UT Benefits Overview
For Plan Year Beginning September 1, 2011
What You Need to Know
Skip to: Basic Coverage Package | Optional Coverage | Premium Sharing
Enrollment
ELIGIBILITY
Employees
You are eligible for benefits as a full-time employee if you are a TRS or ORP member,
and
you work at least 40 hours per week or have a full-time appointment, 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.
At some institutions, nurses may be eligible for full-time benefits if they work less than 40 hours per week. Contact your institution Benefits Office for more information.
You are eligible for benefits as a part-time employee if you are a TRS or ORP member or you are employed in a position that requires you to be enrolled as a student in graduate level courses,
and
you work at least 20 but less than 40 hours per week, or have at least a 50% appointment but less than a full appointment, and your appointment is expected to continue for at least 4 ½ months.
Certain non-employee Post Doctoral Fellows and Graduate Students are eligible for UT Benefits. Please contact your institution Benefits Office for more information.
Dependents
You may also enroll your eligible dependents for certain UT Benefits coverage.
For UT SELECT Medical ONLY, your eligible dependents are:
- your spouse as defined by the Texas Family Code1;
- your child(ren) under age 26, including
- stepchildren, and
- adopted children;
- your unmarried grandchild under age 25, if the child qualifies and is claimed as your dependent for federal tax purposes;
- certain children over age 26, who are determined by OEB to be medically incapacitated and are unable to provide their own support;
- children for whom you are named a legal guardian or who are the subject of a medical support order.
For all other UT Benefits, your eligible dependents are:
- your spouse as defined by the Texas Family Code1;
- your unmarried child(ren) under age 25, including
- stepchildren, and
- adopted children;
- your unmarried grandchild under age 25, if the child qualifies and is claimed as your dependent for federal tax purposes; or
- certain children over age 25, who are determined by OEB to be medically incapacitated and are unable to provide their own support;
- children for whom you are named a legal guardian or who are the subject of a medical support order.
1 Eligibility for a common-law spouse must be established by proof of a valid
certificate of informal marriage or a valid court order.
Examples of dependents who are not eligible for coverage include:
- your opposite-sex or same-sex domestic partner;
- your former spouse;
- your married child (for coverage other than UT SELECT Medical);
- your child over age 25 (age 26 for UT SELECT Medical), if not medically incapacitated and unable to provide their own support;
- your grandchild, if they are married or over age 25;
- foster children covered by another government program, unless coverage is required by law or court order;
- any dependent insured by another UT employee or retired employee;
- any dependent insured by another plan that receives State of Texas premium contributions; or
- any dependent who is on active duty in the armed forces of any country (for coverage other than UT SELECT Medical).
UT System conducts audits for dependents insured by other plans that receive State of Texas premium contributions such as Texas A&M System or Employees Retirement System of Texas (ERS). If you currently cover a dependent that is also receiving premium sharing for coverage through one of these plans, please choose to have that person covered under only one plan and make the appropriate enrollment changes at this time.
Surviving Dependent Benefits
The surviving spouse or other benefits-eligible dependent of an employee or retired employee who, on the date of the employee's death had at least five (5) years of Teacher Retirement System of Texas (TRS) or Texas Optional Retirement Program (ORP) creditable service, including at least three (3) years with UT as a benefits-eligible employee at the time of death, is eligible for benefits as a surviving dependent if the dependent had been participating in UT Benefits at the time of the employee or retired employee's death.
A surviving spouse may continue UT Benefits coverage for the remainder of the surviving spouse's life. A dependent child may continue until the child loses his or her status as a dependent child. The dependent of an individual who has not met the service requirements at the time of death may elect COBRA coverage for a period not to exceed 36 months.
BASIC COVERAGE PACKAGE
UT Benefits includes the following basic coverage package for eligible employees:
- UT SELECT Medical Plan, with Prescription Drug
Coverage
- $20,000 Basic Group Life Insurance
- $20,000 Basic Accidental Death and Dismemberment (AD&D) Insurance
OPTIONAL COVERAGE
You may select the following Optional Coverage(s) for yourself and your eligible dependents, unless stated otherwise:
PREMIUM SHARING
If you are a benefits-eligible full-time employee, UT and the State of Texas will pay 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 benefits-eligible part-time employee, UT and the State of Texas will pay 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 part-time employee who is eligible for benefits because of your status as a graduate student, UT and the State of Texas will pay 50% of your premiums for the basic coverage package, and up to 25% of the premiums for your dependents' medical coverage. Your institution may also choose to supplement premiums for its graduate student employees. For more information, contact your institution Benefits Office.
