Annual Random Audit of UC Health and Welfare Plan Enrollees

In May 2005, UC HR/Benefits will conduct its annual random audit of UC employees, retirees and their family members enrolled in UC-sponsored health and welfare plans. The audit is required by UC insurance plan regulations and helps contain costs for both UC and employees/retirees by verifying that only those who are eligible for coverage are enrolled in UC-sponsored plans. To prevent a de-enrollment (cancellation) of your UC-sponsored health and welfare coverage for 12 months, you must de-enroll any ineligible family member immediately. Before the verification process starts, the Benefits Office asks that you review your health and welfare plan enrollments and make sure that your enrolled family members are eligible for UC-sponsored coverage.

Examples of Eligibility Criteria

Stepchild or a domestic partner's child - Tax dependency required

In order to be eligible for UC-sponsored coverage, your stepchild or domestic partner's child (children) must be claimed as your or your spouse's/domestic partner's tax dependent.

Example 1:  If your step/domestic partner's child is claimed as a tax dependent by you or your spouse/domestic partner in 2001, 2003 and 2005, those are the years the child can be covered by UC-sponsored health plans. During Open Enrollment you can add or delete family members as needed for each tax year.

Example 2:  If you or your spouse/domestic partner share in the support of children (Joe and Bonny) with their biological parent and the custody agreement states you or your spouse/domestic partner may claim Joe and the biological parent may claim Bonny, only Joe can be covered by UC-sponsored health plans. Even though you and your spouse/domestic partner are responsible for a portion of the support for both children, only one child (Joe) may be covered under UC-sponsored plans.

Legal Spouse - An individual enrolled as your spouse must be your legal spouse

Common law marriage, although recognized in other states, is not recognized in California and is not considered legal marriage for the purposes of eligibility for enrollment in UC-sponsored coverage. A fiancée is not eligible for enrollment in UC-sponsored coverage. Former spouses and legally separated spouses are not eligible for enrollment in UC-sponsored coverage; if instructed to continue coverage for a former spouse as part of a divorce agreement, an employee must make arrangement for coverage outside the UC-sponsored plans (as required by law, the former spouse will be offered COBRA continuation in the UC-sponsored plans when de-enrolled at the time of divorce).

Example 1: An employee (Louis) plans to marry his fiancée (Ann) in August 2005. Joe cannot enroll Ann as a dependent on his UC-sponsored coverage until they become legally married in August; he has 31 days to enroll her as a dependent after the date of his marriage and coverage begins on the date of marriage.

Example 2: An employee (Mark) has divorced his spouse (Lucy), however the divorce agreement states that he must provide medical and dental coverage for Lucy and their children until the children reach age eighteen. While he can continue coverage for the children (who are eligible dependents until age 23 if they are unmarried), he must de-enroll Lucy as a dependent since she is no longer eligible. The Benefits department will provide Lucy with information on continuing participation in the UC-sponsored plans via COBRA for up to 36 months.

De-enrollment Period

In May, UC will send notification to those who will be included in this year's audit. If UC determines through the audit process that an ineligible person is enrolled in a UC-sponsored plan(s), the employee and all family members will be de-enrolled (cancelled) for 12 consecutive months from the plan or plans in which the ineligible family member was enrolled. Those who do not respond to the random audit by submitting verification of eligibility will also be de-enrolled from UC-sponsored coverage for 12 consecutive months. After you receive an audit letter you will not have the option to voluntarily de-enroll an ineligible person identified during the audit process to retain coverage in the UC-sponsored plans; you and all eligible family members will be de-enrolled (cancelled) for 12 consecutive months

To review your enrolled family member information, go to UC's At Your Service website by selecting the blue "Your Benefits Online" icon located on the right side of the homepage. After signing in, select "View Your Enrollments" in the "Your Health & Welfare" section, and review your enrolled family members to ensure they are eligible.

To review the eligibility rules for family members, see the Group Insurance Eligibility Factsheet. After reviewing the factsheet, verify your enrollments and de-enroll anyone who does not meet UC's eligibility rules.

If you need to de-enroll an ineligible family member, submit an Enrollment, Change, Cancel or Opt Out - UPAY 850 form to the Benefits Office at MS 937-600.

COBRA coverage

The employee and all eligible family members who are de-enrolled may elect coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). The cost of coverage under COBRA is 102% of the combined employer and employee premium. Ineligible family members, however, will not be able to elect COBRA. During the de-enrollment period, certain family members (such as adult dependent relatives) must continue coverage under COBRA in order to remain eligible for UC-sponsored coverage after the de-enrollment period ends. For additional information about COBRA, employees should check with the Benefits Office at ext. 6403.

After the 12 month de-enrollment period, the employee and all eligible family members may re-enroll in UC-sponsored coverage. Employees should contact the Benefits office at ext.6403 about enrollment periods.