with Senior Management Appointments)

• Basic Dependent Life • Expanded Dependent Life • AD&D

• Business Travel Accident • Basic Disability • Voluntary Short-Term Disability • Voluntary Long-Term Disability • Legal • Automobile & Homeowner/Renter • DepCare FSA • Health FSA

• Family Care Resources

Mid-level Benefits (BELI 2, 3)

Mid-level Benefits include: • Medical • Core Life • Supplemental Life • Basic Dependent Life • Expanded Dependent Life • AD&D

• Business Travel Accident • Basic Disability • Voluntary Short-Term Disability • Voluntary Long-Term Disability • Legal • Automobile & Homeowner/Renter • DepCare FSA • Health FSA Core

Benefits (BELI 4)

Core Benefits include: • Core Medical • Core Life • AD&D • Business Travel Accident

• Basic Disability • Voluntary Short-Term Disability • Voluntary Long-Term Disability • Legal • DepCare FSA • Health FSA No Benefits

(BELI 5) No Benefits


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BELI Codes and Requirements for Initial Benefits Eligibility – Group A

ASSIGNED BENEFIT

PACKAGE AND BELI

Combined Appointment % & Duration

UCRP Membership Required?

Continuing Requirements Examples

Full Benefits, BELI 1

50% or more for 12 months or more Accumulation of 1,000- eligible hrs. (or 750 hrs. for Unit 18) in a rolling 12-month period.

YES

Minimum 17.5 average hours of service weekly, measured after each standard measurement period

Admin Assistant I, appointed indefinitely at 50% time Lecturer, 7/1/16 to 6/30/17 at 66% time

Mid-Level Benefits, BELI 2

50% or more for 12 months or more (but not eligible for UCRP)

NO


”Visiting” Professor, 7/1/16 to 6/30/17 at 50% time Floater, 3/1/16 – 2/28/17 at 100%

Mid-Level Benefits, BELI 3

100% for 3 months or more, but less than one year

NO


CRS II appointed at 100% from 9/1/16 to 12/1/16 (3 months) Lecturer, 10/1/16 to 12/31/16 (1 quarter) at 100% Assistant I, 1/1/16 to 12/15/16 (11.5 mos. at 100%

Core Benefits, BELI 4

43.75% or more but does not satisfy % and duration for BELI 1, 2, or 3

NO


Senior Clerk, one month, 100% Employee appointed at 43% indefinitely Lab Assistant 9/15/16—11/30/16 at 100% (less than 3 months)

No Benefits, BELI 5 Less than 43.75% at any duration

NO Minimum 17.5 average hours of service weekly measured after each standard measurement, if found eligible after IMP.

Limited employee appointed at less than 43.75% for any duration of time


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BELI Codes and Requirements for Initial Benefits Eligibility – Group B

ASSIGNED BELI CODE

Combined Appointment % & Duration

UCRP Membership Required?

Continuing Requirement Examples

Core Benefits, BELI 4. Secondary BELI Status Qualifier 51

75% or more for 3 months or more

NO

Minimum 30 average hours of service weekly, beginning with the initial measurement period

Student with two appointments, totaling 75% or more indefinitely Assistant I, 15 hours/week, indefinitely (student title) PLUS Assistant I, 15 hours/week) indefinitely (student title) = 75% time indefinitely Nurse, Per Diem, 90% indefinitely

No Benefits. BELI 5 75% for less than 3 months, Less than 75%, Seasonal employees

NO Subject to initial and standard measurement periods, with a threshold of 30 average hours of service weekly

Recreation Instructor, 3 hours per week Agricultural Worker


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Out of Compliance BELIs

It is very important that an employee’s BELI is correct, since it determines the benefits for which an individual is eligible. Departmental and Central benefits and payroll representatives are responsible for entering the BELI information into the payroll system, as well as reviewing BELI compliance reports and making adjustments as necessary to resolve situations that report as out of compliance.

