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State Employees' Group Benefits Program (Group Insurance) Policy
Group insurance, including health and life is available to all full-time University employees (working 75% - 30 or more hours per week - 120 or more consecutive days per year).
The following persons may be enrolled as dependents:
- Your legal spouse
- Your unmarried (never married) children under 21 years of age who are dependent upon you for support
- Your unmarried (never married) children age 21 or older, but under 24 years of age, who are enrolled and attending classes as full-time students and are dependent upon you for support. Full-time student is one enrolled in an accredited university, college, vocational, technical, or trade school or institute, or a secondary school, for the number of hours or courses considered to be full-time attendance by that school.) YOU MUST FURNISH PROOF OF FULL-TIME STATUS OF A DEPENDENT EACH SEMESTER.
- Natural or legally adopted children of you or your spouse, dependent upon you for support.
- Children who have been placed with your family for adoption, by agency adoption contract or by irrevocable act of surrender for private adoption; who are living in your household and are or will be included as a dependent on your federal income tax return for the current or next tax year.
- Other children for whom you have guardianship or legal custody that live in your household and are or will be included as a dependent on your federal income tax return for the current or next tax year.
- Grandchildren for whom you do not have legal custody or guardianship, who are dependent upon you for support and whose parent is one of your covered dependents.
The University pays a share of the premium of both health and life insurance, and the employee pays a share.
Included in the health coverage is comprehensive medical benefits, mental health and substance coverage, see the plan document, State Employees Group Benefits Program Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Ochsner Health Plan which are distributed by the Office of Human Resources. Insurance coverage is NOT automatic; IT MUST BE APPLIED FOR WITHIN 30 DAYS OF EMPLOYMENT in the Office of Human Resources Services. Coverage for each employee who completes the applicable Enrollment Form and agrees to make the required payroll contribution is to be as follows:
- If employment begins on the first day of the month, coverage is effective the first day of the following month.
- If employment begins on the second day of the month or after, coverage is effective the first day of the second month following employment;
- Employee coverage will NOT become effective unless the employee completes an Application for coverage within 30 days following the date of employment. An employee who completes an application after 30 days following the date of employment will be considered an overdue applicant.
Pre-Existing Condition (PEC)-Overdue Application - the term, pre-existing condition (PEC) - overdue application applies to all eligible employees who apply for coverage after 30 days from the date the employee became eligible for coverage and to all eligible dependents of employees for whom the application for coverage was not completed within 30 days from the date acquired. All overdue applicants must complete a "Statement of Physical Condition" and an "Acknowledgment of Pre-existing Condition" form. Medical expenses incurred during the first twelve (12) months that coverage for the employee and/or dependent is in force under the plan will NOT be considered as covered medical expenses if they are in connection with a disease, illness, accident or injury, for which medical advice, diagnosis care, or treatment was recommended or received during the six (6) month period immediately prior to the effective date of coverage.
If the covered employee was previously covered under a Group Health Plan, Medicare, Medicaid or other creditable coverage as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), credit will be given for previous coverage that occurred without a break of 63 days or more for the duration of prior coverage against the initial 12-month period. Any coverage occurring prior to a break in coverage 63 days or more will not be credited against a pre-existing condition exclusion period.
Leave of Absence
If an employee is allowed an approved leave of absence by the University, he/she may retain his/her coverage for up to ONE YEAR, if the premium is paid. Failure to do so will result in cancellation of coverage. The employee MUST NOTIFY Human Resources within 30 days of the effective date of the leave of absence.
The surviving legal spouse and children of a deceased employee are eligible to continue their health insurance coverage if they were covered by the deceased employee's insurance policy prior to that employee's death. The surviving spouse and any dependents are eligible to continue their medical coverage only. Eligibility ceases if the surviving spouse becomes eligible for other coverage, with the exception of Medicare. Also, the addition of new dependents is no longer allowed. Surviving dependents/spouse will be entitled to receive the same participant employer premium contribution as employees and retirees.
If an unmarried, never married dependent child is incapable of self-sustaining employment by reason of mental retardation or physical incapacity prior to the termination age for children and is dependent upon the covered employee for support, the coverage for the dependent child may be continued for the duration of incapacity. Prior to attainment of age twenty-one (21) the insurance company must receive documentation for dependents who are mentally retarded or who have physical incapacity.
Benefits under the health plan for a covered employee will terminate on the last day of the calendar month during which employment terminated voluntarily or involuntarily, the employee no longer meets the definition of an employee or coverage under a leave of absence expires unless the covered employee elects to continue at the employee's own expense. Employees terminated for gross misconduct are NOT eligible for COBRA. Employee must notify the Office of Human Resources Services prior to termination/resignation.
Each Health Maintenance Organization (HMO) and State Employees Group Benefits Program will hold annual enrollment period for coverage effective July 1. Transfer of coverage from State Employees Group Benefits Program to the HMO or vice-versa will only be allowed during this annual enrollment period. Transfer of coverage will also be allowed as a consequence of the employee being transferred into or out of the HMO geographic service area, with an effective date of the first day of the month following transfer.
The employee must notify the Office of Human Resources Services whenever a dependent is added to, or deleted from, the employee's coverage, regardless of whether the addition or deletion would result in a change in the class of coverage. Notice must be provided within thirty (30) days of the addition or deletion.
Group term life is available through the State Employees Group Benefits Program from The Prudential Insurance Company of America. Eligible employees may choose Basic Life ($5,000.00) or Basic plus Supplemental Life Insurance (face amount of 1 1/2 times the employee's annual salary, rounded to the nearest $1,000; maximum face amount of $50,000 on the employee). The life insurance includes special payment provisions for cases of accidental death or dismemberment. Optional dependent life insurance is also available. Active and retired employees age 65 and over, but not yet age 70, will have a face life amount of 75% of the amount in force immediately prior to attainment of age 65. Active and retired employees age 70 and over will have a face life amount of 50% of the amount in force immediately prior to attainment of age 70 (reductions in face life amounts go into effect on the July 1 following attainment of age 65 and 70).