Employee Benefits for 2005-2006

ELIGIBILITY

EMPLOYEES
You are eligible for benefits as a full-time employee if:

• You work at least 40 hours per week, and
• Your appointment is expected to continue for at least 4-1/2 months, and
• You are not currently insured by another State-sponsored medical insurance plan.

• You work at least 20, but less than 40, hours per week, and
• Your appointment is expected to continue for at least 4-1/2 months, and
• You are not currently insured by another State-sponsored insurance plan.

UT and the State of Texas pay 50% of the premium for your Basic Coverage Package and up to 25% of the premium for your dependents.

NOTE: Certain non-employee Post Doctoral Fellows are eligible for certain benefits under the UT Group Insurance Program. Please contact your local campus Benefits Office for more information.

DEPENDENTS
You may also enroll your eligible dependents under plans offered by UT System. Your eligible dependents include:

• Your legally-married spouse
• Your unmarried child under age 25, including
• Stepchildren
• Adopted children
• Children for whom you are the legal guardian

NOTE: Your unmarried child is not required to be enrolled in school.

• Your unmarried grandchild under age 25,
• For UT Select, the natural parent must also be enrolled.
• For HMO coverage, the natural parent does not need to be enrolled, but your grandchild must be claimed by you as a dependent for tax purposes at the time of enrollment.
• Your child over age 25, if determined by EGI to be medically incapacitated

• Your common-law spouse, unless you have obtained a Declaration of Informal Marriage
• Your same-sex partner
• Your former spouse
• Your married child
• Your child over age 25, if not medically incapacitated
• Foster children covered by another government program, unless required by law
• Any child for whom you have Power of Attorney only
• Any dependent insured by another UT employee or retiree
• Any dependent insured by another plan that receives State of Texas contributions
• Any dependent who is active in the Armed Forces of any country

PREMIUM SHARING
If you are a full-time employee, UT and the State of Texas will provide 100% of your premiums for the Basic Coverage Package, and up to 50% of the premiums for your dependents' medical coverage.

If you are a part-time employee, UT and the State of Texas will provide 50% of your premiums for the Basic Coverage Package, and up to 25% of the premiums for your dependents' medical coverage.

If you are a graduate student employee, UT and the State of Texas may supplement premiums for your and your dependent's coverage. For more information, contact your campus Benefits Office.

Newly hired employees and their dependents may be required to satisfy a 90-day waiting period before State Premium Sharing is provided. The waiting period can be from 90 days to 120 days depending on the date your employment began. Consult with your campus Benefits Office for additional information regarding the waiting period.

For information regarding your monthly out-of-pocket premiums, please refer to the Benefit Cost Worksheet for Annual Enrollment 2005-2006.

BASIC COVERAGE PACKAGE
UT provides eligible employees with the following basic coverage:

• UT SELECT Health Plan, with Prescription Drug Coverage (Employee only)
• $10,000 Basic Life Insurance (Employee only)
• $10,000 Accidental Death and Dismemberment Insurance (Employee only)

OPTIONAL COVERAGE
You may select the following Optional Coverages for you and your eligible dependents:

• Dental Insurance
• Vision Insurance
• Voluntary Life Insurance Coverage (in addition to the Basic Life Insurance)
• Increased Accidental Death and Dismemberment Insurance (in addition to the Basic Accidental Death and Dismemberment Insurance)
• Short Term Disability Insurance (for employees only)
• Long Term Disability (for employees only)
• Long Term Care
• UT FLEX Medical Expense Reimbursement Account
• UT FLEX Day Care Reimbursement Account

EVIDENCE OF INSURABILITY (EOI)
Evidence of Insurability (EOI) is the record of a person's past and current health events. EOI is used by insurance companies to verify whether a person meets the definition of good health. An EOI form is required to:

• Add certain dependents to medical coverage who were previously eligible, but not enrolled during your initial 31-day benefit election period. (If these certain dependents can show proof of other active group medical coverage during Annual Enrollment, EOI will be waived for the UT SELECT medical plan.)
• Reinstate terminated or waived medical coverage, unless proof of other active group medical coverage can be provided during Annual Enrollment
• Increase employee, retiree and spouse life insurance coverage
• Add Short Term Disability
• Add Long Term Disability
• Add Long Term Care

CHANGE OF STATUS
You have 31 days from the date of a qualifying Change of Status event to notify your campus Benefits Office and change your benefit selections. If you do not make your changes during the 31-day Status Change period, your changes cannot be made until the next Annual Enrollment period in July, to be effective the following September 1. Evidence of Insurability may be required for some benefit changes if you wait until the Annual Enrollment following your Change of Status event.

The list below includes common examples of qualified Status Changes:

• Marriage, divorce, annulment, legal separation, or spouse's death
• Birth, adoption, medical child support order, or dependent's death
• Significant change in residence if the change affects your or your dependents' current plan eligibility
• Starting or ending employment, starting or returning from unpaid leave of absence, or a change of job
• status (e.g., from part-time to full-time)
• Change in dependent eligibility (e.g. marriage or reaching age 25)
• Change in coverage or cost of other benefit plans available to you and your family

Your benefit selection changes must be consistent with your Change in Status. For questions regarding Status Changes, please contact your campus Benefits Office.

CONTINUATION OF GROUP COVERAGE (COBRA)
If you or your dependents are no longer eligible for coverage, UT will offer you the option to continue coverage for any UT medical, dental, vision plan, and in some cases, your UT FLEX Flexible Spending Account(s). You are responsible for the full premium for elected COBRA coverages. For information regarding the conditions for continuation of coverage, please contact your campus Benefits Office.

If you enroll in the Fort Dearborn Basic or Voluntary Group Term Life, The Hartford Long Term Disability and/or the CNA Long Term Care plans, you may also be able to access a conversion benefit provided as part of these plans. To do so, you must obtain the required form(s) from your campus Benefits Office and forward them to the insurance company within 31 days of the end of the month in which your benefits-eligibility status changes or terminates.

HIPAA
Title 1 of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes certain requirements on group health plans, including:

• Limitations on pre-existing condition exclusion periods
• Special enrollment periods for individuals (and dependents) losing other coverage
• Prohibitions against discriminating against individual participants and beneficiaries based on health status
• Standards relating to benefits for mothers and newborns
• Parity in the application of certain limits to mental health benefits

HIPAA also permits certain self-funded, governmental group health plans the right of exemption from certain provisions of this federal law. The Office of Employee Group Insurance has elected to exempt The University of Texas self-funded health plan (UT SELECT) from most of the HIPAA provisions listed above. Pre-existing condition limitations are no longer included in the UT SELECT plan; however, some plan limitations and exclusions apply. The fully-insured HMO plan described in this booklet is not exempt from the HIPAA requirements.

Dependents who are not enrolled in the fully-insured HMO during their initial period of eligibility may be subject to EOI requirements to enroll in UT SELECT at a later date. UT SELECT does not have annual or lifetime maximums. Serious Mental Illness (as defined in Chapter 1601 of the Texas Insurance Code) will be treated as any other illness under UT SELECT.

Although The University is exempt from the HIPAA provisions relating to hospital stays for mothers and newborns, it is our intent to satisfy all the requirements for maternity and newborn benefits as set out in HIPAA regulations.

Title 2 of HIPAA requires self-funded health plans to comply with certain regulations concerning the privacy and security of personally identifiable health information that the plan collects or maintains about its enrollees. A copy of the privacy notice and policies that apply to UT SELECT, UT DENTAL SELECT and UT FLEX can be found in the HIPAA Policies and Forms page. A paper copy of the privacy notice is provided to all new enrollees and is available to anyone upon request from Employee Group Insurance. You can obtain HIPAA privacy information about the fully-insured health plans described in this booklet directly from the plan.

For more information, contact your campus Benefits Office.