Chapter 19: Benefits
The University offers a wide range of benefits to employees and their eligible dependents (including adult dependent relatives and same-sex dependent partners) in an effort to recruit and retain the best qualified workforce. Dozens of plans and programs are available to employees who meet specified eligibility requirements.
- Guiding Principles
- Training Resources
- Your Role
- Department Benefits Representatives
- Eligibility
- Enrollment
- Life Cycle Events that May Affect Coverage
- Loss of Eligibility
- Other Resources
Guiding Principles
For the most part, benefits fall into categories designed to foster:
- employee wellness and protection against catastrophic expenses (through various medical insurances)
- income protection in the event of death or disability (through benefits such as life insurance and disability insurance)
- financial security for the future (through a mandatory retirement plan and optional savings plans)
- employee morale (by offering the convenience of payroll deduction for benefits such as auto insurance)
Training Resources
Enroll in "OLPPS Policy" at the Developmet & Training Course Catalog to learn more about University personel policies. The course catalog can be found at: http://training.ucsf.edu/.
Your Role
As a manager or supervisor, you are not expected to know all the details pertaining to benefits plans. However, you should:
- Understand the scope of benefit programs
- Be aware of eligibility issues when structuring new appointments or changing existing appointments
- Encourage employees to use telephone and web-based systems for getting information and taking benefits actions
- Know which events in the employee's life cycle trigger changes in eligibility
- Be sure that employees know about all benefits options available to them and that they are enrolled by applicable deadlines
- Assure that when eligibility or coverage ends, the employee has access to information on possible options
- Advise employees to contact your Department Benefits Representative (DBR) for routine issues in the benefits arena
- Refer employees to the UCSF HR/Benefits Office to apply for benefits (such as disability and retirement) as soon as you become aware of special situations
- Encourage employees to consider their options when new benefits are introduced, or during special periods of eligibility such as the annual Open Enrollment Period
Department Benefits Representatives
Every department has a Department Benefits Representative (DBR) who has current plan literature, eligibility rules, and enrollment procedures. The DBR provides front-line access to benefits information for new and continuing employees, helps employees through the enrollment process, and assists management throughout the employment life cycle in communicating benefits options. While it is not appropriate for DBRs to make decisions about benefits or take benefits action on behalf of employees, they can help by referring employees to the resources that are available. The DBRs work closely with UCSF HR/Benefits staff, who provide training and information with regular communications through e-mail and the UCSF HR/Benefits web site
Whenever there is a change in who has been designated as DBR, please contact the UCSF HR/Benefits Service Desk (476-1400) to make the appropriate arrangements for authorization, training, etc., for the newly designated DBR.
Eligibility
Basic Eligibility Requirements: Generally, an employee must have an appointment which meets minimum percent- and duration-of-appointment requirements for initial health and welfare benefits eligibility. Or for the Limited Appointee, upon working 1000 hours in a rolling, 12-month period (see OLPPS/IHR2), UCRP Membership and Full Benefits eligibility is conferred effective the first of the month following the month in which 1000 hours is reached.
Once eligible and enrolled in any benefits package, e.g., Full Benefits, Mid-level Benefits, or CORE Benefits, ongoing eligibility continues provided that the employee maintains average regular paid time of 17.5 hours per week (Avg Hr/Wk) or more (see OLPPS/IHRS). (This differs from UCRP eligibility where membership continues until there is a break in service.). Once this average drops to below 17.5 for two consecutive months, eligibility is lost. COBRA/conversion materials must be provided to the employee as soon as possible.
For a more detailed description of benefits eligibility, see the Benefits Eligibility Level Indicator Reference Material.
Still want more?
Your Group Insurance Plans booklet
UC Group Insurance Eligibility Factsheet
Visit At Your Service
Enrollment
Once the employee becomes eligible for a particular benefits package, coverage under specific plans within the package will either be:
- automatic
- through positive enrollment by the employee within a Period of Initial Eligibility (PIE)
- through positive enrollment any time
- by default, for certain plans, if the employee does nothing to enroll
Period of Initial Eligibility (PIE)
Some benefits require positive enrollment by the employee within the Period of Initial Eligibility (PIE) and some employment life cycle events create a PIE. The majority of University benefits have a PIE and require positive enrollment. The PIE begins on the date the employee (or an eligible dependent) becomes eligible for benefits and ends 31 days later, or on the last working day within that 31-day period, whichever comes first. The PIE deadlines may differ in certain circumstances if the date of hire is before the date of arrival on campus. If enrollment is within the PIE, the effective date of coverage is retroactive to the beginning of the PIE.
