Group insurance, including health and life is available to all
full-time University employees (working 75% - 30 or more hours per week
- 120 or more consecutive days per year). The following persons may be
enrolled as dependents:
- Your legal spouse
- Your unmarried (never married) children under 21 years of age who are dependent upon you for support
- Your unmarried (never married) children age 21 or older, but under
24 years of age, who are enrolled and attending classes as full-time
students and are dependent upon you for support. Full-time student is
one enrolled in an accredited university, college, vocational,
technical, or trade school or institute, or a secondary school, for the
number of hours or courses considered to be full-time attendance by
that school.) YOU MUST FURNISH PROOF OF FULL-TIME STATUS OF A DEPENDENT
- Natural or legally adopted children of you or your spouse, dependent upon you for support.
- Children who have been placed with your family for adoption, by
agency adoption contract or by irrevocable act of surrender for private
adoption; who are living in your household and are or will be included
as a dependent on your federal income tax return for the current or
next tax year.
- Other children for whom you have guardianship or legal custody that
live in your household and are or will be included as a dependent on
your federal income tax return for the current or next tax year.
- Grandchildren for whom you do not have legal custody or
guardianship, who are dependent upon you for support and whose parent
is one of your covered dependents.
The University pays one half of the premium of both health and life
insurance and the employee pays the other half. Included in the health
coverage is comprehensive medical benefits, mental health and substance
coverage, see the plan document, State Employees Group Benefits
Program Preferred Provider Organization (PPO), Exclusive Provider
Organization (EPO) and Ochsner Health Plan which are distributed by the
Office of Human Resources Services, Southern University System.
Insurance coverage is NOT automatic; IT MUST BE APPLIED FOR WITHIN 30
DAYS OF EMPLOYMENT in the Office of Human Resources Services. Coverage
for each employee who completes the applicable Enrollment Form and
agrees to make the required payroll contribution is to be as follows:
- If employment begins on the first day of the month, coverage is effective the first day of the following month.
- If employment begins on the second day of the month or after,
coverage is effective the first day of the second month following
- Employee coverage will NOT become effective unless the employee
completes an aplication for coverage within 30 days following the date
of employment. An employee who completes an application after 30 days
following the date of employment will be considered an overdue
Pre-Existing Condition (PEC)-Overdue Application -
the term, pre-existing condition (PEC) - overdue application applies to
all eligible employees who apply for coverage after 30 days from the
date the employee became eligible for coverage and to all eligible
dependents of employees for whom the application for coverage was not
completed within 30 days from the date acquired. All overdue applicants
must complete a "Statement of Physical Condition" and an
"Acknowledgment of Pre-existing Condition" form. Medical expenses
incurred during the first twelve (12) months that coverage for the
employee and/or dependent is in force under the plan will NOT be
considered as covered medical expenses if they are in connection with a
disease, illness, accident or injury, for which medical advice,
diagnosis care, or treatment was recommended or received during the six
(6) month period immediately prior to the effective date of coverage.
If the covered employee was previously covered under a Group Health
Plan, Medicare, Medicaid or other creditable coverage as defined in the
Health Insurance Portability and Accountability Act of 1996 (HIPAA),
credit will be given for previous coverage that occurred without a
break of 63 days or more for the duration of prior coverage against the
initial 12-month period. Any coverage occurring prior to a break in
coverage 63 days or more will not be credited against a pre-existing
condition exclusion period.
Leave of Absence - If an employee is allowed an
approved leave of absence by the University, he/she may retain his/her
coverage for up to ONE YEAR, if the premium is paid. Failure to do so
will result in cancellation of coverage. The employee MUST NOTIFY Human
Resources Services within 30 days of the effective date of the leave
Surviving Dependents/Spouse - the surviving legal
spouse and children of a deceased employee are eligible to continue
their health insurance coverage if they were covered by the deceased
employee's insurance policy prior to that employee's death. The
surviving spouse and any dependents are eligible to continue their
medical coverage only. Eligibility ceases if the surviving spouse
becomes eligible for other coverage, with the exception of Medicare.
Also, the addition of new dependents is no longer allowed. Surviving
dependents/spouse will be entitled to receive the same participant
employer premium contribution as employees and retirees.
Over-age dependents - If an unmarried, never
married dependent child is incapable of self-sustaining employment by
reason of mental retardation or physical incapacity prior to the
termination age for children and is dependent upon the covered employee
for support, the coverage for the dependent child may be continued for
the duration of incapacity. Prior to attainment of age twenty-one (21)
the insurance company must receive documentation for dependents who
are mentally retarded or who have physical incapacity.
COBRA - Benefits under the health plan for a
covered employee will terminate on the last day of the calendar month
during which employment terminated voluntarily or involuntarily, the
employee no longer meets the definition of an employee or coverage
under a leave of absence expires unless the covered employee elects to
continue at the employee's own expense. Employees terminated for gross
misconduct are NOT eligible for COBRA. Employee must notify the Office
of Human Resources Services prior to termination/resignation.
Open Enrollment - Each Health Maintenance
Organization (HMO) and State Employees Group Benefits Program will hold
annual enrollment period for coverage effective July 1. Transfer of
coverage from State Employees Group Benefits Program to the HMO or
vice-versa will only be allowed during this annual enrollment period.
Transfer of coverage will also be allowed as a consequence of the
employee being transferred into or out of the HMO geographic service
area, with an effective date of the first day of the month following
The employee must notify the Office of Human Resources Services
whenever a dependent is added to, or deleted from, the employee's
coverage, regardless of whether the addition or deletion would result
in a change in the class of coverage. Notice must be provided within
thirty (30) days of the addition or deletion.
Life Insurance - Group term life is available
through the State Employees Group Benefits Program from Continental
Assurance Company (CAN). Eligible employees may choose Basic Life
($5,000.00) or Basic plus Supplemental Life Insurance (face amount of 1
½ times the employee's annual salary, rounded to the nearest $1,000;
maximum face amount of $40,000 on the employee). The life insurance
includes special payment provisions for cases of accidental death or
dismemberment. Optional dependent life insurance is also available.
Active and retired employees age 65 and over, but not yet age 70, will
have a face life amount of 75% of the amount in force immediately prior
to attainment of age 65. Active and retired employees age 70 and over
will have a face life amount of 50% of the amount in force immediately
prior to attainment of age 70 (reductions in face life amounts go into
effect on the July 1 following attainment of age 65 and 70).
Office of State Group Benefits
A. Office of Group Benefits 2008-09 Rates These are the new rates for the health insurance that will be effective 7-1-2008.
- Official Schedule of Premium Rates
- Official Schedule of Premium Rates - Medicare Advantage Plans
B. New OGB dependent verification policy
- Instructions for PLAN Members - Dependent Verification
- Notice to PLAN Members - Dependent Verification
C. Fees - This is in regards to the dependent verification and any
fees associated with getting another copy of a marriage license or