U. T. Employee Group Insurance

Employee Benefits for 2006-2007
Benefits Available for 2006-2007 Who is Eligible for Benefits Employer Premium Contribution	Medical Plans Optional Coverage Evidence of Insurability (EOI)	Continuation of Group Coverage HIPAA Contact Benefits Office
Group Benefits Handbook for Employees - Download the booklet (PDF) View Bookcover - Featuring the UT Tower at The University of Texas at Austin
Links to detailed information about each plan offered, including all plan certificates and provider lists, can be found on the benefits pages. The Website addresses and Customer Service telephone numbers for insurance plans are listed in the Who to Contact page. Please read all material carefully and discuss your benefit options and any questions you may have with your local Benefits Office staff. 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 are eligible for benefits as a part-time employee if: 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. 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 are: 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 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. Certain children over age 25, who are determined by OEB 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 retired employee 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 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. 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 Group 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: HMO Blue Texas, a fully-insured HMO plan. Employee Only coverage may require an out-of-pocket premium. Dental Insurance Vision Insurance Voluntary Group Term Life Insurance Coverage (in addition to the Basic Group Term Life Insurance) Voluntary 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 UT SELECT 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, 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 Increase or reinstate employee, retired employee and spouse voluntary group life insurance coverage Add Short Term Disability Add Long Term Disability Add Long Term Care CONTINUATION OF GROUP COVERAGE (COBRA) If you or your dependents are lose eligibility 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 lose eligibility for coverage and are already enrolledl 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 Benefits 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 OEB. 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.

Employee Benefits for 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
Employee Group Insurance Guide - Download the booklet (PDF) View Bookcover - Featuring images of "Old Red" at UT Medical Branch Galveston (PDF)
Links to detailed information about each plan offered, including all plan certificates and provider lists, can be found on the specific coverage web pages. You will also find the Website addresses and Customer Service telephone numbers for insurance plans. If you have any questions about your benefits or a change in status, please contact your local campus Benefits Office. WHAT'S NEW Monthly Medical plan premium rates increase 9.4% for UT SELECT and an average of 14% for the HMO Blue Texas plans. 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. IRS relaxes ‘Use It or Lose It’ rules 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. 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 are eligible for benefits as a part-time employee if: 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 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 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.