Once a month, a variety of audit reports on the Benefits Eligibility Level are produced, including: PPP6502

BELI Out-of-Compliance – By Date PPP6504 BELI Out-of-Compliance – By Home Department PPP6511 New Benefits Excluded Employees (report no longer applicable) PPP6513 Employees with BELI Status Qualification Codes

New Benefits Excluded Employees Report No longer applicable.

Employees with BELI Status Qualification Codes (SQC)

Review this report to ensure that assigned SQCs are still appropriate, given the employee’s current status.


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BELI Status Qualification Codes

Background The Benefits Eligibility Level Indicator (BELI) Status Qualification Code (SQC) is a number used to identify employees in specific qualified situations to designate the appropriate eligibility status. The SQC will also prevent employees from being reported as out of compliance on BELI Control Reports The designated department or local benefits/payroll entry person should enter the SQC into the Payroll Personnel System (PPS) when a qualified status situation begins and delete the SQC when the condition no longer applies. The BELI SQC is used in addition to the BELI code. Additionally, there may be situations where two BELI SQCs should be used if two qualifying conditions apply. The Primary SQC applies to the condition which will last longest and the Secondary SQC may be used if another condition applies temporarily. A status qualification date should be used for each SQC representing when the qualified status begins.

A BELI SQC applies to UC-sponsored plans with continuing eligibility and disenrollment requirements as follows:

• Medical • Dental • Vision • University-paid Life Insurance • Supplemental Life Insurance • Dependent Life Insurance • Accidental Death and Dismemberment (AD&D) • Legal • Basic Disability Insurance • Short-Term Disability Insurance • Long-Term Disability Insurance • Dependent Care Flexible Spending Account (DepCare FSA) • Health Flexible Spending Account (Health FSA)

The BELI SQC also identifies whether an employee must maintain a minimum appointment

after establishing initial eligibility or whether benefits are blocked for the employee. See the Qualified Status explanations in the following sections. The SQCs currently in use are as follows: 20 - Average Appointment Percent Employee (Academic) 25 – Academic Student Employee or Graduate Student Researcher 30 - Extended Sick Leave Recipient 40 – Transitional Work (Formally Approved) 60 - Seasonal Employee 90 - Sabbatical/Leave for Professional Renewal


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Qualified Status – Maintaining Eligibility

In the following situations, the SQC establishes initial eligibility, but the employee must meet average weekly hours of service requirements for his/her Group in order to maintain benefits. 20 - Average Appointment Percent Employee (Academic) SQC 20 is for an academic year appointment (July 1 through June 30) with different levels of percent time (greater than zero) in each quarter or semester. The appointment should be treated as a variable time appointment and welfare benefits eligibility based on the average percent time for the total year's appointment. Averaging the appointment does not affect UCRP eligibility. If the appointment is made for two or more years, each year (July 1 through June 30) should be averaged individually with benefits for the year based on the average for that year. The employee’s manager should assign a BELI consistent with the average level of the appointment for the academic year. (July 1 through June 30). If the employment commitment is quarter-by- quarter, the initial appointment for the fall quarter must be evaluated separately with additional appointments treated as shown in this Administrative Supplement.

25 – Academic Student Employee or Graduate Student Researcher

SQC 25 is for an Academic Student Employee (ASE) represented by the UAW or a Graduate Student Researcher (GSR) who meets the eligibility requirements based on title code and appointment percentage (43.75% or more) to participate in the non-student UC-sponsored Dependent Care Flexible Spending Account (DepCare FSA) plan for faculty and staff employees permitted under the collective bargaining agreement. Continuation of the program is subject to collective bargaining.

Qualified Status - Benefits Are Retained

In the following situations, the SQC continues eligibility for benefits in effect before the qualified status, even if the employee's average regular paid time falls below required minimums. The assigned BELI in effect before the qualified status period begins should not be changed.

