EDB MANUAL

UCLA Payroll Services

A guide for departments to use when adding or changing employee records on the Employee Data Base (EDB).
EDB MANUAL, SECTION E - BENEFITS

E5.0 EDB BENEFITS - HEALTH AND WELFARE BENEFITS


To meet the varied needs of its employees, the University offers a comprehensive and competitive health and welfare benefits program that includes medical, dental, vision, life and accident, disability and legal insurance.

E5.0 (a) Dual Coverage

UC Group Insurance Regulations DO NOT permit dual coverage. An employee may be covered as an employee or annuitant OR as an eligible family member of a UC employee or annuitant. They may NOT be covered as both. If the employee has medical, dental, or vision coverage as an eligible family member and then becomes eligible for UC coverage as an employee, there are two options:

If both parents are UC employees or annuitants, only ONE parent may cover the children.

E5.1 Enrollment Procedures

Family members (EFM’s) are eligible for coverage on UC group insurance plans as long as they meet the requirements shown on Chart 4.C.

Below are the two screens in the Benefits Bundle: BENE.

 PPEINS0-E1440                 EDB Entry/Update                12/18/YY 11:41:09
 12/13/YY 23:41:35           Insurance Enrollment              Userid:  ABCDE   
 ID: 121212121 Name: EXAMPLE,IMA                                  Pri Pay: MO    
 Assigned BELI:     Derived BELI:     Effective Date:                           
 BELI Status Qualifiers:  Primary:    Date:         Secondary:    Date:         
 CURRENT ENROLLMENTS
         Plan  Cov Eff Date End Date    Opt Out                   BRSC          
 Medical  HN   UA   0701YY                                                      
 Dental   D1   UA   0701YY                                                      
 Vision   VI   UA   0701YY                                                      
 Legal                                                                          
 Future Enrollment Pending: NO   State Dom Part Dec:     Contribution Base:  42 
                                              Cov Eff Date    BRSC              
 AD&D       Prin Sum: 100 Coverage   : S         0715YY                         
 Disability Wait Per: 030 Salary Base:  3179     0401YY                         
 Supplemental Life  : 1   Salary Base:  39       0701YY                         
 Dependent Life Plan:                                                           
 Basic Life         :     Salary Base: 039       0701YY                         
 Insurance Reduction Code  :                                                    
 Next Func:      ID:           Name:                            SSN:            
                                                                                
 ===>                                                                           
 F:  1-Help      2-Jump      3-PrevMenu                                        
 F:                          9-Update                           12-Exit
  1. The EINS - Insurance Enrollment Screen (above) is used to enroll, change, or cancel an eligible employee in University benefits.  

  2. The EDEP - Dependent Data Screen (below) is used to enroll, change, or cancel an eligible dependent's benefits.

PPEDEP0-E1281                 EDB Entry/Update                07/02/YY 12:01:44
07/01/YY 23:42:39              Dependent Data                 Userid:  ABCDE   
ID: 121212121 Name: EXAMPLE,IMA                               Pri Pay: MO    
                                                                  Pg 1  of 1    
                                                                                
     Dependent Name                 Deenrol Birth  Coverage Effective/End Dates 
 No  Relationship         Sex SSN     CTL   Date   Medical Dental Vision Legal  
 51  EXAMPLE,ASA N                         081260  0701YY  0701YY 0701YY        
     S SPOUSE              M 212121212                                          
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
                                                                                
 Next Func:      ID:           Name:                            SSN:            
                                                                                
 ===>                                                                           
 F:  1-Help      2-Jump      3-PrevMenu                                        
 F:                          9-Update                           12-Exit        


E 5.1 (a) How to Enroll Employee in Health and Welfare Plans

All enrollments have to be processed during the PIE - Period of Initial Eligibility, which is the first 31 days from the Eligibility date.

