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Medical insurance eligibility

Faculty and staff who work for the UM System generally fall into one of two categories when it comes to benefits: benefit-eligible or benefit-ineligible. But eligibility for medical insurance is different because of the Patient Protection and Affordable Care Act (PPACA). Under the PPACA, some variable-hour employees become eligible for UM System medical insurance while remaining ineligible for the university’s dental, vision, life, long-term disability, and accidental death and dismemberment insurance plans.

This webpage explains what makes you eligible for UM System medical insurance, how to enroll, and how you can appeal the determination if you wish to do so. Jump to the information you’re interested in by using these links:


Am I eligible for university medical insurance?

To learn about your eligibility for university medical insurance, find the category that pertains to you from the following:

Fully benefit-eligible faculty and staff

If you are a fully benefit-eligible faculty or staff member of the UM System, you are by definition eligible for medical insurance. The PPACA in no way alters your eligibility. Fully benefit-eligible employees are those faculty and staff whose primary position is at least 75% of a full-time equivalent (FTE) position and have an indicated appointment duration of at least nine months, as defined by HR-101: Employee Status in the UM System Human Resources Manual.

The UM System offers a competitive and valuable benefits package that includes medical insurance to our 19,000 full-time, benefit-eligible employees. Our current medical plan is fully compliant with all of the coverage requirements of the PPACA. Learn more about our benefits package on the Benefits homepage.

Fully benefit-eligible faculty and staff who have waived university insurance

If you are a benefit-eligible employee, please note that the PPACA requires that you have medical coverage from some source—whether you get it from the university or another employer, your spouse’s or partner’s employer, an insurance company, or the government. But if you waived university coverage for this calendar year, then you may not enroll in a university medical insurance plan until one of two things occurs:

  • You reach the next annual enrollment period.
  • You have a qualifying family status change – These changes include the birth of a child, a marriage or divorce, a change in entitlement to Medicare, or similar. A full list of qualifying family status changes can be found in your medical insurance Summary Plan Description (SPD). Find SPDs for all plans in our forms and guides tool.
Non-benefit-eligible staff members

This section is about staff; it does not pertain to faculty. If you are a variable-hour staff member who averages 30 hours of work per week over a measurement period, you are eligible for university medical insurance, although you may decline or waive the coverage. You are not eligible for other insurance (dental, vision, etc.) unless you qualify as a fully benefit-eligible staff member as described above.

A staff member whose regular assignment is not full-time, who may or may not work a set schedule, and whose weekly hours may vary are referred to in the PPACA as “variable-hour employees.” The PPACA requires the university to offer medical coverage to variable-hour employees who average 30 work hours or more per week; the university can be fined for not offering coverage. The university measures your work hours, and if you meet the criteria for coverage during a measurement period, you will be notified by the UM System that you are eligible to enroll. Learn more about measurement periods on the PPACA webpage.

Employees who work in more than one university job may also be eligible for medical insurance if their work hours add up to 30 hours per week or more, on average, during the measurement period. Although their hours don’t vary, the combination of jobs may give them access to the university’s medical plans. 

Student workers

The term “student workers” refers to workers whose primary relationship to the university is as a student. Students use part-time jobs for several purposes, including offsetting their educational expenses and gaining work experience.

If you are a student worker who works an average of 30 hours or more per week in all university jobs over a measurement period, you are eligible for the UM System’s medical plans, although you may decline or waive the coverage. You are not eligible for other insurance (dental, vision, etc.).

The university measures your work hours, and if you meet the criteria for coverage during a measurement period, you will be notified by the university that you are eligible to enroll. Learn more about measurement periods on the PPACA webpage.

The majority of student workers do not average 30 hours per week; in fact, most work significantly less than that in order to focus on their academic programs. We expect that most student workers will remain outside the eligibility criteria.  

Adjunct faculty and other academic appointments

There are more than 1,400 part-time faculty and other academic personnel in the UM System who teach courses, perform duties within our research laboratories, tutor students, etc. These individuals rarely work more than part-time; their jobs by definition are part-time. If you are an adjunct faculty member and/or hold another academic appointment, and if you work an average of 30 hours or more per week over a measurement period, you are eligible for the university’s medical plans, although you may decline or waive the coverage. You are not eligible for other insurance (dental, vision, etc.).

Because the law determines eligibility based on hours worked, the UM System has established new policies in regard to quantifying work time for part-time faculty and other academic personnel. This is a systemwide method to ensure that those eligible are offered medical insurance. After consultation with the campus provosts, we have established that—for teaching academic personnel—every course credit hour equals 3.3 hours worked. This means a 3-credit-hour course is equivalent to 10 hours of work per week, or .25 full-time equivalent (FTE). 

Other part-time faculty and academic personnel who perform functions other than, or in addition to, teaching are required to document their hours worked. This is not an attempt to move these individuals from salary to hourly wages, but simply to track eligibility for medical benefits.

The university measures your work hours (sometimes partly based on your own reporting, as described in the previous paragraph), and if you meet the criteria for coverage during a measurement period, you will be notified by the university that you are eligible to enroll. Learn more about measurement periods on the PPACA webpage.

How do I enroll?

How you enroll for university medical insurance depends on whether you are a newly eligible employee or have ongoing eligibility:

Newly eligible employees

This information is for employees who are newly eligible for medical insurance only. Employees who are fully benefit-eligible should go to the webpage about enrolling in benefits for the first time.

If you are newly eligible for university medical insurance, because your average hours worked per week increased to 30 hours or more during a measurement period, you will be given a window of time in which you may enroll in insurance. The window of time varies; your particular enrollment period will be defined in the letter notifying you of your eligibility.

During your window of time, select and submit your medical insurance choice using myHR. Navigate to Main Menu >> Self Service >> Benefits >> Benefits Enrollment. If you cannot access myHR, you may use the Benefit Enrollment Form found on the Benefit Forms webpage. You may also wish to review the webpage about enrolling in benefits for the first time. Regardless of whether you are a new employee or an employee who has been with the university for a while now, this webpage offers a number of tools for choosing the medical insurance plan that is right for you and your family.

Ongoing eligibility

Every calendar year, employees must re-enroll in their medical insurance during the university’s annual enrollment period, or waive coverage if they do not want to enroll in any of the university’s medical plans. The UM System’s enrollment periods occur once every year in the fall, usually for two weeks in either October or November. Each period pertains to enrollment for the next calendar year (e.g., enrollment in fall 2014 pertains to your benefits for the 2015 calendar year).

If you are a fully benefit-eligible employee, you may proceed to select and submit a medical plan choice (or waive coverage) during annual enrollment. Many communications will be sent to you leading up to enrollment to help you learn about your options.

If you are a variable-hour employee who continues to work 30 hours or more per week on average, you will receive a letter in the mail notifying you that you may re-enroll in medical insurance (or waive coverage) during the annual enrollment period. The university re-measures the eligibility of variable-hour employees every year and informs eligible employees by mail that they may re-enroll. The ongoing measurement period runs from October 4 of one year to October 3 of the next year, so notifications are usually mailed in mid-October.

I was not offered medical insurance, but I think I should be. How do I request a review?

If you believe you are eligible for medical coverage, but were not offered coverage, please view the process for requesting review of your medical benefit eligibility. Visit the university’s PPACA FAQs to learn more about processes for tracking the hours worked of variable-hour employees. 

I was offered medical insurance, but I don’t think I should have been. How do I request a review?

Read the same process for requesting review of your medical benefit eligibility as described in the previous section.

Reviewed May 26, 2016.