Benefits for Employees

What You Need To Know Eligibility Premium Sharing Change of Status Basic Coverage Package Optional Coverage Evidence of Insurability Continuation of Group Coverage (COBRA) Surviving Dependent Benefits HIPAA

Plan Information Medical Pharmacy Benefits Dental Vision Life Insurance Accidental Death & Dismemberment Long-Term Disability Short-Term Disability Long-Term Care UT FLEX

Resources Group Benefits Handbook for Employees Enroll using My UT Benefits What will my monthly out-of-pocket cost be? Publications & Forms Contact Benefits Office

What You Need to Know

Notice about Retiree Health Insurance (Required Disclosure by Section 2264.103 of the Texas Government Code)

Health and other insurance benefits for employees and retirees are subject to change based on available State funding. The Texas Legislature determines the level of funding for such benefits and has no continuing obligation to provide those benefits beyond each fiscal year.

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 ½ 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 ½  months, and
• You are not currently insured by another State-sponsored insurance plan.

Certain non-employee Post Doctoral Fellows are eligible for UT Benefits. Please contact your institution Benefits Office for more information.

Dependents

You may also enroll your eligible dependents under plans offered by UT. Your eligible dependents are

• Your legally-married spouse, or person with whom you have filed a Declaration of Informal Marriage;
• Your unmarried child(ren) under age 25, including

• Stepchildren,
• Adopted children, and
• 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; and
• Certain children over age 25, who are determined by OEB to be medically incapacitated and are unable to provide their own support.

UT requires additional supporting documentation when you request to add a dependent to your plan.  You may be asked to provide copies of your marriage license, your children’s birth certificate(s), and/or appropriate adoption paperwork.  This paperwork is required not only to support the coverage of eligible dependents but, in the case of marriage or the birth of a new child, to support a mid-year change of status. 

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 and unable to provide their own support;
• 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; and
• 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. You may request the removal of an ineligible dependent during Annual Enrollment, within 31 days after a qualified status change or immediately upon determination of their ineligibility.

PREMIUM SHARING

Employee Status	Premium Sharing for the Basic Coverage Package provided by UT & the State of Texas	Premium Sharing for Dependent Medical Coverage provided by UT & the State of Texas
Full-time	100%	50%
Part-time	50%	25%
Retired	100%	50%
Graduate Student *	50%	25%

* Institutions may supplement premiums for graduate student employees. For more information, contact your institution Benefits Office.

INITIAL PERIOD OF ELIGIBILITY

You have 31 days from your hire date (initial period of eligibility) to complete enrollment in UT Benefits. Employees moving from a non-benefits eligible status to a benefits eligible status also have 31 days from their new benefits eligible status (initial period of eligibility) to complete enrollment in UT Benefits. If elections are not made within the 31-day initial period of eligibility, you will be required to wait until the next Annual Enrollment or a qualified Change of Status event to make changes, including adding or dropping coverage. To enroll in certain insurance coverages may require Evidence of Insurability (EOI).

WAITING PERIOD

Newly hired employees and their dependents may be required to satisfy a state mandated 90-day waiting period before enrollment in UT SELECT medical plan is allowed and State Premium Sharing is provided. The waiting period can be from 90 to 120 days depending on the date your employment began.  You may enroll in coverage for the voluntary plans within your initial period of eligibility and will begin receiving voluntary plan benefits on your date of hire or the first of the following month.  To enroll in certain coverage may require evidence of insurability (EOI) in which case the effective date of that coverage will be the first of the month following the approval of your EOI application.

Your institution may choose to supplement all or a part of the waiting period. Consult with your institution Benefits Office for additional information regarding the waiting period.

