Employee Benefits for 2007-2008

This Website is intended to provide an overview of the group benefit options available to 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.

Special Notices:

Effective September 1, 2007, there will no longer be an HMO option available under UT System benefits. IF YOU ARE CURRENTLY ENROLLED IN HMO BLUE TEXAS, YOU WILL AUTOMATICALLY BE MOVED INTO THE UT SELECT PLAN, AT THE SAME COVERAGE LEVEL, FOR THE 2007 – 2008 PLAN YEAR. DURING ANNUAL ENROLLMENT, YOU WILL HAVE THE OPTION TO TERMINATE THIS COVERAGE OR CHANGE COVERAGE LEVEL.

UT SELECT no longer requires that the biological parent of your grandchild be enrolled in the plan for an eligible the grandchild to be eligible for coverage. However, the grandchild must be your dependent for income tax purposes. If you have or had grandchildren enrolled as dependents on your HMO plan and lost that coverage due to different eligibility requirements under UT SELECT, you may apply to re-enroll those dependents under UT SELECT without EOI. Please contact your Benefits Office for additional information. To enroll an eligible grandchild you will be required to complete a Grandchild Certification form. The Office of Employee Benefits randomly audits eligibility status of enrolled dependents. If you are randomly selected for an audit, you will be required to provide proof that you claim your grandchild for income tax purposes.

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.

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, 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.

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.

WAITING PERIOD

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. Your institution may choose to supplement all or a part of the waiting period. 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:

• 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 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 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 Short Term Disability coverage after the July 2007 Annual Enrollment or after your initial 31-day benefit election period
• Add Long Term Disability coverage after your initial 31-day benefit election
• 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.

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.

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.