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Change in Benefits Eligibility Status

Sample Letters

As an employee you may want to review these sample letters to learn how your benefits eligibility status might be affected by a change to your appointment.  A data element called the Benefits Eligibility Level Indicator (BELI) code is assigned by your department and resides in your On-Line Payroll Personnel System (OLPPS) file.  The BELI code controls access to benefits.  Upon certain changes to the nature of your appointment, your department may be required to re-assign a new BELI code resulting in your eligibility for more, fewer, or no benefits.  Be sure to check with your Department Payroll/Personnel or Benefits Representative should you have any questions about changes in your appointment and how they might affect your on-going benefits eligibility status.  If you sustain a loss of coverage find out about your COBRAcontinuation/conversion privileges as soon as possible. As a Department Payroll/Personnel/Benefits Representative you may wish to (copy/paste) issue these letters to employees upon a change in their assigned BELI code.  Be sure to refer to your department’s copy of the OLPPS Entry/Update Procedure and Reference Guide, Appendix J, should you have any questions on how an appointment change might affect an employee’s on-going benefits eligibility status.

For initial eligibility criteria regarding the different benefit levels, please refer to Your Group Insurance Plans booklet.





BELI CODES
BELI 1:Full Benefits
BELI 2 & 3:Mid-Level Benefits
BELI 4:CORE Benefits
BELI 5:No Benefits

Sample Letters

Re-assignment of BELI from 1, 2, 3, or 4 to BELI 5

Re-assignment of BELI from 1, 2, or 3 to BELI 4

Re-assignment of BELI from 4 or 5 to BELI 2 or 3

Re-assignment of BELI from 5 to BELI 4

Re-assignment of BELI from 4 or 5 to BELI 1

Re-assignment of BELI from 2 or 3 to BELI 1