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Managers, Supervisors and HR Professionals

Guide to Managing Human Resources

Chapter 19: Benefits

Contents
Summary

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

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)

Department Benefits Counselors

Every department has a Department Benefits Counselor (DBC) who has current plan literature, eligibility rules, and enrollment procedures. The DBC provides front-line benefits information to 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 DBCs 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 DBCs work closely with Human Resources Benefits staff, who provide training and information with regular communications through e-mail and the Human Resources Web site.

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 the Benefits Unit 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
Eligibility

Establishing Eligibility
The Benefits Eligibility Level Indicator (BELI) is a code corresponding to the appointment. BELI codes are:

BELI 1: Career benefits are provided to retirement plan members who are appointed to work at least 50% time for one year or more.

BELI 2 and 3: Career Limited benefits are provided to employees who are not retirement plan members (such as those in visiting titles) but are appointed to work 100% time for three months or more or at least 50% time for one year or more.

BELI 4: CORE benefits are provided to eligible employees who are not eligible for Career or Career Limited benefits but who are appointed at 43.75% time (17.5 hours per week) or more.

BELI 5: Ineligible categories include those paid per diem, by agreement, without salary, certain student titles, etc.

Ongoing Eligibility
For the duration of the employee's appointment, the payroll system looks at the employee's title, duration of appointment, and average paid time (APT) over the past 12 consecutive months of pay and uses this information to derive a BELI. If the system-derived BELI conflicts with the departmentally-assigned BELI, the employee's name will appear on a monthly out-of-compliance report, which will be sent to the department.

If the APT falls below or increases above the eligibility requirements for the departmentally-assigned BELI, it is your responsibility to take appropriate action by:

  • correcting the BELI if a mistake has been made in setting the BELI (may result in increased or decreased benefits eligibility)
  • changing the employee's record to correctly reflect the appointment (may result in increased or decreased eligibility)
  • changing the employee's hours to conform to the appointment

In addition to the BELI codes, there are status qualifier codes to identify employees in "qualified satus" situations who would otherwise show up as out of compliance. These codes are assigned and noted on the BELI form by the department as appropriate at the beginning of the "qualified status" situation or when the employee appears on the out-of-compliance report.

The following is a list of qualified status situations and codes. See your Department Benefits Counselor for a complete explanation of status qualifier code usage.

Status Qualifier Codes (SQC):
  • SQC 10: Appointee with Ending Date for Funding Purposes Only
  • SQC 20: Average Appointment Percent Employee (Academic)
  • SQC 30: Extended Sick Leave Recipient
  • SQC 40: Employee Rehabilitation (Formally Approved)
  • SQC 50: Split Student/Non-Student Appointee Ineligible for Benefits
  • SQC 60: Seasonal Employee
  • SQC 80: "Grandfathered Employee"
  • SQC 90: Sabbatical/Leave for Professional Renewal
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.

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. 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 losing dependent status due to divorce or legal separation, or a child losing dependent status upon turning age 23 or marriage.

For more information, visit http://hrweb.berkeley.edu/benefits/cobra.htm.

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.

Life Cycle Events that May Affect Coverage

Your department's DBC can help you determine how employment life cycle events affect benefits eligibility and how you can best communicate benefits options to employees.

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
Other Resources

 

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