Guidelines for Enrollment

Important information about APS employee benefits.

Introduction

Through its Benefits Program, Albuquerque Public Schools helps you pay health care expenses, build capital for the future and provide financial security for you and your family. The program also offers you a range of optional benefits, including extending coverage to family members, to let you customize your coverage to meet your personal needs. You contribute towards the cost of any optional benefits you elect.

This APS District believes our current health plans are a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that our plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination
of lifetime limits on benefits.

Your benefit enrollment is very important. Please review the following guidelines to assist you in submitting the appropriate forms and documentation to enroll in the APS benefit plans offered. Timely submission of your forms and documents will ensure coverage for you and your family members. If you have any questions
about your benefit plan options, please contact the APS Employee Benefits Department at (505) 889-4859.

Eligibility

Who is eligible?

• You, if you are classified as full-time (working 30 hours or more per week) and/or current part-time employees already enrolled for benefits who work at least a .45 FTE or greater
• Your legal spouse
• Your Domestic Partner (must complete notarized Affidavit of Domestic Partnership)
• Your married or unmarried natural, adopted children or stepchildren under age 26. Dependents under the age of 26 who have access to other employer-sponsored coverage effective for plan years beginning on or after January 1, 2011 are not eligible for coverage under APS Employer-sponsored medical plans.
• Your foster children for whom you have a placement order (married, unmarried and under age 26). Dependents under the age of 26 who have access to other employer-sponsored coverage effective for plan years beginning on or after January 1, 2011 are not eligible for coverage under APS Employer-sponsored medical plans.
• Your other children for whom you have legal guardianship ( married, unmarried and under age 26). Dependents under the age of 26 who have access to other employer-sponsored coverage effective for plan years beginning on or after January 1, 2011 are not eligible for coverage under APS Employer-sponsored medical plans.

* Extended family members are not eligible under any circumstance.

Part-time Benefits Eligibility

Full-time employees who elect to move to part-time status may continue their  current insurance benefits (with the exception of long term disability) provided:

• The employee has completed 12 continuous months of service or one contract year of employment with APS as a full-time employee; and

• Part-time employment for purposes of benefit continuation is .45FTE or greater; and
• The employee’s premium contribution rate is based on his/her annualized salary. Therefore, premium rates will remain the same and will not change to a lower  amount when the status changes to parttime.
• Long Term Disability, (LTD) is not offered to part-time employees in keeping with industry standard and underwriting policies.
• If a part-time employee currently enrolled for benefits cancels coverage, he/she will no longer be eligible for benefits unless he/she changes to full-time status.  Benefits coverage must be continuous.

When Can I Enroll?

A new full-time employee has 60 days from the date of hire in which to enroll for benefit plan coverage offered by Albuquerque Public Schools. An employee may also enroll within 60 days of incurring a “change of status/qualifying life event”. Qualifying Life Events are listed below.

Member Responsibilities

• Timely notification (within 60 calendar days of a qualifying event)
• Timely enrollment (within 60 calendar days of a qualifying event)
• Timely submission of documents (within 60 calendar days of a qualifying event,  provided you enroll within 60 days)

General Enrollment Guidelines

• Employer Paid Basic Life & Accidental Death & Dismemberment (AD&D) Coverage
  If you work the minimum number of hours per week, you are automatically covered for Basic Life & AD&D Insurance for a principal sum of $5,000. The District provides basic life and AD&D coverage at no cost to you. You should complete a beneficiary designation card, even if you do not enroll for any other benefit.
• The Two-Year Lock-in Dental Rule
  Late enrollment is not allowed for APS dental coverage unless you involuntarily lose their dental coverage or unless you enroll during the annual Switch/Open  Enrollment period held in October. If you apply for dental during Switch/Open Enrollment, your coverage will begin January 1st of the following year. Once enrolled in dental, you may not drop or switch dental plan options until you and each of your covered dependents have been enrolled for two years.
• The Two-Year Lock-in Vision Rule
  Late enrollment is not allowed for APS vision coverage unless you involuntarily lose  other vision coverage or unless you enroll during the annual Switch/Open  Enrollment period held in October. If you apply for vision during Switch/Open  Enrollment, your coverage will begin January 1st of the following year. Once enrolled in vision, you may not drop the plan until you and each of your covered  dependents have been enrolled for two years.
• The Medical/Prescription Drug Coverage - Plans’ 6-month Pre-Existing Condition Exclusion
  If you enroll into any of the medical plans and you are a new hire or newly eligible employee, there is a 6-month pre-existing condition exclusion that will apply. (Pre-existing conditions limitation does not apply to pregnancy, newborns, newly adopted children, and children under age 19 in compliance with the Patient Protection and Affordable Care Act). This 6-month period could be reduced if you had prior health coverage and have not been without coverage for 95 days or more.
• The Late Entrant Rule
  If you decline any coverage, or if you have not enrolled timely (past 60 days for enrollment), you and/or your dependents are late enrollees. As late enrollees, you and/or your family will be subject to the following conditions:
• No late enrollment is allowed into the Dental or Vision Plans, unless you apply within 60 days from involuntarily losing other dental or vision coverage.
• Late enrollment is allowed into all medical plans but 18-month pre-existing condition exclusions will apply. (Pre-existing conditions limitation does not apply to pregnancy, newborns, newly adopted children, and children under age 19 in compliance with the Patient Protection and Affordable Care Act). This 18-month pre-existing condition exclusion period if applicable, could be reduced if you had prior health coverage and have not been without coverage for 95 days or more.
• Late enrollment into the Voluntary Life and Long Term Disability plans is subject to approval by The Standard, based on medical underwriting. There is no guarantee you will be approved.

