This form must be completed and returned to Benefits Administration +0602 no later than September 27, 2013. Coverage will be effective October 1, 2013.
In order to be eligible for coverage under the University's part-time health benefit program, a part-time employee must meet a two-fold eligibility requirement: must be working at least one‑half of a specified full-time equivalent during the period for which coverage is provided, and must also have been employed by the University during at least one of the three immediately preceding semesters or summer sessions. The prior employment relationship requirement does not need to be at a level of at least one‑half of full-time equivalency. Please review the following requirements carefully before completing and submitting this form.
For purposes of this program, one-half of full-time service levels are defined as follows:
•Credit Based Lecturers - Scheduled for 6 or more credit hours of instruction for a semester.
•Non-Credit Based Lecturers - Scheduled for 90 or more contact hours during a semester.
•Administrative/Staff - Regularly scheduled to work at least 20 hours per week for the full duration of a semester.
Monthly premium rates for the program are as follows, through December 31, 2013:
|Coverage Level||SummaCare Gold 90||SummaCare Blue 80|
|Employee & Spouse/Dom Partner||1132||1014|
|Employee & Children||1075||963|
|Employee, Spouse/DP & Children||1641||1470|
|Employee & Adult Children||792||710|
|Employee & Spouse/DP & Adult Children||1358||1217|
|Employee & Children & Adult Children||1301||1166|
|Employee & Spouse/DP & Children & Adult Children||1867||1673|
Part-time members who decline to participate in the program as of the first coverage period for which they are eligible (i.e., the first February 1 or October 1 as of which they meet the applicable current and prior employment service requirements) will only be allowed to subsequently enroll in the program if they have a qualified change in family status as defined by the Internal Revenue Service (IRS).
Questions should be directed to Debbie Ann Mason in Benefits Administration at (330) 972-7072.
Once you have determined you are eligible for this program, complete the application form and return to Benefits Administration. If your eligibility is confirmed your enrollment form will be processed and you will receive monthly billing statements from SummaCare. Identification card (s) will be mailed to your residence directly from your carrier. If verification of employment status does not allow for enrollment you will be notified immediately.