If you are a benefits-eligible employee and elect to waive the basic coverage package, you are eligible to use state premium sharing (50% if you are full-time and 25% if you are part-time) to purchase one or more of the following optional coverages that are paid on a pre-tax basis: Dental, Vision, Voluntary Group Term Life (up to $50,000), and Voluntary Accidental Death and Dismemberment.
Note: Individuals may not receive premium sharing based on membership in more than one state sponsored group insurance plan.
ENROLLMENT
Initial Period of Eligibility for Employees
You have 31 days from your hire date (initial period of eligibility) to complete benefits enrollment. Employees moving from a non-benefits eligible status to a benefits-eligible status also have 31 days from their change of status (initial period of eligibility) to complete benefits enrollment. 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. Enrolling in certain insurance coverage may require evidence of insurability (EOI).
Waiting Period
Newly hired employees and their dependents may be required to satisfy a state-mandated waiting period before enrollment in the UT SELECT Medical plan is allowed and state premium sharing is available. 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 may begin receiving voluntary plan benefits on your date of hire or the first of the following month. If EOI is required and approved, the coverage will begin the first of the month following approval of your application.
Your institution may choose to supplement premium sharing for all or part of the waiting period. Consult with your institution Benefits Office for additional information regarding the waiting period.
Annual Enrollment
Annual Enrollment
For plan year 2011-2012, Annual Enrollment will be held July 15-31, 2011. During this time you may change your group insurance benefit elections and add, update or remove dependents from coverage using the My UT Benefits online system. On or around July 15, you will receive a letter or email titled "Your U.T. Benefit Enrollment Options" that lists your current coverage and future coverage options and informs you if any action is required on your part.
Your Annual Enrollment elections will become effective September 1, 2011, if EOI is approved prior to September 1, 2011 or is not required. If EOI is required and not approved until after September 1, 2011, coverage will become effective on the EOI approval date.
Special Enrollment Period for Adult Children to Age 26 for Plan Year 2011-2012 Only
Effective September 1, 2011, eligible dependent children can join or remain on UT SELECT Medical coverage through the end of the month in which they turn 26 regardless of marital, military, or employment status.*
If coverage for your dependent child(ren) currently under age 26 ended (or coverage or eligibility was denied) due to age, marital, employment or military status, you may enroll these dependents online through My UT Benefits during this Annual Enrollment period (July 15–31, 2011). After Annual Enrollment, enroll by contacting your institution's Benefits Office by September 30, 2011. Enrollment will be effective September 1, 2011.
IMPORTANT! Supporting documentation of the child relationship will be required.
*Adult children under age 26 who are also eligible for enrollment in UT SELECT Medical coverage as an employee or medical coverage offered by the Employee Retirement System of Texas or Texas A&M System may not be able to participate in the special enrollment period.
CHANGE OF STATUS
You have 31 days from the date of a qualified change of status event to notify your institution Benefits Office and make qualified changes to your benefits that are consistent with that event. If you do not make your eligible 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 change 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 you 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., reaching age 26 for UT SELECT Medical, marriage or reaching age 25 for all coverage other than UT SELECT Medical, or gaining or losing eligibility for any other reason); or
- significant change in coverage or cost of other benefit plans available to you and your family.
An employee
- whose dependent loses insurance coverage under the Medicaid or CHIP program as a result of loss of eligibility of either the employee or the dependent; or
- whose dependent becomes eligible for a premium assistance subsidy under Medicaid or CHIP
may enroll this dependent in the basic coverage under UT Benefits, as long as the dependent meets all other UT eligibility requirements and is enrolled within 60 days from the date of the applicable event. If enrollment of the dependent is conditioned on enrollment of the employee, the employee will also be eligible to enroll.
Note: EOI may be required for some benefit changes following a qualified change of status event.
For more information, contact your institution Benefits Office.
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 Health Care Reimbursement Account plan. You are responsible for the full premium for elected COBRA coverage plus a 2% administration fee. For information regarding the conditions for continuation of coverage, 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 directly to you under an individual plan from the plan carrier. To do so, you must obtain the required form(s) from your institution Benefits Office and forward them to the appropriate plan carrier within 31 days of the end of the month in which your eligibility status changes or terminates.