  1. Go to the screen function BENE - the 1st screen in the Bundle is EINS. It will open with the cursor blinking on the ‘Assigned BELI’ Always ‘tab’ to move the cursor; it will direct you to the fields that require data entry
  2. Check the Assigned BELI – it should be the same as the ‘DERIVED BELI’ (exceptions apply)
  3. Tab directly to the Medical Plan field to enter the Medical Plan Code
  4. Keep the cursor on the Medical Plan field and press F1 for the list of available codes
  5. Put the cursor on the requested code and press F4 to copy the code in the field
  6. Tab to ‘Effective Date’ and enter it as MMDDYY- usually it is the same as the BELI effective date (exceptions apply)
  7. Tab three times – skip ‘End Date’ and ‘BRSC’ fields. The ‘End Date’ field is used to end coverage. This field will automatically derive end dates as soon as there is a ‘Separation’ or ‘Termination’ date in the system. At the ‘Dental Plan’, ‘Vision Plan’ and ‘Legal Plan’ fields repeat steps 4-7
  8. Tab a few times until the cursor lands on the field ‘Prin sum:’ for the Accidental Death & Dismemberment (AD&D) coverage
  9. Press F1, find the requested amount of coverage, the Principal Sum, put the cursor on the code for the sum requested, press F4 to copy
  10. Tab to ‘Coverage’, Press F1, put the cursor on the requested code, press F4 to copy
  11. Tab to ‘Cov Eff Date’. The effective date for the AD&D plan is ALWAYS the date of entry: Today’s Date MMDDYY
  12. Skip BRSC and tab to ‘Disability Wait Per’*, Press F1, put the cursor on the requested code, press F4 to copy
  13. Skip ‘Salary Base’**, tab to ‘Cov Eff Date’. The effective date is the same as the BELI effective date: MMDDYY
  14. Skip BRSC, tab to ‘Supplemental Life’*, Press F1, put the cursor on the requested code, press F4 to copy
  15. Skip ‘Salary Base’*, tab to ‘Cov Eff Date’. The effective date is the same as the BELI effective date: MMDDYY
  16. Skip BRSC, tab to ‘Dependent Life Plan’*, Press F1, put the cursor on the requested code, press F4 to copy
  17. Tab to ‘Cov Eff Date’. The effective date is the same as the BELI effective date: MMDDYY
  18. If there are NO family members to enroll, press ENTER, review the information entered, Press F9, enter comments regarding enrollment: (e.g. ‘Enrolling employee in all benefits effective MMYYDD, no eligible family members’), Press F9 again to complete enrollment

Encourage employees to use the website http://atyourservice.ucop.edu for enrollment!

*Any Level of coverage is available during PIE ONLY. Enrollment outside of PIE requires a ‘Statement Of Health’ approval from the insurance carrier. Such enrollment is processed in the Central Benefits Office.

**Salary Base - EDB should have already derived the monthly and annual salary base from information on the appointment screen. If this base does not appear, or if it is incorrect, please contact your Central Benefits Office.

E5.1 (b) How to Cancel Health and Welfare Coverage

  1. To cancel MEDICAL, DENTAL, VISION, & LEGAL plan coverage, go to EINS
  2. Tab to the field right below the Coverage Effective date, which is the Coverage End Date
  3. Enter the last day of coverage. (e.g. Employee wants to terminate coverage in June. Premiums for the above plans are paid in advance and are NOT prorated. The last day of coverage will be June 30th.) Enter coverage End Date: MMDDYY (0630YY)
  4. Press F9 to update. You have now terminated coverage effective the day following the Coverage End Date entered on the EINS screen
  5. To cancel AD&D, SUPPLEMENTAL DISABILITY, SUPPLEMENTAL LIFE, & DEPENDENT LIFE plan coverage, put an asterisk (*) on the first digit of each entered field then press F9
  6. Make a comment regarding the cancellation request/process on the PAN (Post Audit Notification) screen and press F9 again to complete cancellation
  7. Fill out the shaded sections of the UBEN 102 ‘COBRA’ Enrollment Form and sign it.
  8. Give/mail (Certified) the form and the COBRA* Instructions Packet to the employee within 30 days of the separation/cancellation date.

    *COBRA Packet & UBEN 102 available at: http://atyourservice.ucop.edu/forms_pubs/subject/cobra.html

E5.1(c) How to Enroll Dependents

  1. If there are family members to enroll, go to the Benefits Bundle, BENE, and press F11 to skip to the 2nd screen; or you may bypass the BENE bundle and go to EDEP.
  2. The screen will open up with the cursor blinking on the field of NO. The field is for the family member number. The spouse is normally assigned number 51 and other dependents are assigned subsequently, i.e. 52, 53, etc.
  3. Tab to the next field: ‘Dependent Name’. Enter Last name (or = if dependent’s last name is the same as the employee’s last name), comma, First name, space, Middle initial.

