July 11,1995 BA-2600.1
Policy No. BA-2600.1A
POLICY & PROCEDURES MEMORANDUM
TITLE:HOSPITALIZATION &
LIFE INSURANCE
INTERIM COVERAGE
EFFECTIVE DATE:July 11, 1995*
(*Title Updates 12/14/05)
CANCELLATION:DCI 2600.1 (7/1/81)
OFFICE:Business Affairs (BA)
POLICY STATEMENT
Full-time employees of DelgadoCommunity College are eligible to participate in the statewide uniform insurance program for hospitalization and life insurance coverage which is administered by the State Division of Administration.
Employees, who are on leave without pay and will be returning to DelgadoCommunity College for employment, must make arrangements and follow the procedures as specified in this memorandum to receive continuous hospitalization and life insurance coverage while on leave.
PROCEDURES & SPECIFIC INFORMATION
1.Purpose
To establish procedures for ensuring continuity of hospitalization and/or life insurance coverage for employees who are on leave without pay.
2.Scope and Applicability
This policy and procedures memorandum applies to employees of Delgado Community College who are working on a full-time basis in the following employee categories: 9-Month Faculty (HRS Codes 01); 12-Month Faculty (HRS Code 04); Academic Support- 9 Month (HRS Code 05); Academic Support- 12 Month (HRS Code 06); Unclassified Staff (HRS Code 07); Civil Service/Classified (HRS Code 08); Temporary Faculty- 1 Academic Year (HRS Code 10); Grant Employees- 9 Months (HRS Code 12); Grant Employees- 12 Months (HRS Code 13); and Administrators with Rank (HRS Code 19).
3.General Provisions
An employee, who is on leave without pay, such as sabbatical, military, furlough, etc., may continue life and health insurance coverage for this period of absence at the employee's expense. This interim coverage will be effective only if the employee submits a completed Interim Coverage of Hospitalization-Life Insurance Form, Form 2600/001 (Attachment A) to the Office of Human Resources, and makes the required premium payments while on leave without pay. The employer portion will be paid by the College for the period approved by the Board of Trustees for StateColleges and Universities.
4.Responsibilities
A.An employee on leave without pay will:
(1)Submit a completed Interim Coverage of Hospitalization-Life Insurance Form, Form 2600/001, Attachment A, to the Office of Human Resources prior to his/her extended absence from the College.
(2)Meet with the designated representative of the Accounting Office regarding the schedule of required premium payments.
(3)Make required premium payments for this coverage on or before dates due.
B.The Accounting Office will:
(1)Complete the payment schedule and retain executed Interim Coverage of Hospitalization-Life Insurance Forms.
(2)Receive and process all insurance premium payments.
(3)Cancel insurance if employee's portion of premiums is not paid.
5.Cancellation
This policy and procedures memorandum cancels DCI 2600.1, Hospitalization and Life Insurance Interim Coverage, dated July 1, 1981.
SIGNATURE
Ione H. Elioff
President
Policy Reference:
Louisiana Community and TechnicalCollege System Policy 6.034, “LCTCS Force Majeure Exigency Policy for Modification and/or Discontinuation of Programs As a Result of Hurricanes Katrina and Rita”
Review Process:
Ad Hoc Committee on Interim Hospitalization/Life Insurance Coverage 6/12/95
Executive Council 7/11/95
Distribution:
Currently distributed on the College’s web site.
Original Distribution (1995):
President, Vice Presidents and Assistant to the President (SDL A)
Campus Deans (SDL B)
Associate Deans/Assistant Deans (SDL C)
Division Chairs (SDL D)
College Directors/Coordinators (SDL E)
Department Heads (SDL F)
Faculty and Unclassified Staff Members (SDL G)
Classified Staff (SDL H)
President, Faculty Senate
*SDL = Standard Distribution List
Attachment:
Attachment A - Interim Coverage of Hospitalization-Life Insurance Form,
(Form 2600/001)
Attachment A
INTERIM COVERAGE OF
HOSPITALIZATION-LIFE INSURANCE FORM
Name:______Social Security No.:______
Address:______
Mailing Address City State Zip Code
I elect to continue hospitalization-life insurance coverage as indicated below:
Coverage: Hospitalization Life Insurance
Period: From:______To:______
Payment Schedule:**
Month of CoveragePayment DueAmount
______
______
______
______
______
______
**Note: Advanced payment of premiums can be paid at any time.
The time of payment may be extended one or more times and from time to time without notice to or further assent of any of the parties hereto who shall remain bound, notwithstanding such extension(s).
In the event of non-payment of all amounts due on the above dates, I understand that my coverage may be cancelled by the College.
______
Signature of Employee Date
I do not elect to continue hospitalization-life insurance coverage during the period: From:______To:______
I understand that I and/or my family will be required to qualify for insurance coverage if I decide to renew my insurance.
______
Signature of Employee Date
Form 2600/001 (12/05)
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