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UT System Administration Policy Library -- Policy UTS127 Office of Employee Benefits Administrative Manual

 

Responsible Officer: Assistant Vice Chancellor for Employee Services
Sponsoring Office: Office of Employee Benefits
Effective Date: August 6, 2003
Last Reviewed: July 14, 2008
Next Scheduled Review: August 1, 2008
Errors or changes to: policyoffice@utsystem.edu

 

CONTENTS

 

Policy Statement

Rationale

Scope

Website Address For This Policy

Related Statutes, Policies, Requirements Or Standards

Contacts

Definitions

Responsibilities

Procedures

Forms Tools/Online Processes

Appendix

POLICY STATEMENT

 

Mission Statement:
The Office of Employee Benefits will lead in designing, implementing, and administering high quality, cost effective group insurance programs for active and retired employees to support the mission of The University of Texas System.

 

Introduction:
The University of Texas System Employee Group Insurance Program is authorized by Chapter 1601 of the Texas Insurance Code. This Administrative Manual contains the policies and procedures that The University of Texas System is required to adopt in order to implement Chapter 1601.  It also contains the policies and procedures for administration of System retirement programs and plans.  It has been prepared by the Office of Employee Benefits to ensure that Program coverage and access to System retirement programs and plans is uniformly provided to eligible employees at the fifteen (15) University of Texas System institutions and System Administration.

 

This manual is available at: http://www.utsystem.edu/benefits/policies/Policy_Manual_Table_of_Contents.pdf
and on OEB’s Web site at http://www.utsystem.edu/benefits/  on the “Forms and Publications” page.

RATIONALE

 

 

Primary Objective
The primary objective of The University of Texas System Employee Group Insurance Program is to maximize the benefits and services that active and retired employees of The University of Texas System receive for each dollar spent on insurance benefits. In doing so, the Office of Employee Benefits, while working within the requirements of Chapter 1601 of the Texas Insurance Code, other applicable laws and the limitations of the marketplace, must weigh the needs and desires of The University of Texas System active and retired employees and their eligible dependents who participate in one or more of the group insurance plans.

SCOPE  

 

 

All institutions and UT System Administration

 

WEBSITE ADDRESS FOR THIS POLICY

 

http://www.utsystem.edu/policy/policies/uts127.html

RELATED STATUTES, POLICIES, REQUIREMENTS OR STANDARDS

 

 

 

CONTACTS

 

Subject	Office Name	Telephone Number	Email/URL
Senior Benefits Analyst - Robert L. Westmoreland	Office of Employee Benefits The University of Texas System	Phone: (512) 499-4796 Fax: (512) 499-4620	rwestmore@utsystem.edu

 

DEFINITIONS  

 

 
Employee Group Insurance Program Terms and Definitions

 

RESPONSIBILITIES 

 

 
http://www.utsystem.edu/benefits/policies/Policy_Manual_Table_of_Contents.pdf

 

Office of Employee Benefits

• Administration of an actuarially sound uniform group insurance program for the benefit of The University of Texas System;
• Administration of the System retirement programs and plans;
• Maximization of quality group insurance benefits and services offered to Program participants for each dollar available for the Program;
• Monitoring Program activities to ensure that Employee Group Insurance Program benefits and access to System retirement programs and plans are provided in compliance with applicable state and federal law, System policies and contractual requirements;
• Procurement, selection and administration of contractual relationships with carriers and other vendors providing services to and on behalf of the Program and System retirement programs and plans;
• Oversight of the administrative functions performed by System institution benefit managers and staff on behalf of the Program and System retirement programs and plans;
• Creation and oversight of the Program enrollment process and maintenance of the eligibility database for all Program participants;
• Processing and reconciliation of Program financial transactions including plan premium payments from System institutions to carriers and third party administrators;
• Provision of training to System institution benefit managers and staff concerning the Program and System retirement programs and plans;
• Assistance to participants in the resolution of member complaints; and
• Communication of Program and System retirement program and plan information to institutions and Program and System retirement program and plan participants.

OEB works closely with, and receives invaluable assistance from the Human Resource Departments of each institution. 

PROCEDURES  

100. General Information

111. Uniform Insurance Benefits Act for Employees of The University of Texas System and The Texas A&M University System

• Chapter 1601, Texas Insurance Code (effective 06/01/03, revised June 20, 2003 and September 1, 2003)

120. Employee Group Insurance Program Administration

• Objectives of Employee Group Insurance Program
• Responsibilities of the Office of Employee Benefits
• System Wide Insurance Advisory Committee

 

130. Employee Group Insurance Program Terms and Definitions

 

140. Funding for Group Insurance Coverage

• Eligibility for Premium Sharing
• Payment for Coverage
• Effective Dates
• Dual State Coverage Prohibited

 

141. Waiting Period for Group Insurance Benefits

• Policy on Institution Eligibility Waiting Periods
• Benefits Eligibility
• Program Coverage Elections
• Premium Sharing
• Adding Dependents
• Elimination of the Waiting Period

 

142. Premium Sharing for Graduate Students and Part-Time Employees

 

• Graduate Students
• Part-Time Employees
• Waiving Coverage
• Leave Without Pay
• Retired Employees
• The University of Texas System Policy

 

200. Eligibility & Enrollment for Group Insurance

 

210. Employees

 

• Eligibility for UT Group Insurance
• Premium Sharing
• Employee Benefits
• Initial Period of Employment
• Change in Coverage After Initial Period of Eligibility and Outside of Annual Enrollment
• Annual Enrollment
• Transfers
• Re-Employment with UT
• Dual State Premium Sharing Prohibited
• Termination of Employee Coverage
• Misrepresentation
• Certification of Health Insurance Waiver/Declination Election Form