    For example: =,Michael E

  4. Tab to the field ‘Birth Date’. Enter it as MMDDYY
  5. The cursor will jump to the following field, which is the Medical coverage Effective date. Enter MMDDYY
  6. The cursor will jump to the Dental coverage Effective date. Enter MMDDYY
  7. The cursor will jump to the Vision coverage Effective date. Enter MMDDYY

  8. The cursor will jump to the Legal coverage Effective date. Enter MMDDYY

  9. The cursor will jump to the field below the ‘Dependent Name’, which is the ‘Relationship’. Keeping the cursor on the field, press F1, find the corresponding relationship code, put the cursor on the code, and press F4 to copy
  10. Tab to the field ‘Sex’; enter F for Female or M for Male
  11. The cursor will jump to the field: SSN, which is the Social Security Number. Enter SSN
  12. If there is another family member, tab to the field NO and enter the subsequent dependent number and follow steps 1-11.
  13. The field right below the Coverage Effective date is the coverage End date. The field should always be blank unless you mean to terminate coverage for the specific dependent
  14. Once the information is entered correctly, press Enter, then F9, make comments on the PAN (Post Audit Notification) screen, then press F9 again to complete the enrollment

E 5.1(d) How to Cancel Health & Welfare Coverage for Dependents

  1. To cancel or end coverage for family member(s), go to the screen function EDEP
  2. Tab to the field right below the Coverage Effective date, which is the Coverage End Date
  3. Enter the last day of coverage: MMDDYY
  4. Press F9 to update. The message at the bottom of the screen will say: “Update Process Complete”.
  5. Fill out the shaded sections of the UBEN 102 ‘COBRA’ Enrollment Form and sign it
  6. Give/mail (Certified) the form and the COBRA* Instructions Packet to the employee or dependent within 30 days of the separation/cancellation date.

    *COBRA Packet & UBEN 102 available at : http://atyourservice.ucop.edu/forms_pubs/subject/cobra.html

E5.2 New Hire Enrollment Procedure

To enroll in benefit plans, the newly hired employee should go to the UCOP website at http://atyourservice.ucop.edu.

E5.2(a) Initial Hire Data

EDB preparers must do the following before the employee can use the website to enroll:

E5.2(b) Steps in the New Hire Website Enrollment Process

NOTE:  The website is available seven days a week, 24 hours a day.

Tasks for the  Departmental EDB Preparer:

  1. Give the employee information about the various employee benefit plans (i.e., Your Group Insurance Plans, Summary Plan Description, provider directories/carrier website addresses and spreadsheets).
  2. Advise the Employee to do the following:
    1. Go to http://atyourservice.ucop.edu.
    2. Click on New Employees.
    3. Read through and listen to the Health & Insurance Orientation.
    4. When ready to begin enrollment, click on Log on.
    5. Enter Social Security number and UC Password, which is the employee's Date of Birth (dd/mm/yyyy) by default.  Create a password then proceed.
    6. Keep a record of the confirmation number.  A confirmation statement will be generated at the end of the transaction. The employee should verify enrollment upon receipt of the first direct deposit statement or check-stub received after enrolling in the benefit plans.

The employee’s choices are automatically registered, and the information downloaded into the Personnel/Payroll System (PPS).  However, the insurance carriers will not receive the enrollment information until 30 days from the date of enrollment.  Employees should allow 30 days before making an appointment to see a doctor.  If a visit to a doctor is necessary before the 30 day period is completed, contact the appropriate  Central Benefits Office to expedite the update.

E5.2(c) Documents to Employees

The EDB preparer should give the Employee three IDOC’s:

NOTE: The PIE end date is 31 days from the date of hire (calculated from the most recent hire date).

E5.2(d) Limitations

  1. Employees may select plans on one or multiple on-line transactions. However, they may NOT change a plan selection once the system gives them a confirmation number.
  2. Dependents being added to plans must be enrolled during the same on-line session prior to confirmation of the transaction.
  3. Once "confirmed," employees may not go back on-line to add or delete family members.  The have to complete the UPAY850 form.

