[UCRDBR] Group Insurance Regulations - Clarification for Involuntary Loss of Coverage (ILOC) and Retirement – Active Employee Coverage

[Departmental Benefits Representatives]

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August 15, 2023

To:
Department Benefits Representatives
From:
Central HR Benefits Office on behalf of the UC Office of the President
Re:

Group Insurance Regulations - Clarification for Involuntary Loss of Coverage (ILOC) and Retirement – Active Employee Coverage
_______________________________________________________________________________________


The following is clarification of the policy regarding the Period of Initial Eligibility (PIE) for an employee whose

spouse or domestic partner retires from the University of California (UC).



Under the Faculty/Staff Group Insurance Regulations (GIRs), a UC employee will be granted a PIE to add a dependent to their coverage if their family member experiences an Involuntary Loss of Coverage (ILOC). A UC employee enrolled in UC health and welfare benefits coverage, who loses eligibility at the time of retirement, is considered to have an ILOC event, irrespective of the retiring UC employee’s eligibility for retiree health benefits.

The continuing UC employee will be granted a PIE to add the retiring spouse or domestic partner under their UC insurance.



Dependents enrolled under the retiring UC employee’s coverage will also be considered to have an ILOC when the retiring employee loses active employee benefits. The dependents may then be added to the continuing UC employee’s coverage, even if the retiring UC employee gains coverage under retiree health benefits. The continuing UC employee may also switch health plans under this PIE. Please note that changing health plans is allowed only if family members are added to active employee coverage. The effective date of coverage under the continuing UC employee is the first of the month following the UC retiree’s loss of active employee coverage.



As it relates to retiree health benefits, retirement itself does not currently create a PIE to add or remove dependents or make changes to their retiree health plan. A UC employee or retiree may make changes (including adding or dropping dependents’ coverage) during the Open Enrollment period prior to or after retirement.



A retiring employee or retiree may make changes related to other PIEs. For example, if two married/partnered UC employees are retiring at the same time and one is not eligible for retiree health benefits (thus experiencing an ILOC when they lose active employee benefits), the individual eligible for annuitant benefits has a PIE to add their spouse or domestic partner to their retiree health benefits.  As another example, a retiring UC employee may make changes to their retiree health plan if they’re moving out of their service plan area.  Please note the Annuitant GIRs are currently under review by Retirement Policy.


NOTE: “Retiree health benefits” includes those UC employees retired under the University of California Retirement Plan (UCRP), members receiving “UCRP Disability Income”, and family members eligible for “UCRP Survivor Income”.


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