1. Policy No.   BA-2600.1A
  2. POLICY & PROCEDURES MEMORANDUM
    1.  PROCEDURES & SPECIFIC INFORMATION
    2. INTERIM COVERAGE OF
    3. HOSPITALIZATION-LIFE INSURANCE FORM
    4. Payment Schedule:**

 

Policy No.    BA-2600.1A

 

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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 Delgado Community 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 Delgado Community 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 State Colleges 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 Technical College 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 Coverage       Payment Due      Amount

__________________________  ______________________  __________________

__________________________  ______________________  __________________

__________________________  ______________________  __________________

__________________________  ______________________  __________________

__________________________  ______________________  __________________

__________________________  ______________________  __________________

**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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