E5.2(e) New Hire Enrollments Requiring a Form and EDB Update by Preparers

The following transactions should be entered on the EDB directly by the department representative/EDB preparer. The UPAY850 On-line Enrollment, Change & Cancellation form should be completed, signed, and sent to the appropriate Central Benefits Office within PIE (Period of Initial Eligibility).

E5.2(f) Enrollments Requiring a Form and EDB update by the Central Benefits Office 

The Central Benefits Office will process enrollment in the EDB for:

The employees should submit the UPAY850 enrollment form attached to the required documentation to the appropriate Central Benefits Office during the PIE.

E5.3 Medical Insurance Plans

The UC offers eligible employees a choice of one fee-for-service plan -- Core, three health maintenance organizations (HMOs) -- Kaiser, Health Net, PacifiCare, one point-of-service plan -- Blue Cross Plus, and one Preferred Provider Plan - Blue Cross PPO.

For MEDICAL eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


The medical Plan Code is a two-character field that identifies the medical plans offered by UC.  Use this code in the "Plan" field along with an entry in "Coverage Effective Date" (see below) for enrollments:

CM Core Medical HN Health Net
KS Kaiser Permanente (South) FP PacifiCare
KN Kaiser Permanente (North) BC Blue Cross Plus
KU Kaiser Umbrella (Out of California) BP Blue Cross PPO
KW Kaiser Mid Atlantic BH High Option*
*HIGH OPTION (BH) IS NOT AVAILABLE TO NEW HIRES.

E5.4 Dental Plans

The University provides a choice of two dental plans for its eligible employees. Delta Dental provides worldwide coverage from any dentist. Delta will pay a maximum of $1,500 per person in a calendar year. 

The PMI Dental Health Plan is a prepaid dental service requiring members to use a PMI dentist.

For DENTAL eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


The Dental Plan code is a two-character field that indicates the dental plans offered by UC in which employees, and any eligible family members, may be enrolled:

D1 Delta Dental Service
D3 PMI

E5.5 Vision Plans

UC provides a comprehensive Vision Services Plan (VSP). Benefits include one vision examination and one set of corrective lenses or contact lenses every calendar year, one set of frames every two years. There are limitations on the amount that can be spent on each of these items.

For VISION eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


This is a two-character code that identifies the Vision plan that UC offers:

VI Vision Service Plan

 E5.6 Coverage Levels for Medical, Dental and Vision Plans

The coverage level is identified by a system-derived code of up to three characters based on the number of dependents (if any) who will be entered on the EDEP screen. The codes are:

U Employee only
UA Employee and another Adult
UC Employee and child/children
UAC Employee and Family

E5.6(a) Coverage Effective Date

The "COV EFF DATE" is a six-digit number that indicates the effective date for the current insurance plan and coverage level.

NOTE: This date is normally derived from the EAPP screen based on the appointment or change in status date (the BELI effective date).

E5.7 Default Plan Enrollment for Medical, Dental and Vision ONLY

By assigning a BELI 1, 2, 3, or 4, the department is automatically enrolling employee in the following default coverage (s):

ASSIGNED BELI #  DEFAULT COVERAGE
1  Core Medical, Delta Dental, Vision Plan – Employee ONLY
2  Core Medical – Employee ONLY
3  Core Medical – Employee ONLY
4  Core Medical – Employee ONLY


Due to Consolidated billing, premiums for the default coverage are charged to the department ledger automatically. Consequently, the department will be responsible for premium payments even if they make a mistake with the assigned BELI. (No refunds for payments incurred beyond 60 days). To prevent unnecessary charges to the department, it is imperative to find out if the employee wants to keep the default coverage. If:

YES - ask: are there eligible family members? If so, have the employee enroll on the web or follow instructions in Section 5.1(c): ‘How to Enroll Dependant Coverage’.

NO - ask the employee to Opt out on the web or Opt him/her out manually following the instructions below (Again: this will save money to your department)!!

E5.8 How to Opt Out of Default Coverage

NOTE: The Opt out function should be used during the first 31-day Period of Initial Eligibility – PIE ONLY. If it’s passed the first 31-day PIE, refer to Section E5.1(b): ‘How to Cancel Health & Welfare Coverage’.