 

220. Retired Employees

• Eligibility for UT Group Insurance
• Premium Sharing
• Retired Employee Benefits
• Initial Period of Eligibility
• Change in Coverage After Initial Period of Eligibility and Outside of  Annual Enrollment
• Retired Employees Returning to Active Employment
• Dual State Premium Sharing Prohibited
• Termination of Retired Employee Coverage
• Disability Retired Employees
• Coordination of Benefits
• Retired Employee Payment in Arrears to Institution
• Certification of Health Insurance Waiver/Declination Election Form
• Retirement Eligibility Flowchart

 

230. Dependents

• Eligibility for UT Group Insurance
• Dependent Benefits
• Initial Period of Eligibility
• Change in Coverage After Initial Period of Eligibility and Outside of Annual Enrollment
• Annual Enrollment
• Special Dependent Application
• Dual State Premium Sharing Prohibited
• Termination of Dependent Coverage
• Dependent Amnesty Period and Audit Process
• Misrepresentation

 

231. Special Dependent Application Process

• Definition of Special Dependent
• EGI Forms for Adding Special Dependents
• Children Subject to Medical Support Order (MSO)
• Procedure to Add Special Dependent Child
• Documentation
• Effective Date of Coverage
• Misrepresentation
• Special Dependent Application Form
• Dependency Certification of a Grandchild Form
• Coverage For Incapacitated Child Form

 

240. Surviving Dependents

 

250. COBRA Participants

• Initial Notification Requirements
• Eligibility for COBRA Coverage
• Qualifying Events for COBRA Coverage
• Qualified Beneficiaries
• Eligible Benefits
• COBRA Enrollment Process
• Effective Date of COBRA Coverage
• COBRA Premiums
• Termination of COBRA Coverage

 

260. Health Insurance Premium Payment Reimbursement Program

• Impact on The University of Texas System
• Group Insurance Enrollment Options
• Payment of Premiums
• Termination of HIPP Coverage
• Contacts for Additional Information

 

270. Evidence of Insurability (EOI)

• When EOI is Required
• When EOI is Not Required
• EOI Process for Coverage
• Effective Date of EOI Approval
• Appeal of EOI Decisions
• Questions
• Appendix

 

300. Benefit Status Changes

 

310. Change In Status

• Summary of Valid Events and Changes
• Consistency Rules
• Notification by Employee of Status Change
• Effective Date of Coverage Change
• Change in Status Form for Mid-Year Benefit Election Changes

 

320. Active Military Duty

• Quick Summary of Benefits for Active Military Personnel
• Dependent Called to Active Military Duty
• Medical and Optional Coverage Options
• Eligibility Coding
• Effective Dates
• Change in Status
• Discharge from Active Military Duty
• Premiums
• Tracking Active Military
• TRICARE

 

400. Health Insurance Portability and Accountability Act (HIPAA)

• The University of Texas System Administration HIPAA Privacy Compliance Manual
• Appendix

o UT SELECT, UT DENTAL SELECT AND UT FLEX Notice of Privacy Practices

o HIPAA Forms

 

500. Benefit Plan Descriptions

 

570. UT FLEX Program

• Insurance Premium Redirection Plan (Section 125)
• Medical Expense Reimbursement Account (MERA)
• Day Care Reimbursement Account (DCRA)
• Enrollment
• Change in Status Event During Plan Year
• Request to Change UT FLEX Election Due to a Mistake
• Transfer from One UT Institution to Another UT Institution
• Termination of UT FLEX Enrollment
• Claims Processing

 

571. UT FLEX Contribution Reporting

• Process for Creating Contribution Remittance Data set
• Steps for Processing Contribution Acknowledgement
• UT FLEX Contribution Calculations
• Flex Termination Calculations

 

600. Information Systems

 

700. Finance

 

701. Premium Billing & Reconciliation

• Premium Billing
• Institution Response to Billing Data sets
• Reconciliation to Eligibility

 

702. Billing of Postage to Components

• Process for Delivery
• Process for Monitoring Outstanding Postage Due to System Administration
• Collection Strategy

 

705. Employee Assistance Program

• Calculation of EAP Credit
• Communication to Chief Business Officer
• Mid-Year Changes in EAP Credit Amount

 

706. BCBS Eligibility Audit

• Process for Conducting the Eligibility Audit

 

707. Retroactive Eligibility Adjustments

• 90-Day Retroactive Adjustment Window for Eligibility Information
• Authorization for Retroactive Eligibility Adjustment Outside 90-Day Window
• Process for Approval/Denial
• Additional Documentation Suggested
• Distribution of Documentation

 

800. Retirement Programs

810. Optional Retirement Program

820. UTSaver Tax-Sheltered Annuity Program

830. UTSaver Deferred Compensation Plan

 

FORMS AND TOOLS/ONLINE PROCESSES

 

 

Manual Section	Online Form
210. Employees	• Certification of Health Insurance Waiver/Declination Election Form
220. Retired Employees	• Certification of Health Insurance Waiver/Declination Election Form • Retirement Eligibility Flowchart
231. Special Dependent Application Process	• Special Dependent Application Form • Dependency Certification of a Grandchild Form • Coverage For Incapacitated Child Form
310. Change In Status	• Change in Status Form for Mid-Year Benefit Election Changes

 

APPENDIX

 

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None

 

 

 

 

 

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