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Wednesday, April 27, 2005

Reminder: Benefits Audit Starts in May

Starting May 1, UC HR/Benefits will conduct a random audit of UC employees, retirees and their family members enrolled in UC-sponsored health and welfare 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, you should review your health and welfare plan enrollments and make sure that your enrolled family members are eligible for UC-sponsored coverage.

Special Situation:

Court ordered coverage for an ex-spouse or ex-California state registered domestic partner.

UC health and welfare eligibility rules do not allow for coverage of an ex-spouse or ex-California state registered domestic partner, even when the court orders the UC employee to pay for such coverage. You must de-enroll your ex-spouse or ex-California state registered domestic partner from all plans in which he/she is enrolled (medical, dental, vision and legal).

Eligibility for a spouse stops on the last day of the month in which a divorce, legal separation, or annulment is final. Eligibility for California state registered domestic partner stops on the last day of the month in which the court deems the relationship dissolved, legally separated or annulled.

Example:   Kendra is a UC employee who has divorced her husband, Roberto. The divorce settlement states that Kendra is responsible for providing Roberto with health insurance. This means that Kendra, not UC, is required to provide Roberto with health coverage. Kendra may choose to pay for Roberto's COBRA coverage (providing he meets the eligibility requirements) or she may choose to purchase an individual policy for Roberto.

If the court orders a UC employee to pay the cost of providing health insurance to an ex-spouse or California state registered domestic partner, the court is not requiring UC to continue the health insurance coverage.

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 939-200.

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; see the 2005 COBRA rates. 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 x6403.

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.


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