CHANGE OF STATUS

Changes to your UT Benefits may be made during Annual Enrollment each year or following a qualified Change of Status.  You have 31 days from the date of the Change of Status event to notify your institution 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 events:

• 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 non-benefits eligible part-time to full-time)
• Change in dependent’s eligibility (e.g., marriage or reaching age 25)
• Change in coverage or cost of other benefit plans available to you and your family

NEW: Effective January 1, 2010, an employee whose dependent loses insurance coverage under the Medicaid or CHIP program as a result of loss of eligibility may enroll this dependent in UT Benefits without Evidence of Insurability, as long as the employee and dependent meet all other UT eligibility requirements and is enrolled within 60 days from the date coverage was lost.

Your benefit changes must be consistent with your Change of Status event. For questions regarding a qualified Change of Status, please refer to OEB Policy 310, or contact your Institution 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.

BASIC COVERAGE PACKAGE

UT Benefits provide eligible employees with the following Basic Coverage Package:

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

Employees

You may select the following Optional Coverage(s) for you and your eligible dependents, unless stated otherwise:

• UT SELECT Medical Plan, with Prescription Drug Coverage, for your eligible dependents
• 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 Insurance (for employees only)
• Long-Term Care
• UT FLEX Medical Expense Reimbursement Account
• UT FLEX Dependent Day Care Expense 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 the employee’s initial 31-day benefit election period. (If these certain dependents can show proof of other group medical coverage that was in effect within 63 days prior to the beginning date of UT SELECT coverage, EOI will be waived for the UT SELECT medical plan);
• Reinstate employees’ medical coverage that was previously terminated or waived, unless proof of other active group medical coverage can be provided;
• Increase or reinstate employees’ and spouses’ voluntary group life insurance coverage;
• Add Short-Term Disability coverage after your initial 31-day benefit election period, except following a qualified status change during the plan year;
• Add Long-Term Disability coverage after your initial 31-day benefit election period, except following a qualified status change during the plan year; or
• Add Long-Term Care coverage after your initial 31-day benefit election period. EOI is required at all times for spousal enrollment.

Completed EOI forms must be submitted electronically or printed and mailed by the deadline to the appropriate insurance company for review. The postmark deadline for Annual Enrollment is August 15. For new employees, your EOI form must be postmarked no later than 15 days following your initial eligibility period. Forms are available through your local institution Benefits Office and, during Annual Enrollment, through online My UT Benefits (formerly U.T. Touch) on the OEB Web site at www.utsystem.edu/benefits.

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, and/or UT FLEX Medical Expense Reimbursement Account plan. You are responsible for the full premium for elected COBRA coverage plus a 2% administration fee, unless you qualify for the premium subsidy under the federal American Recovery and Reinvestment Act of 2009. For information regarding the conditions for continuation of coverage including if you may qualify for the COBRA premium subsidy, please contact your institution Benefits Office.

If you lose eligibility for coverage and are already enrolled in the Basic or Voluntary Group Term Life, Long-Term Disability and/or 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 institution Benefits Office and forward them to the appropriate insurance company within 31 days of the end of the month in which your eligibility status changes or terminates.

SURVIVING DEPENDENT BENEFITS

A surviving dependent is a spouse or other benefits-eligible dependent of an individual who was participating in UT Benefits as the dependent of an employee or retired employee on the date of the employee’s/retired employee’s death. A surviving dependent is eligible for coverage in UT Benefits as described below.

• The surviving dependent may continue UT Benefits coverage for the remainder of the surviving spouse’s life or, if a dependent child, until the child reaches age 25, if the employee had at least five (5) years of TRS or ORP creditable service, including at least three (3) years with UT as a benefits-eligible employee; or
• The surviving dependent of an active employee at a UT institution with less than five (5) years of TRS or ORP creditable service, or with five years service credit but less than three years of service as a benefits-eligible UT employee, may continue UT Benefits coverage for a period not to exceed the number of months equal to the number of months of service credit of the deceased employee. If the amount of creditable service is less than 36 months, once the individual’s surviving dependent coverage ends, the individual may elect COBRA coverage for a period not to exceed 36 months minus the number of months the individual received coverage as a surviving dependent of an employee.

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; and
• 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 UT 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 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 institution Benefits Office.