2,111: Eligibility and Enrollment for Group Health Insurance

Revised: November 2017

Eligibility: An employee must have an FTE of at least 50% to be eligible for health insurance coverage. An employee may not be covered both as an employee and as a dependent; if an employee is eligible for their own group health insurance coverage through the Nevada System of Higher Education (NSHE), they may only be covered as an employee. Employee categories that are typically eligible for health insurance coverage are:

• Classified employees at 53% FTE or greater
• Academic and Administrative Faculty employees at 50% FTE or greater
• Postdoctoral Scholar employees at 50% FTE or greater
• Letter of Appointment employees at 50% FTE or greater
• Graduate Assistants (insurance coverage through Graduate School)
• Medical Residents (insurance coverage through Medical School)

Employees not eligible for medical insurance through NSHE include:

• Casual, temporary, hourly, or seasonal employees who are not reasonably expected to be full time or work more that 50% FTE. "Not reasonably expected to be full time" is defined in the NSHE Affordable Care Act (ACA) policy as an employee hired for a position that is not expected to average 130 or more hours of service per month.
• Student employees
• Letter of Appointment employees at 49% or less

Per NSHE ACA policy, hourly and variable hour employees who are not reasonably expected to be full time will be placed into a ten (10) month initial measurement period to determine if the employee is averaging more than 130 hours of service per month during the initial measurement period. If the employee averages more than 130 hours of service per month during the initial measurement period, the employee will be offered medical health insurance through NSHE starting on the first day of the calendar month following the end of the initial ten (10) month measurement period.

Health Insurance Effective Date: Health insurance is effective on the first day of the month that follows or coincides with the eligible employee's hire date.

Health Insurance Enrollment: Health plan includes medical, prescription, dental, vision, term life insurance, and long term disability. All new health insurance eligible employees must enroll themselves and their eligible dependents, if dependent coverage is desired, within 15 days of their hire date. Employees will receive enrollment information via email and through regular mail and will have the opportunity to attend a new hire benefits orientation in person or online. Health Insurance Enrollment Forms and supporting documentation must be completed and returned to the Human Resources Office within the allotted 15-day enrollment period.

If the employee does not complete their insurance election within the first 15 days of their hire date, they may be automatically enrolled in "default coverage". Default coverage is the self-funded Consumer Driven Health Plan (CDHP) with the Health Reimbursement Arrangement (HRA). Default coverage is for the employee only. If dependents such as a spouse, domestic partner, or children under the age of 26 are not enrolled when the employee is first hired, they can only be enrolled during the annual open enrollment period or upon the occurrence of a mid-year qualifying event (examples: marriage, divorce, birth of baby, loss of health insurance through spouse's employer) as defined by Public Employees' Benefits Program (PEBP) and IRS regulations. Proof of the mid-year qualifying event and the request to add dependents to the employee's current PEBP Insurance Plan must be presented within 60 days of the occurrence of the mid-year qualifying event.