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In May 2006, UC will conduct its annual random audit of employees, retirees, and their family members enrolled in UC-sponsored health and welfare plan(s). This audit is required by UC plan regulations and helps ensure that your family members enrolled in health and welfare plans are fully eligible for coverage as described in UC's Group Insurance Eligibility Factsheet.
Verification of Eligibility
The University incurs significant costs to provide group insurance coverage for employees and their family members. To ensure that only those who are truly eligible for coverage are enrolled and to meet health contract obligations, UC must verify family member eligibility.
UC HR/Benefits will randomly select a percentage of all UC members enrolled in UC-sponsored health plans and notify them in writing of the documentation required for each type of dependent. Examples of documentation include marriage or birth certificates, verification of same-sex domestic partnerships, adoption records, and tax records.
De-enrollment Period
The result of an employee or retiree enrolling ineligible individuals, failing to respond to the University's eligibility verification, or failing to provide the required documentation when requested is a 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 from any plan in which an ineligible person is enrolled.
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 from Health Net.
Continuation of coverage will be made available to the employee and eligible family members if the employee chooses to continue health coverage at their own expense.
Eligibility Rules
You can review eligibility rules for family members:
Group Insurance Eligibility Factsheet for