UNIVERSITY OF PITTSBURGH PROCEDURE 07-06-08

CATEGORY:             PERSONNEL
SECTION:                 Employee Support
SUBJECT:                Domestic Partner Benefits
EFFECTIVE DATE:  October 15, 2014 Revised
PAGE(S):                   3

I.    PURPOSE

      To define the steps for extending certain benefits to domestic partners of University 
      faculty, staff, graduate students and others with eligible academic appointments and for 
      certifying that a domestic partnership meets University criteria for benefit eligibility.

II.   SCOPE

      This procedure is applicable to all faculty and staff on all campuses of the University of 
      Pittsburgh and includes the following benefits for faculty and staff, as established by 
      Policy 07-06-08:

      -     Health Insurance (medical, dental, vision, and flexible spending account)
      -     Educational Benefits
      -     Bereavement leave in the case of the death of a domestic partner or the parent of a 
            domestic partner
      -     Dependent Life Insurance

      This procedure is also applicable to graduate students and others with eligible academic 
      appointments on all campuses of the University of Pittsburgh and includes the following 
      benefits for graduate students and others with eligible academic appointments, as 
      established by Policy 07-06-08:

      -     Health Insurance (medical, dental, and vision)

III.  DEFINITIONS

      Domestic Partnership - A committed relationship between two adults of the same or 
      opposite sex, which meets the criteria described in the University of Pittsburgh Affidavit of 
      Domestic Partnership for Faculty and Staff (see Exhibit A) and for Graduate Students &
      Others with Eligible Appointments (see Exhibit B).

IV.  ADMINISTRATIVE RESPONSIBILITIES

      The Office of Human Resources, Benefits Section is responsible for administering 
      Domestic Partner benefits to eligible faculty, staff, graduate students and others with 
      eligible academic appointments, for providing, upon request, the appropriate Affidavit for 
      certifying a domestic partnership, and for verifying on the basis of the documentation 
      provided, that the criteria for eligibility are met.

      University departments are responsible for verifying, upon request for domestic partner 
      bereavement leave, that a domestic partnership certification is on file with the Office of 
      Human Resources.

V.   PROCEDURE

      Certifying the Existence of a Domestic Partnership

      Human Resources                        1.    Upon request of a staff or faculty  member, provide 
                                                                    FORM 0185 PITT 1424, University of Pittsburgh 
                                                                    Affidavit of Domestic Partnership - Faculty and 
                                                                    Staff (Exhibit A).  Upon request of Graduate 
                                                                    Student or Other with Eligible Appointment, provide 
                                                                    FORM 0187 PITT 1443, University of Pittsburgh 
                                                                    Affidavit of Domestic Partnership - Graduate 
                                                                    Students &Others with Eligible Appointments
                                                                    (Exhibit B).

      Faculty/Staff Member or
      Graduate Student/Other with
      Eligible Academic Appointment     2.    Certify the existence of the domestic partnership by
                                                                    completing the appropriate University of Pittsburgh
                                                                    Affidavit of Domestic Partnership and returning the 
                                                                    affidavit, notarized, to the Office of Human Resources.

                                                                    a.   Present any documentation available to support 
                                                                          statements 9A, B, or C of the affidavit.

      Human Resources                        3.    Review the Affidavit and supporting documents to 
                                                                    ensure that the necessary requirements have been 
                                                                    met for certifying the domestic partnership.

                                                             4.    Verify that no certification of a previous domestic 
                                                                    partnership is currently on file, or that one year has
                                                                    elapsed since the termination of a previous 
                                                                    domestic partnership, in accordance with Policy 
                                                                    07-06-08.

                                                             5.    Maintain Affidavit on file in a manner that ensures 
                                                                    confidentiality of the document.

      Granting Domestic Partner Benefits

      Human Resources                         1.    Issue the appropriate documents for health 
                                                                     insurance or education benefits to the eligible 
                                                                     domestic partner.

      Department                                     2.    Upon request for domestic partner bereavement 
                                                                     leave, verify with the Office of Human Resources 
                                                                     that a domestic partner certification is on file.

      Termination of a Domestic Partnership Certification

      Faculty/Staff Member or
      Graduate Student/Other with
      Eligible Academic Appointment      1.    Within 30 days of the dissolution of a certified 
                                                                     domestic partnership, complete FORM 0186 
                                                                     PITT 1442, Statement of Termination of Domestic 
                                                                     Partner Status (Exhibit C), in the Office of Human 
                                                                     Resources.

                                                                    NOTE:  One year must elapse between the time a 
                                                                    Statement of Termination is filed with the Office of 
                                                                    Human Resources and the awarding of benefits to
                                                                    a new domestic partner.

                                                            2.    Maintain statement on file in a manner that ensures 
                                                                   confidentiality of the document.

VI.  EXHIBITS

      Exhibit A - FORM 0185 PITT 1424, University of Pittsburgh Affidavit of Domestic 
      Partnership - Faculty and Staff

      Exhibit B - FORM 0187 PITT 1443, University of Pittsburgh Affidavit of Domestic 
      Partnership - Graduate Students & Others with Eligible Academic Appointments

      Exhibit C - FORM 0186 PITT 1442, Statement of Termination of Domestic Partner Status

VII. REFERENCES

      Policy 07-06-08, Domestic Partner Benefits

      Policy 02-07-01, Employee/Spouse/Dependent Scholarships for Faculty

      Procedure 07-11-01, Employee/Spouse/Dependent Scholarships for Staff