Please read this information carefully before completing the form below.
Not complying with the following guidelines can result in fines to both the institution as well as the individual departments, in addition to the cost of the benefits.
Prior to the Start of Employment/Contract
Public Employee Benefits Program (PEBP) must be notified of employees who are eligible for health insurance prior to the start of employment (per Federal ACA guidelines).
Note that FTE for benefits eligibility is calculated from work at all NSHE institutions combined. You must ask employees if they are working at other intuitions and determine what their total FTE is.
- For employees working 50% FTE or more: requests for LOB approval are required to be submitted to the TMCC Human Resources Office prior to the start date of a contract.
- Approval is required from Dean/Director, Vice President and Budget Office.
- For instructors teaching over 75% FTE: part-time instructor teaching over 75% FTE requires approval from the Vice Chancellor for Academic Affairs in the Chancellor's Office by completing the Request for Exception to Limitation to 75 Percent of FTE per Semester form prior to the start of employment (per Board of Regents Code).
- Departments must submit the completed form to the Vice President of Academic Affairs who will submit the form to the Vice Chancellor for approval.
Employee Health Plan Coverage
Elect or Decline Coverage
- Once the TMCC Human Resources Office receives the Request for LOB Approval, HR will verify with the Dean/Director, Vice President and Budget that the request is approved.
- Once approved, HR will notify PEBP of the employee’s eligibility. Within 15 days of eligibility, the employee must elect or decline coverage or default to an Employee Only health plan.
- Employees can only elect and decline coverage through the PEBP participant portal.
Benefits Waiting Period
There is no waiting period for benefits. Employees are eligible to receive health insurance on the next first of the month after they start working.
If these forms are not completed on time and/or notification is sent to PEBP late, the institution will be charged for benefits from the time of eligibility, even if the employee declines. No refunds are granted.
End of LOB Contract
As soon as a department becomes aware that an employee on LOB will no longer be working at 50% FTE or more, notification is required to be made to TMCC's Human Resources Office. Failure to do so will result in the institution continuing to be charged. No refunds are granted.