[UCRDBR] January 2025 Active Employee Group Insurance Regulations Updates

[Departmental Benefits Representatives]

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April 14, 2025

To:
Department Benefits Representatives (DBRs)
From:
Central HR Benefits Office on behalf of UC Office of the President
Re:
January 2025 Active Employee Group Insurance Regulations Updates

DBRs, please share this information via your internal listserv.  Do not reply to this mail.  Please send a separate email with questions to benefits at ucr.edu<mailto:benefits at ucr.edu>.


The Group Insurance Regulations (GIRs) for Faculty/Staff have been updated effective January 1, 2025.

The GIRs are posted on UCnet at: https://ucnet.universityofcalifornia.edu/tools-and-services/administrators/health-welfare-benefits.html

The following lists content changes to the GIRs:
Part II


  *   Graduate Student Researchers and Graduate Student Trainee Job Codes Added
  *   Removal of Legacy Dependents - Other Children under Family Members
     *   Eligibility criteria for adding a new Legacy Dependent - Other Children can no longer be met (enrolled prior to September 1, 1994, and under the age of 26)


  *   FMEV
     *   Inclusion of Retirees
     *   Inclusion of Re-verification Policies

Part III

  *   CORE Medical - Cannot Disenroll at Anytime
     *   Previously, employees enrolled in CORE Medical were allowed to disenroll themselves and/or their Family Members from coverage at any time.  Now that CORE Medical has a premium associated with the plan, the IRS requires the employee to have a Life Event in order to disenroll themselves and/or Family Members outside of an Open Enrollment period.


     *   Unions in "status quo" continue to fall under the previous rule, which allows for disenrollment from CORE Medical at any time.  Please note that this language does not appear in the GIRs.  This cover memo codifies this rule until all employees fall under this rule.


  *   Return from Unpaid Leave of Absence (LOA) if LOA is 120 Days or More or LOA is Less than 120 days and Return is in a New Plan Year
     *   PIE that is provided applies to all plans, not just plans the employee was enrolled in prior to the unpaid LOA


  *   Return from Unpaid LOA if LOA is Less than 120 Days
     *   When employee returns to Pay Status, mandatory re-enrollment into plans enrolled in prior to LOA

Administrative Supplements

  *   Administrative Supplement I-A Appeals Process
     *   Removal of FMEV appeal process
        *   FMEV appeals go through normal appeals process
  *   Administrative Supplement II-C Procedures for Continuing Coverage Via Direct Pay
     *   Inclusion of payment plans options for employees and postdocs expressing financial hardship
  *   Administrative Supplement III-C Payment Plans
     *   Describes the process of arranging a payment plan for employees or postdocs who owe up to 6 months of back premiums

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