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.

Retiree Benefits for Plan Year 2005-2006
What's New Who is Eligible for Benefits Employer Premium Contribution Basic Coverage Package	Benefits Available for 2005-2006 Medical Plans Optional Coverage Evidence of Insurability (EOI)	Change of Status Continuation of Group Coverage HIPAA Contact Benefits Office
Retiree Annual Enrollment Guide - Download the booklet (PDF) View Bookcover - Featuring images of "Old Red"at UT Medical Branch at Galveston (PDF)
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. WHAT'S NEW UT SELECT offers 24-hour Nurse Hotline. UT SELECT offers new Disease Management programs. UT SELECT offers Special Beginnings Prenatal Program. UT SELECT introduces Formulary First through Medco Health Solutions. HMO Blue no longer available to enrollees who live in Galveston County. Delta Dental annual maximum increases to $1,250 per plan year. Delta Dental lifetime orthodontic maximum increases to $1,250. CNA Long Term Care offers increased coverage with no EOI to current participants. UT TOUCH has been redesigned for easier use. WHO IS ELIGIBILE Retired Employees Individuals who met the requirements in Texas Insurance Code Section 1601.102(b)(1)-(3), and who retired, as an annuitant (for ORP you do not have to be an annuitant), on or before 8/31/03 may participate as a retired employee in group insurance benefits if: the individual had at least 3 years of service with UT for which the individual was eligible to participate in the group insurance plan; and the individual’s last state employment before retirement was with UT; and the individual retired under the jurisdiction of: the Teachers Retirement System of Texas; or the Employees Retirement System of Texas; or the Optional Retirement Program established by Chapter 830, Government Code or any other federal or state statutory retirement program to which The University of Texas System has made employer contributions. Individuals who were employed with The University of Texas System or were eligible to retire on 8/31/03, but chose not to and currently meet the requirements in Section 1601.102(b) as enumerated in a-c above and who retire as an annuitant after 8/31/03 must meet the criteria as defined above in number one. Individuals that began work on or after 9/1/03 and who subsequently retire as an annuitant, must meet the following criteria in order to be eligible for UT group retirement benefits: the individual has at least 10 years of UT service; and the individual’s last state employment before retirement was with UT; and the individual retires under the jurisdiction of: the Teachers Retirement System of Texas; or the Employees Retirement System of Texas; or the Optional Retirement Program established by Chapter 830, Government Code or any other federal or state statutory retirement program to which The University of Texas System has made employer contributions. the individual meets the rule of 80 with at least 10 years total creditable service, or the individual has10 years total creditable service and is age 65. Dependents You may also enroll your eligible dependents under most plans offered by UT System. Your eligible dependents include: Your legally-married spouse, or person with whom you have filed a Declaration of Informal Marriage Your unmarried child under age 25, including Stepchildren Adopted children Children for whom you are the legal guardian 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 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 EMPLOYER PREMIUM CONTRIBUTION 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. BASIC COVERAGE PACKAGE UT provides eligible retirees with the following basic coverage: UT SELECT Health Plan, with Prescription Drug Coverage (Retiree only) $3,000 Basic Life Insurance (Retiree only) OPTIONAL COVERAGE You may select the following Optional Coverages for you and your eligible dependents: Dental Vision Voluntary Group Term Life Insurance (in addition to Basic Group Term Life Insurance) Long Term Care 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 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 Status Changes: Marriage, divorce, annulment, legal separation, or spouse’s death Birth, adoption, medical child support order, or dependent’s death 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 For questions regarding Status Changes, please contact your campus Benefits Office./li> 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 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. 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 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. For more information, contact your Contact Benefits Office.