Forms and Required Documents

Completing the correct paperwork is crucial to your enrollment into the plans offered. APS requires dependent documentation to safeguard against fraudulent enrollments.

• Your Social Security Number (SSN) is required to meet the requirements of the Mandatory Insurer Reporting Law (Section 111 of Public Law 110-173) for purposes of coordination of benefits for all insured members (employee, spouse and dependent children) to the Centers for Medicare and Medicaid Services (CMS).
• A marriage certificate is required to enroll a spouse.
• An affidavit and evidence of financial responsibility is required to enroll a Domestic Partner.
• Download the Affidavit of Domestic Partnership
• Download the Domestic Partners Policy
• Download the Termination of Domestic Partnership form
• A birth certificate and/or Adoption Decree provided by a court are required to enroll a child.
• A qualified medical child support order is required for children for whom you are legally responsible to provide health care coverage.
• A Placement Order is required to cover foster children.
• Legal guardianship papers are required (if the child is not your child or adopted).
• Loss of Coverage Letter from prior employer (if enrolling due to an involuntary loss of coverage)

Qualifying Life Events

• New Hire — Complete Enrollment/Change Form and Beneficiary Designation within 60 days from date of hire.
• Marriage — Complete Enrollment/Change Form within 60 days of event. Review your beneficiary designation for any changes or updates necessary.
• New Baby — Complete Enrollment/Change Form and provide copy of Birth Certificate or Hospital Proof of Birth within 60 days of date of birth.
• Divorce — Complete Enrollment /Change Form as soon as possible (not later than the end of the month in which the divorce decree is final). Provide a copy of Final Divorce Decree to include first and last page and any section concerning health insurance. Review your beneficiary designation for possible changes. Timely notification is required to provide COBRA continuation coverage. It is fraudulent to continue coverage for your ex-spouse on the APS active health plans.
• Employment Status Change — Change in status from Part-time to Full-time (working 30 hours or more per week) – May enroll in all benefits offered to full-time employees. (Marriage certificate required to add spouse/birth certificate to add children/affidavit for domestic partner).
• Full-time Short-term Employees — May enroll in all benefits when first hired ONLY. If coverage is dropped employee will be subject to Late Entrant Rules. If employee’s contract is renewed after the first day of school, he/she will receive a new “Hire Date”. Employee is considered a new hire and may enroll in benefits at that time.
• Involuntary Loss of Coverage — Complete Enrollment/Change form to add the coverage you and your eligible family members lost within 60 days of the loss. Provide Loss of Coverage letter from previous employer which specifies who was covered, type of coverage and the date coverage terminated. Include required dependent documentation. Effective date of coverage for you and/or your family will be the 1st day of the month following  the date you submit your Enrollment/Change form and required documentation. If you fail to meet these deadlines, you will be subject to Late Entrant Rules.
• Your Child turns Age 26 — Complete Enrollment/Change Form. If you do not complete an Enrollment/Change Form, the Plan Administrator will cancel coverage at the end of the child’s birthday month and forward a Confirmation Notice.
• Change of Address — Complete APS Name/Address Change Form within 30 days of change to ensure that your benefit information is updated to reflect new address.
• Leave of Absence — For 10 or more consecutive days of absence, contact the Extended Leaves Specialist, Human Resources Department at 889-4865 to file for Extended Leave of Absence. Please refer to APS Employee Handbook and/or Negotiated Agreement if applicable.
• Resignation, Retirement, or Termination — Contact the APS Employee Benefits Department to find out when your coverage ends. COBRA continuation of coverage may be available.

Insurance Fraud (Federal and State Insurance Laws Apply)

Anyone who knowingly or willfully makes any false or fraudulent statement or representations shall risk forfeiting all employee and dependent rights to coverage or benefits. APS will take the appropriate disciplinary action against the offending official or employee.