If PIE Deadline is Missed
An employee who does not enroll during the PIE may NOT be able to enroll in the future. While some benefits are open annually for enrollment, others require the submission of a statement of health acceptable to the carrier if the PIE deadline has passed.
Life Cycle Events that May Affect Coverage
Your department's DBR can help you determine how employment life cycle events affect benefits eligibility and how you can best communicate benefits options to employees. Benefits Checklists and Factsheets are available to help you and your employees learn how these events may impact their insurance, savings programs, etc., and what they need to be aware of.
Changes in Appointment or Personal Circumstances
- new appointment/new hire
- extension of original appointment
- appointment added or eliminated in same or other department
- increase or decrease in appointment percentage
- title code change
- payment method change
- marriage or divorce
- birth, adoption, or attaining legal guardianship of a child
- child reaching age 23 or getting married
- death of a dependent
- travel or relocation out of health plan service area
- involuntary loss of insurance coverage
- change in employment status that affects dependent care expenses
Possible Ramifications are:
- a new PIE may be created for enrolling or adding dependents, changing plans or changing levels of participation
- if eligibility ends, options may be available for continuing coverage
Leaves
Leaves can also affect benefits coverage. Leaves of absence can occur for a variety of reasons and can be fully paid, partially paid, or unpaid. Leave periods include:
- leave without pay for health reasons
- leave without pay-personal
- leave with pay
- sabbatical leave
- professional leave
- furlough/temporary layoff
- disability leave
- maternity leave
- family and medical leave (may run concurrently with other leaves)
- military leave
- Workers' Compensation Extended Sick Leave
Possible Ramifications are:
- some coverages may continue automatically
- the employee may be able to make arrangements with the Campus Payroll Office to pay for certain benefits
- savings plans contributions may need to be adjusted
- retirement system service credit, lost during a leave, may be eligible for buyback if initiated within the specified time
- reenrollment in certain benefits may be necessary upon return to regular appointment
Employment Ends
When employment ends, benefits options will depend on which of the following circumstances applies:
- employee is vested in UCRP or PERS and is age 50 or over
- employee is vested, but is under age 50
- employee is not vested
- employee is going to PERS-covered employment
- employee is being laid off
- employee is being medically separated
Possible Ramifications are:
- health and dental insurance may continue in retirement if the retirement date is within 120 days of separation
- COBRA conversion for health, dental, and vision insurance may be available
- other insurances may be eligible for conversion
- a number of options (and tax ramifications) pertain to savings and retirement plan accumulations
- retirement plan benefits may be available if the employee is age 50 or over with five years of service credit
- inactive status in retirement and savings plans may be available even if the employee is under age 50
- employees terminated due to Indefinite Layoff need specialized counseling about additional options available which may help preserve certain benefits
- employees terminated under Medical Separation policies may be eligible to apply for a variety of retirement and group insurance benefit plans, and may lose the opportunity to apply for these benefits if application deadlines are not met
- employee may be eligible for Unemployment Insurance
Loss of Eligibility
Loss of Health, Dental, or Vision Insurance
The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 requires employers to notify employees and their eligible dependents of their right to continue their group medical, dental, and vision plans for a limited period of time if they lose coverage. Notification must be given within legally established deadlines. Failure to provide timely COBRA notification could incur a financial liability upon the department. Loss of coverage can occur through termination of employment (for reasons other than gross misconduct), layoff/approved leave without pay, reduction in appointment, employee's death, a spouse/same-sex domestic partner losing dependent status due to divorce or legal separation/termination of domestic partnership, or a child losing dependent status upon turning age 23 or marriage.
Loss of Other Insurance
It is the department's legal responsibility to notify employees of conversion options for University life and accident insurances upon termination or loss of coverage by specific deadlines.
Please refer to our local UCSF HR/Benefits pages to learn more about COBRA/conversion options and procedures
Other Resources
- The Campus Benefits Unit training for DBRs and employees, as well as individual counseling
- Benefit forms and literature, available from DBRs
- UCSF HR/Benefits
- UCSF Payroll Office
- At Your Service
- Checklists and Factsheets
- Contact Your Plan