8.22 – Group Dental Plan

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Details

Scope: NMSU System

Source: ARP Chapter 8 | HR-Benefits

Rule Administrator:

Last Updated: 06/27/2016

Related

Cross-Reference:

Revision History:

2017 Recompilation, formerly Rule 7.15.10
06/27/2016 Change in Benefits approved by Board of Regents
06/21/2016 Change in Benefits approved by Chancellor
10/21/2015 Policy 7.15.05 approved as initial Rule 7.15.05 approved by Board of Regents
06/20/2013 Amendment to policy 7.15.10 approved by Board of Regents

PART 1: ELIGIBILITY


The university offers group dental insurance for all eligible employees.  Effective July 1, 2016, eligible employees are defined as those employees working at least .75 FTE in a regular, nine-month, or term appointment position.  Optional dependent coverage is also available to eligible employees.  Nine -month regular employees will receive full benefits, except for unemployment compensation, during the off employment period provided they return to employment the following academic year.  Eligible employees also include any employee continuously enrolled in this benefit from June 30, 2016.

Employees working in a position less than a .75 FTE; temporary employees; graduate assistants; other student employees; and Cooperative Extension Service employees with federal appointments are not eligible to participate in the group policy.

 

PART 2: EFFECTIVE DATE OF COVERAGE


Coverage is optional and is available from the date of eligible employment.  Coverage is effective the first pay period after 30 days of employment. Coverage may begin on the first or sixteenth day of the month.  The employee must complete and return an enrollment form to the Office of Human Resource Services department within 31 calendar days of their regular date of employment to receive this benefit.

 

PART 3: ENROLLMENT PROCEDURES


Coverage is not automatic.  Within the first 31 calendar days of employment, each eligible employee must either enroll in or waive coverage under the policy by completing an enrollment form.  Details of coverage and provisions of the dental plan are available in the plan Benefit Summary.

 

PART 4: PREMIUM PAYMENTS


Premium payments are made by payroll deduction.  The university pays a percentage of the premium for the employee and, if the employee’s dependents are enrolled in the plan, a percentage of the dependent premium also.  Premium payments begin the pay period in which coverage begins. Note: A full fiscal year of premiums (July-June) will be deducted over 18 paychecks (August – May) for 9 month faculty/staff.

 

PART 5: COVERAGE CHANGES


An employee is responsible for requesting changes to insurance coverages by completing and submitting appropriate forms in order to adjust premiums. When an employee experiences a change in status the employee has 31 calendar days from the date of the status change to contact the Office of Human Resource Services to make coverage changes.

  1. A change in status includes, but is not limited to:
    1. Marriage
    2. Divorce
    3. Childbirth or adoption
    4. Loss of prior coverage or gain of new coverage
    5. Dependent no longer meeting insurance eligibility rules due to age
  2. All status changes which result in an insurance coverage and/or premium change will be effective the day following the date of the change in status, except in the following cases:
    1. For a newborn or placement of child(ren) through adoption – the coverage becomes effective the date of birth or date of placement
    2. For divorce or legal separation – the change is effective the day the legal documents are filed with the appropriate court
    3. For dependent children who lose eligibility due to age – the change is effective the end of the month in which the dependent reaches 26 years of age.
  3. All changes that affect premiums will result in a full premium being deducted for the pay period in which the change takes place.

 

PART 6: COVERAGE AFTER RETIREMENT OR TERMINATION (12-MONTH FACULTY AND STAFF)


Coverage ceases at midnight on the 15th day of the month if employment terminates between the 1st and 15th day of the month, provided the applicable premium for the pay period has been paid. If an employee terminates employment between the 16th and last day of the month, coverage ceases at midnight on the last day of the month, provided the applicable premium for the pay period has been paid.  The policy contains continuance provisions.  Complete information on these procedures is available in the Office of Human Resource Services.

 

PART 7: COVERAGE AFTER RETIREMENT OR TERMINATION (9-MONTH FACULTY AND STAFF)


When an employee or faculty member does not return the next academic year, only dental and medical coverage will remain in effect until June 30th (all other insurances stop at the end of the pay period in which their employment ends). The policy contains continuance in compliance with state and federal law.

 

PART 8: COVERAGE DURING LEAVE WITHOUT PAY (LWOP)


During periods of LWOP, dental insurance may be continued at the option of the employee.  Continued coverage will not exceed the length of time agreed upon by the individual vendor agreements.  Arrangements for payment of premiums will be made with the Office of Human Resource Services and the Office of University Accounts Receivable. If the employee is on LWOP for a full pay period, the employee is responsible for both the university’s and employee’s portions of premium (except FMLA LWOP, Professional LWOP and Educational LWOP). Failure to make full payment of premiums may result in cancellation of coverage. If the coverage is not continued or cancelled during the leave without pay period, the employee may re-enroll during the next scheduled open enrollment period.