U. T. Employee Group Insurance

Web site addresses and Customer Service telephone numbers for each insurance plan are listed in the Who to Contact page. If you have any questions about your benefits or a change of status, contact your local campus Benefits Office.

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

Examples of dependents who are not eligible for coverage include:

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 received State contributions
Any dependent who is active in the Armed Forces of any country

As a retiree, 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). You are responsible for all Optional Coverage premiums.

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

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

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:

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.

For questions regarding Status Changes, please contact your campus Benefits Office./li>

If you or your dependents are no longer eligible for coverage, UT will offer you the option to continue coverage at your expense for any UT health, dental and vision plan. 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.

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

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 medical 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 on the EGI web site at www.utsystem.edu/egi/hipaa/. 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 medical plans described in this booklet directly from the plan.