  1. Go to the screen function EFBC.
  2. Always ‘tab’ to move the cursor; it will direct you to the fields that require data entry
  3. Tab all the way to Current Enrollments – midway down the screen, Medical Plan field.
  4. Change the Medical Plan code to XX . The cursor will jump to the effective date. Since the request is being processed during the PIE, the opt-out effective date should be the same as the BELI effective date.
  5. Press F9 to update
  6. Repeat steps 3-4 for the Dental and Vision Plans.

E5.9 Cancellation of Previous Opt-Out Function

To cancel a previous "Opt Out" the employee must show an involuntary loss of coverage within 31 days of when the coverage is lost (e.g.: an employee was covered by a spouse’s medical, dental, or vision plan and the spouse involuntarily loses coverage, the employee has 31 days from the date the coverage ends to cancel the "Opt Out" and to enroll in University-sponsored plans.)

To Opt Back In (refer to Section E5.1(a) for more information) :

NOTE:  If the 31 day period from the qualifying event date is missed, the next opportunity to enroll in Medical, Dental, and Vision plans is during Open Enrollment in November with coverage effective January 1 of the following year. Or, request 90-day late enrollment for Medical only.

E5.10 Legal Insurance

The University offers a prepaid legal expense insurance plan that gives employees access to basic, personal legal assistance. The plan provides unlimited access to a toll-free telephone line and covers specific legal services. These services are provided through ARAG at an annual cost roughly equal to one or two hours in an attorney’s office.

For LEGAL eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


E5.10(a) Legal Plan

This is a two-character code that identifies the Legal plan that UC offers:

J2 ARAG Legal Plan

E5.10(b) Coverage Levels for Legal Plan

The coverage level is identified by a system-derived code of up to three characters based on the number of enrolled dependents (if any) who will be entered on the EDEP screen. The codes are:

U Employee only
UA Employee and another Adult
UC Employee and child/children
UAC Employee and Family

NOTE:  There is no "Employee and Another Adult" or "Employee and Child/Children" category for Legal coverage.   If Employee and just another member, the system will derive "UAC"=Family coverage.

E5.10(c) Coverage Effective Date

The "COV EFF DATE" is a six-digit number that indicates the effective date for the current coverage level.  Enter as MMDDYY.

E5.11 Accidental Death and Dismemberment (AD&D) Plan

The University offers the accidental death and dismemberment (AD&D) plan to help protect employees and their families from the unforeseen financial hardship of an accident. The plan is administered by American Home Assurance.

For Beneficiary forms see Section E2.13.

For AD&D eligibility and enrollment criteria, please refer to Chart 4.A.


E5.11(a) Principal Sum

The "Prin Sum" is a three-digit code that indicates the amount of Accidental Death and Dismemberment (AD&D) insurance coverage that the employee has selected.

Code Dollar
Amount
Code Dollar
Amount
Code Dollar
Amount
010 $ 10,000 070 $  70,000 150 $ 150,000
020 20,000 080 80,000 175 175,000
030 30,000 090 90,000 200 200,000
040 40,000 100 100,000 300 300,000
050 50,000 125 125,000 400 400,000
060 60,000 500 500,000

E5.11(b) AD&D Coverage Code

This is a one-character code for the AD&D coverage level selected by the employee:

S Single-party coverage -- employee only
F Family coverage -- employee and spouse OR employee, spouse and children
M Modified family coverage -- employee and eligible child(ren)

NOTE: If both the husband and wife are eligible employees of the University, only one employee may elect to cover the eligible children. (Coverage is offered at a modified rate under these circumstances.)

E5.11(c) Coverage Effective Date

This is a six-digit number that indicates the effective date of AD&D coverage. The effective date of coverage is the date the information is keyed into the system (e.g., if the data entry date is 3/3/05, the effective date is 3/3/05).

