Home < Human
Resources and Benefits Briefing < April
2007
In May, UC/HR Benefits will conduct its annual random audit of family members enrolled in UC-sponsored health and welfare plans.
Randomly selected employees and retirees will receive a letter asking them to submit documentation to verify that their family members are eligible for health and welfare benefits under UC’s rules.
The consequence for an employee or retiree enrolling ineligible individual is the permanent de-enrollment (cancellation of coverage) of the ineligible individual. In addition, the employee and all family members will be de-enrolled for 12 months. Failing to respond to the University’s eligibility verification or failing to provide the required documentation when requested will also result in de-enrollment of the ineligible individual.
For example, if it is determined through the audit process that an ineligible individual is enrolled in a UC-sponsored medical plan, such as Health Net, the employee, the ineligible family member and all other family members will be de-enrolled.
This yearly audit fulfills health contract obligations and helps ensure that those enrolled in UC health and welfare plans are fully eligible for coverage.
Review eligibility of enrolled family members
Each year, the audit results in de-enrollment of a number of UC employees,
retirees, and their family members. Employees are being asked to review their
health and welfare plan enrollments before the verification process starts
to ensure all enrolled family members are eligible under UC’s rules.
You can access your enrolled family member information through the At
Your Service website.
If you have ineligible family members enrolled, such as a child who recently married or an ex-spouse you forgot to de-enroll, complete an Enrollment, Change, Cancellation, or Opt Out form (UPAY 850) and submit the form to your local Benefits Office as soon as possible. This form is also available from your local Benefits Office. Changes made during the audit will be subject to the penalties of the audit.
In the event of de-enrollment, continuation of coverage will be offered to the employee and eligible family members, but the employee must pay the full cost health coverage at his or her own expense. UC will not make any contributions for the expense during the continuation period.
For additional information on eligibility, refer to UC’s Group Insurance Eligibility Factsheet. If you have any additional questions about the audit, please contact your local Benefits Office.
