For starters, there are eligibility rules defining benefits-eligibility concerning hours worked and FTE. There are three definitions pertaining to benefits eligible, which are described below:
Full Benefits Eligible: This is defined as 30 or more hours per week or .75 FTE and greater, which applies to regular faculty and regular staff employees. Full benefits include all benefits in accordance with University System of Georgia of Board of Regents policy.
Partial Benefits Eligible: This is defined as 20 to 29 hours per week or .5 FTE to .74 FTE. Partial benefits eligible may apply to regular faculty and regular staff employees. Partial benefits include retirement and pro-rated leaves.
Non Benefits Eligible: This is defined as 19 or fewer hours per week (.49 FTE or less), which applies to regular faculty and staff employees. Non-benefits eligible also includes temporary faculty, staff and student employees who may not work more than 1,300 hours in a 12-month period. Students may not be placed into a regular status.
Benefits Effective Dates
Beginning July 1, 2017, the benefits effective date for newly hired or newly benefits-eligible faculty and staff is based on hire date. Benefits will be effective on the first day of the month following the hire date, unless an employee is hired on the first of the month; then benefits are effective on the date of hire (i.e. first day of the month), regardless of the enrollment date. Employees have 30 days from their hire date to enroll in benefits. For Regents’ Optional Retirement Plan (ORP) and Teachers Retirement System (TRS), an employee will have 60 days from the effective hire date to enroll in a retirement plan.
Qualifying Events for Changing Benefits
Because your premiums for medical, dental and vision are deducted from your salary on a pre-tax basis, the IRS has established strict rules about the operation of your plans. Your choices during the annual open enrollment period must remain in effect for the entire plan year (January 1 – December 31). Exceptions are permitted under IRS rules when a member has a qualifying event. If you have an event, you are required to notify Human Resources Benefits office within 31 days and complete the appropriate forms. Some examples of qualifying events include:
- Change in marital status
- Birth or adoption of a child
- Death of a covered dependent
- Loss of eligibility status by a covered dependent
- Change in employment status that affects eligibility for coverage
- Loss or gain of healthcare coverage eligibility under Medicare or Medicaid
- Change in residence to a location outside a healthcare plan’s service area
In order for a change in status to qualify for a midyear election change, the change in status must be “on account of,” and must correspond to, a change in status that affects the eligibility of an employee, spouse, or dependent for coverage under an employer’s plan. This change in status includes only a change that would make an individual eligible or ineligible for a particular benefit package option under the plan. The regulations do not permit midyear election changes for family members who are not affected by the change in status, such as unaffected children in the case of a divorce or death of a spouse.
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