E5.12 Supplemental Disability Plan

For SUPPLEMENTAL DISABILITY eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


E5.12(a) Disability Waiting Period

This is a three-digit code that indicates the number of calendar days the employee has chosen as the waiting period after the disability begins, but before Supplemental Disability benefits kick in:

007 Seven Days
030 Thirty Days
090 Ninety Days
180 One Hundred Eighty Days

Note: The Short Term and Supplemental Disability insurance plans require that participants use their sick hours up to 176 hours or 22 work days regardless of the waiting period they have chosen. This means that employees who select a 7-day waiting period but have 176 or more earned sick hours are paying an increased premium for the lower waiting period but will not be able to start disability benefits until after the use of the required minimum number of sick hours. These participants may wish to consider changing the waiting period to 30 or 90 days. This will decrease their monthly premium.

E5.12(b) Salary Base

This is a system-derived five-digit code that indicates the employee’s full-time (even if the position is part-time) monthly equivalent salary rate (rounded up to the nearest dollar) of covered compensation, which will be used to compute premiums.

NOTE: When calculating the monthly salary base, do NOT include special pay such as overtime and any compensation beyond the maximum of $14,286 per month. However, the highest paid Shift Differential should be included in these calculations.

DO NOT manually adjust the salary base due to increase/decrease in salary. The salary base will be adjusted automatically every January 1.

E5.12(c) Coverage Effective Date

This is a six-digit number that indicates the effective date of Supplemental Disability coverage (i.e., first date of eligibility). For an increase in waiting period, the effective date is the first day of the month following the month in which the increase is processed. For example, a change to increase the waiting period processed online on 03/15/YY will be effective "0401YY".

E5.13 Supplemental Life Insurance Plan

UC automatically provides basic life insurance coverage to all eligible employees. Employees may also purchase additional life insurance (up to four times the employee’s annual salary with a maximum of $1 million) at special group rates.

For Beneficiary forms see Section E2.13.

For SUPPLEMENTAL LIFE INSURANCE eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


The Supplemental Life Insurance plan code is a one-character field that indicates the amount of life insurance coverage elected by the employee:

1 one times the annual salary
2 two times the annual salary
3 three times the annual salary
4 four times the annual salary
F $20,000 (flat)

E5.13(a) Salary Base

This is a system-derived three-digit code that indicates the employee’s full-time annual salary rate (rounded up to the nearest thousand) as of the most recent January 1 or hire date.

NOTE: DO NOT manually adjust the salary base to reflect an increase/decrease in salary base. Rates and benefit premiums will be automatically adjusted every January along with the annual salary base.

DO NOT key in a salary base for Flat Life Insurance.

E5.13(b) Coverage Effective Date

The "COV EFF DATE" is a six-digit number that indicates the effective date of Supplemental Life insurance coverage.

E5.14 Basic/Expanded Dependent Life Insurance Plan

UC offers two dependent life insurance plans. The basic plan covers the spouse and eligible children for $5,000 each. The expanded plan covers the spouse for an amount equal to 50% of the supplemental life insurance amount (coverage is limited to $200,000) and each eligible child is covered for $10,000.

For BASIC/EXPANDED DEPENDENT LIFE INSURANCE eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


E5.14(a) Basic/Expanded Dependent Life Plan Code

The Basic/Expanded Dependent Life Plan code is a one-character field that identifies the dependent life insurance plan coverage (if any) elected by the employee.

Y Basic Plan
S Expanded dependent life, spouse or same sex domestic partner only
B Expanded dependent life, spouse or same sex domestic partner and child(ren)
C Expanded dependent life, child(ren)

E5.14(b) Coverage Effective Date

The "COV EFF DATE" is a six-digit number that indicates the effective date of Dependent Life insurance coverage.

E5.15 Basic Life Insurance

UC automatically provides group term life insurance coverage to all eligible employees. The two UC-paid plans are: Basic Life (which provides life insurance equal to the employee’s base salary, up to $50,000) and Core Life (which provides $5,000 of life insurance). Eligibility for either plan is based on the appointment rate and average regular paid time.

For BASIC LIFE INSURANCE eligibility and enrollment criteria, please refer to Chart 4.A.
For PIE criteria, please refer to Chart 4.B.


E5.15(a) Basic Life Insurance Salary Base

This is a system-derived code that indicates the employee’s annual salary (rounded UP to the nearest thousand) with a maximum of $50,000 ($45,000 for PERS members).

E5.15(b) Coverage Effective Date

The "COV EFF DATE" is a six-digit number that indicates the effective date of Basic Life insurance coverage.


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