This Website is intended to provide an overview of the group benefit options available to retired employees of The University of Texas System (UT System). The Website addresses and Customer Service telephone numbers for each insurance plan are located in the Who to Contact page. Please read all material carefully and discuss your benefits options and any questions you may have with your local Benefits Office staff.
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 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, if the child qualifies and is claimed as your dependent for federal tax purposes
- Certain children over age 25, who are determined by OEB to be medically incapacitated and are unable to provide their own support.
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 premium contributions
- Any dependent who is active in the Armed Forces of any country
A violation of this OEB policy, including misrepresentation by an employee or retired employee of benefit eligibility requirements, constitutes a violation of OEB’s official policy and a violation of The University of Texas System Rules and Regulations of the Board of Regents, Series 31013(1). Possible sanctions for such a violation range from a reprimand to dismissal. Employees and retired employees who have enrolled ineligible dependents may be held liable for reimbursement of prior premiums or claims incurred by the dependents.
A verified misrepresentation by an employee or retired employee shall be reported by OEB to the appropriate institution for investigation and possible sanctions. Deliberate misrepresentation of dependent eligibility by an employee or retired employee may constitute criminal fraud and may result in a referral to a law enforcement office.
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 2007-2008.
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 Coverage (in addition to the 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 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 employee or retired employee voluntarily 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 Long Term Care coverage after the July 2007 Annual Enrollment or after your initial 31-day benefit election period. EOI is required at all times for spousal enrollment.
CHANGE OF STATUS
Changes to your group insurance benefits may also be made following a qualifying Change of Status event. You have 31 days from the date of the 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 in July, to be effective the following September 1.
The list below includes common examples of Qualified Changes of Status.
- 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 changes must be consistent with your Change in Status. For questions regarding Changes of Status, please refer to OEB Policy 310, available on-line at www.utsystem.edu/benefits or contact your campus Benefits Office. Note: Evidence of Insurability may be required for some benefit changes if you wait until Annual Enrollment instead of enrolling during the 31-day Status Change Period.
CONTINUATION OF GROUP COVERAGE (COBRA)
If you or your dependents lose eligibility for coverage, UT will offer you the option to continue coverage for any UT medical, dental, vision plan, and the Medical Expense Reimbursement Account offered through UT FLEX. 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 enrolled 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.
Although UT 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 SELECT DENTAL and UT FLEX can be found on 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.
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