Benefits for Retired 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 Long-Term Care

Resources Group Benefits Handbook for Retired Employees Enroll using U.T. Touch 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

Retired Employees

1. 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:
  
  1. the Teachers Retirement System of Texas; or
  2. the Employees Retirement System of Texas; or
  3. the Optional Retirement Program established by Chapter 830, Government Code or any other federal or state statutory retirement program to which UT has made employer contributions.

2. Individuals who were employed with UT, 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 above, and who retire as an annuitant after 8/31/03 must meet the criteria as defined above in number one.
3. Individuals who 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 UT has made employer contributions; or
• the individual meets the rule of 80 with at least 10 years total creditable service, or the individual has 10 years total creditable service and is age 65.

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. 

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%
Retired	100%	50%
Part-time	50%	25%
Graduate Student *	50%	25%

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

CHANGE OF STATUS

Changes to your group insurance 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

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 provides eligible retired employees with the following Basic Coverage Package:

• UT SELECT Medical Plan, with Prescription Drug Coverage
• $3,000 Basic Group Life Insurance

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)
• 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 the employee’s 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 employees’ or retired employees’ voluntarily medical coverage that was previously terminated or waived, unless proof of other active group medical coverage can be provided;
• Increase or reinstate employees’, retired employees’ and spouses’ voluntary group life insurance coverage;
• 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 printed and mailed by the deadline to the appropriate insurance company for review.  The postmark deadline for Annual Enrollment is August 15. 

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, and/or vision 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 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 institution 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.

SURVIVING DEPENDENT BENEFITS

A Surviving Dependent is a spouse or a dependent child or grandchild who was participating in the Program 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 the Program as described below:

• The surviving dependent  may continue Program 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 Program 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 Spouse 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 Spouse.

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.