30 - Extended Sick Leave Recipient SQC 30 is for an employee on extended sick leave (80% of regular pay) for a work-related disability covered by Workers' Compensation. An employee may continue benefits up to the six-month maximum period for extended sick leave. The status code of 30 should be deleted at the end of six months or when the employee returns to work in an eligible appointment - whichever is earlier.

40 –Transitional Work (Formally Approved) Campus and laboratory officials may approve continuation of benefits during a period of approved transitional (either stay at work or return to work) employment. The status code of 40 should be assigned at the beginning of the period and deleted at the end of the period. In this context, transitional work refers to an employee who has returned to work part-time at the University as part of an approved accommodation and whose time worked is such that benefits would otherwise be lost during the transitional work period. For example, the accommodation might consist of four months at 25% time, two months at 40% and subsequent periods at 50% or more time. To avoid loss of benefits while the approved plan results in less than 17.5 hours average hours of service during an SMP, the status qualification code is appropriate.


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90 - Sabbatical/Leave for Professional Renewal SQC is for faculty or staff enrolled in medical, dental, vision and/or Basic or Core life insurance who take an approved sabbatical leave or leave for professional renewal at reduced pay. They may continue this coverage for up to 24 months so long as their paychecks cover any required deductions. For dental, vision and Basic Life insurance, earnings during the leave also must be covered compensation for retirement plan purposes. If the leave results in less than 17.5 hours average hours of service during the SMP, status code 90 should be assigned at the beginning of the period and deleted at the end of the period or at the end of 24 months from the date the leave originally began, whichever is earlier.

Qualified Status - Benefits are Blocked

In the following situations, the SQC indicates that the employee is not eligible for benefits.

60 - Seasonal Employee SQC 60 is for individuals who work seasonally each year for less than three months (e.g., agricultural workers). These employees may be excluded from Core benefits. Seasonal employees typically are hired around the same time each year on a temporary basis. The seasonal employee category does not apply to someone who has a series of short-term appointments, with or without breaks in service, during the year. The SQC should be deleted if the employee transfers to a non- seasonal position.

Adding, Changing and Removing a Status Qualification Code

When there is an initial assignment or reassignment of either a BELI or SQC, the employee’s department should complete Form UPAY 726 (Benefits Eligibility Level Indicator (BELI) and Status Qualification Code (SQC)) and submit it to the local benefits/payroll office. At some locations this information is passed electronically to the local benefits/payroll office. The department or local benefits/payroll office should enter the new BELI and/or SQC(s) into the employee’s record. If there are Primary and Secondary SQCs and the Primary SQC is deleted, the Secondary SQC should be re-entered as the Primary SQC. The local benefits/payroll office should review the SQC audit report (PPP6513 – Employees with BELI Status Qualification Codes) on a regular basis to ensure that employees’ SQCs remain appropriate.


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Discontinued Status Qualification Codes

The following SQCs are no longer used because there are no more employees in these categories or the employees in these categories were reassigned to other categories that may (or may not) need a SQC. 10 – Appointee with Ending Date for Funding Purposes Only SQC 10 previously was applied to an employee appointed for at least 50% time and the Personnel Action Form indicated that the ending date is for funding purposes. Use of the duration code “B” now accomplishes the same purpose. 50 – Split Student/Non-Student Appointee Ineligible for Benefits SQC 50 previously was applied to an employee with a casual/restricted appointment whose title was restricted to students (Class Title Outline 400-499). Under previous policy, the employee was ineligible for benefits, regardless of the nature of the other appointments. Current policy allows benefits to be provided based on eligible non-student and student appointments. 70 – Phased Retiree SQC 70 previously was applied to Phased Retirees who were permitted to continue medical, dental, vision and University-paid life insurance during the period of the phased retirement agreement. Current policy does not allow for phased retirement. 80 – Grandfathered Employee SQC 80 previously was applied to a limited number of employees who were enrolled in medical, dental, or vision coverage at the time the BELI system was implemented and who otherwise would have been transferred to Core plans on January 1, 1990. There are no longer any members of this group.


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Examples


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