||Fringe Benefits: Vision Care Insurance
||Date of Present Issue:||
||Date of Previous Issues:
- Eligibility for Group Coverage
All faculty bargaining unit members, and full-time administrative/professional
employees and ESP bargaining unit members are eligible to enroll in the
group vision care plan. Eligible employees (and/or their spouses) reaching
age 65, who elect to remain in the group insurance plan, will have vision
insurance continued under the same conditions as other employees during
the term of their employment.
New employees may enroll before the 26th of the month in which hired
or rehired for coverage effective on the first day of the following month.
New employees hired or rehired between the 26th and the last day of the
month may enroll at time of hire, but coverage will become effective
one month later. EXAMPLE: an employee hired between January 26 and February
25 will be covered March 1. An employee hired on February 26 will be
covered on April 1. Employees who fail to apply for group coverage at
the time of hire may sign up only during the yearly re-opening
period in November with coverage effective on December 1.
Newly hired, full-time faculty who have signed a letter of appointment
may complete enrollment procedures in the month prior to being initially
placed on payroll so that coverage will be effective on the first day
of the month in which they are to be placed on payroll. Usually this
will be September 1.
The group vision care plan provides for vision testing examinations
and glaucoma testing (with a $5 co-payment); lenses for correcting vision
(co-pay of $7.50 for lenses and dispensing fee); contact lenses when
medically necessary; if selected optionally, a flat fee of $35 will be
paid; and eyeglass frames every twelve months, at "reasonable and customary" rates
for qualified participating providers.
The University pays the basic rate of the one-person, two-person, or
family premium for vision care insurance, for eligible full-time employees
(employed over 26 hours per week).
The Faculty Association and Educational Support Personnel Agreements outline
contribution requirements for these two employee groups.
Children reaching age 19 may continue on the family coverage through
December 31 of the year in which they become 19. Rider coverage may be
provided for a child past age 19, possibly at the employee's expense,
by completing a Family Continuation rider application form and a payroll
deduction form for payment of premiums, if the child is:
- between 19 and 25
- a member of the subscriber's household
- subscriber provides more than half of the dependent's support
- related to the subscriber by blood, marriage or legal adoption
- a full-time student for at least five months of the year or received
gross income of less than four times the current personal exemption
identified by the IRS.
If required, the cost of the Family Continuation Riders is paid by the
employee and is deducted each month from the first paycheck of the month
for coverage for the current month.
- Changes in Coverage
Any changes in coverage: birth, death, marriage, or divorce, must be
reported immediately on a Change of Record form, available in the Human
Resources Office within 30 days of occurrence. Failure of the enrollee
to report these changes places liability for loss of coverage, or additional
costs on the individual.
- Termination of University-Paid Coverage
University-paid coverage terminates on the last day of the same month
if employment terminates on or before the 15th of any month. University-paid
coverage will be continued to the last day of the following month if
employment terminates on or after the 16th of any month.
University-paid coverage for faculty members on academic year appointments
terminating at the end of the academic year (May) will be extended through
August 31 of their year of termination.
- Cash Payments and Election of Continuation of Coverage
- Payments may be accepted for employees on unpaid medical leave, or
on unpaid leave of absence of up to one year, if payment is made prior
to the 20th of the preceding month for each month of coverage.
- The option to continue coverage in the group is available, with identical
coverage, without proof of insurability, under the same conditions
as other group members, by paying the group premium rate, plus 2%,
for the following: (COBRA Law).
18 months for employees and qualified beneficiaries who:
- Lose coverage due to termination of employment (other than
gross misconduct), reduction in work hours or layoff.
29 months for employees and qualified beneficiaries who:
- were disabled before they stopped working and then applied
for disability at the time of work termination.
- Become disabled at anytime during the first 60 days of COBRA
36 months for spouses or dependents who lose coverage for any
of the following reasons:
- Death of the subscriber.
- Employee becomes entitled to Medicare.
- There is a divorce or legal separation.
- Dependent becomes ineligible.
Election to remain in the group plan must be made within 60 days
of notification of the right to elect this option. Premiums must
be paid by the 20th of the prior month, for continuous coverage,
and retroactive payments made within 45 days of election of continuous
- Persons desiring to make payments should contact the Human Resources
Office for assistance.
- Termination of Subscriber-Paid Coverage
The University will terminate Continuation Coverage prior to expiration
of the 36- or 18-month optional period if:
- the vision plan provided to any employee is eliminated
- the beneficiary fails to pay the premium
- the beneficiary becomes eligible for another vision plan upon re-employment,
remarriage, or attainment of Medicare eligibility.
Forms are available in the Human Resources Office.