Employee Eligibility - #310

Eligibility for benefit programs is determined by state and/or federal regulations that establish which categories of employees are eligible for specific benefit programs and when eligibility begins, changes or terminates. SGIP contribution information can be found in Procedure 200.

Definition of Employee

Editor's Note:

The style for this section is that of The Insurance Code, which is different from the style used elsewhere in this handbook. The text below is also online at http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1601.htm#1601.101.

The Insurance Code of 1951, State University Employees Uniform Insurance Benefits Act, Chapter 1601, §1601.101 (Text of section effective June 1, 2003.):

  1. An individual who is employed by the governing board of a system, who performs service, other than as an independent contractor, for the system, and who is described by this section is eligible to participate as an employee in the uniform program.

  2. An individual is eligible to participate in the uniform program as provided by Subsection (a) if the individual receives compensation for services performed for the system, is eligible to be a member of the Teacher Retirement System of Texas, and either:

    1. is expected to work at least 20 hours per week and to continue in the employment for a term of at least 4½ months, or

    2. is appointed for at least 50 percent of a standard full-time appointment.

  3. An individual is eligible to participate in the uniform program as provided by Subsection (a) if the individual:

    1. receives compensation for services performed for the system,

    2. is employed at least 20 hours a week only, and

    3. is not permitted to be a member of the Teacher Retirement System of Texas because the individual is solely employed by the system in a position that as a condition of employment requires the individual to be enrolled as a student in the system in graduate-level courses.

Eligibility for Benefits

  1. An employee's Form 500R, Request for Form 500 or EPA should be reviewed to verify eligibility (per System Policy 31.02 and System Regulation 31.02.02) before taking any action related to benefits (see Procedure 350).

  2. Employee eligibility for summer coverage if not working (taken from System Policy 31.02.02)
    In the following situations, an employee is eligible to receive the state contribution and continue insurance coverage.

    1. When an employee transfers temporarily to wages before separating from employment to provide a training period for a replacement;
    2. When an employee is on a paid leave;
    3. When an employee is on an unpaid leave of less than a full calendar month;
    4. When an employee is on a Family and Medical Leave Act leave with or without pay; or
    5. During the months an employee does not work if the employee is scheduled to work less than 12 months, was a regular employee during the semester immediately preceding the time off and is expected to continue employment in the following fiscal year.

  3. Graduate student eligibility

    1. To be eligible for benefits, graduate students must be enrolled in graduate-level classes at an A&M System institution as a condition of employment.

      1. The Graduate College at Texas A&M University has established admission and enrollment requirements for the following positions:

        1. Graduate Assistant, Teaching

        2. Graduate Assistant, Nonteaching

        3. Graduate Assistant, Research

      2. Other A&M System members have established similar admission and enrollment requirements for the following positions:

        1. Graduate Assistant, Extension

        2. Graduate Student Worker

        3. Graduate Student Intern

        4. Graduate Coaching Assistant

        5. Graduate Library Assistant

    2. The term of employment should be indicated on the Form 500R or EPA source lines.

    3. If a graduate student employee experiences a break in service and the effective date of resumption of employment is not in the following month, the graduate student should be placed on leave of absence without pay (LWOP) status.

    4. When a graduate student employee with health, dental or vision benefits terminates employment, he/she must be offered the opportunity to continue to participate in benefit plans according to federal COBRA regulations.

    5. Like other 9- or 10½-month employees, a graduate student employee who is eligible for benefits will receive the state contribution (SGIP) during the summer if his/her department has a reasonable expectation that he/she will be offered benefit-eligible employment in the fall semester. For a graduate student employee for whom the department does not have a reasonable expectation of benefit-eligible employment in the fall semester, benefits should be terminated and COBRA offered. If the graduate student is billed for his/her summer premiums but does not pay the premiums, his/her coverage will be cancelled at the end of the month in which the last premium was collected. If the graduate student is employed again in the fall, and re-enrolls in coverage, he/she will have new start dates and will have a new pre-existing period before benefits would be paid if enrolled in Long-Term Disability.
  4. Prior to 9-1-12, post-doc fellows were considered eligible for SGIP. As of September 2012, they
    are still eligible for insurance but are no longer eligible for SGIP. Section (d) of 1601.101 has
    been repealed and replaced with Section 1601.1021 (reproduced for your assistance, below).
    Sec.A1601.1021.AAPARTICIPATION ELIGIBILITY: CERTAIN POSTDOCTORAL
    FELLOWS AND GRADUATE STUDENTS.
    1. An individual who is not eligible to participate in the uniform program under Section
      1601.101 is eligible to participate in the uniform program under this section if the individual, at
      an institution in a system:
        1. holds:

          (A) a postdoctoral fellowship; or
          (B) one or more graduate student fellowships awarded to the individual on a
          competitive basis that, either singly or in combination, are valued at not less than
          $10,000 per year; and

        2. is currently receiving a stipend from an applicable fellowship.
    1. An individual who is eligible to participate in the uniform program under this section shall
      pay all contributions required under this chapter for the coverage selected by the individual,
      except that an institution of higher education may make contributions for the individual from
      available funds other than money appropriated to the institution from the general revenue fund.
    2. An institution of higher education shall determine which individuals are eligible to participate
      in the uniform program under this section and, at the time of initial eligibility, shall notify each
      individual of the individual’s eligibility to participate in the program.
    3. An individual who participates in the uniform program under this section is not considered an
      employee of an institution of higher education solely as a result of the individual’s participation
      in the program.

    This means coverage must be made available to individuals who are technically not employees
    of the A&M System. Because this will be a small group and because they will be liable for the
    full cost of coverage, the most expedient way to code the individual would be to follow the rules
    for coding a survivor and bill the individual for coverage, since we do not pay him or her and
    cannot withhold premium from a paycheck. This would require the person to be given a UIN
    and would also require a minimum amount of information to be collected for the 101 screen.

    The legislation allows an institution to make funds available for the employer premium portion
    other than money appropriated from general revenue funds. As with other similar coverage
    situations, System Benefits Administration asks that you treat similarly situated individuals in
    the same manner; meaning that if your institution decides to contribute to the cost of coverage
    for a particular post doc fellow, you then contribute to coverage for all.

    Add a comment to the 106 screen that this is a post-doc fellow (grad student on fellowship) not a
    survivor. You will need to develop your own notification procedure when the individual has
    completed the fellowship so that you can terminate the coverage.

  1. Wage employees are normally not eligible for benefits. However, if a wage employee is expected to be employed for 4½ months or has worked for more than 4½ months, he/she becomes eligible for benefits and is required to contribute to TRS (see Procedure 410).

  2. Eligibility questions not answered by this manual should be addressed to the Employee Benefits Manager, System Benefits Administration.

 

Benefit Procedures Manual • August 2013