SUBJECT:
OPTIONAL GROUP INSURANCE PROGRAMS
APPLICABILITY: ALL INSURANCE ELIGIBLE
FACULTY, STAFF, AND GRADUATE STUDENTS
1. Purpose:
To provide eligible faculty, staff, and graduate students the opportunity
to participate in insurance programs designed to protect them and their
families against financial hardship due to illness, disability or death;
and, to comply with the rules and regulations under the Uniform Group
Insurance Program (UGIP) administered by the Employees Retirement System
of Texas (ERS), and the rules and regulations of the University’s
Long Term Care Program.
2. Policy:
It is the policy of the University to provide an opportunity for participation
in the Uniform Group Insurance Program, TexFlex and the Long Term Care
Plan to all insurance eligible faculty, staff and graduate students; to
cover each insurance eligible regular faculty and staff member under employee
only basic health and term life unless a waiver is signed; and, to contribute
each month a premium amount set by state law toward the cost (premium)
of each insurance eligible employee's basic health and life coverage,
in accordance with Texas Insurance Code, Chapter 1551, Texas Employees
Group Benefits Act, as amended, (House Bill No 2, Seventy-second Legislature
of Texas, 1991) and the rules and regulations under the Uniform Group
Insurance Program administered by the Employees Retirement System of Texas.
In the event of any discrepancy between the policy and provisions stated
herein and the official documents, statutes and administrative rules governing
the programs administered by the Employees Retirement System of Texas,
those documents, statutes and administrative rules will prevail.
3. Responsibility:
The University Human Resources Department is responsible for coordinating
the participation of insurance eligible employees in the Uniform Group
Insurance Program and TexFlex that are administered by the Employees Retirement
System of Texas. The University Human Resources Department and ERS are
responsible for the administration of the Long Term Care Plans.
4. Programs:
The following programs are available on an optional basis:
(For specific information regarding plan options, coverage schedules,
and premium rates, consult with the Benefits section of Human Resources.)
4.1 Group Comprehensive Medical: Insurance-eligible
employees may elect to cover themselves and their dependents in HealthSelect
of Texas or, if available, an approved health maintenance organization
(HMO). These programs provide for comprehensive medical benefits for
hospital services, physician's or surgeon's services, nursing care,
x-ray, and laboratory exams, and other medical expense benefits for
employees and eligible dependents. Insurance eligible regular faculty
and staff are required to be covered by the employee only basic health
plan (HealthSelect of Texas), unless coverage is waived or another option
is chosen.
4.2 Basic Term Life and Accidental Death and Dismemberment
(AD&D): Employees who participate in the basic health plan or in
an HMO are also provided with $5,000 basic term life insurance and $5,000
basic AD&D coverage.
4.3 Optional Coverages: Upon enrollment in the Uniform
Group Insurance Program basic health plan (either HealthSelect or an
HMO), employees may during their initial period of eligibility (first
31 days of employment) enroll in any of the following optional coverages:
4.3.1 Optional Term Life With AD&D Life: Coverage
(for the employee) is available in an amount equal to one (1) or two
(2) times the employee's basic annual salary rounded to the next higher
multiple of $1,000 without evidence of insurability. Coverage equal
to three (3) or four (4) times annual salary is available only after
satisfying evidence of insurability. The maximum amount of Optional
Term Life Insurance may not exceed $400,000.
4.3.2 Voluntary Accidental Death and Dismemberment
(AD&D) Plan: Voluntary accidental death and dismemberment coverage
is available for the employee and/or eligible dependents in an amount
of $10,000 to $200,000 in increments of $5,000. (See current schedule
of benefits for amounts available to employees over 70.)
4.3.3 Dependent Term Life: Group term life insurance
equal to $5,000 with $5,000 AD&D is available to cover eligible
dependents.
4.3.4 Disability Insurance: Eligible employees may
elect to participate in short term disability, long term disability
or both short and long term disability coverage. (See current schedule
of benefits for details of coverage.)
4.3.5 Dental Coverage: Eligible employees may elect
coverage for themselves and eligible dependents in either a dental indemnity
plan or in a dental maintenance plan. The dental indemnity plan allows
the participant freedom to select care from any dentist while the dental
maintenance plan offers benefits with specific providers. (See schedules
of benefits for details.)
4.3.6 Premium Conversion: Premium conversion enables
employees to pay for out-of-pocket premiums for health, dental, life,
and AD&D, with tax-free dollars. Premium conversion for dependent
life coverage is not allowed by IRS regulations. Disability premiums
are also not tax-deferred to allow for tax-free benefits.
4.4 TexFlex Programs: Participants in the Uniform
Group Insurance Program may participate in the flexible benefits program
called TexFlex. TexFlex allows employees to pay for eligible health
care and day care expenses with tax-free dollars. The following programs
are available: (Detailed information regarding TexFlex is available
in the Human Resources Department.)
4.4.1 Health Care Reimbursement Account: A Health
Care Reimbursement Account (HCRA) enables employees to set aside tax-free
dollars to cover eligible health care expenses incurred by the employee
and eligible dependents.
4.4.2 Dependent Care Reimbursement Account: A Dependent
Care Reimbursement Account (DCRA) enables employees to pay for dependent
care expenses for children under age 13 or for elderly or disabled dependents
with tax-free dollars.
4.5 Long Term Care Insurance: All insurance-eligible
employees may enroll in group long term care insurance coverage for
themselves and their spouses without evidence of insurability during
the employee's initial 31 days of employment.
5. Enrollment Eligibility – Health and Basic Life:
5.1 A new full-time insurance-eligible faculty or
staff member is required to be covered by the "employee only"
basic health and term life plan the first of the month following their
initial ninety (90) day waiting period unless coverage is waived, except
for new faculty and staff hired on September 1, 2003. New faculty and
staff hired on or before September 1, 2003, will be eligible for coverage
effective September 1 without an initial 90-day waiting period. The
University will provide the employer contribution from local (non-appropriated
funds) for those hired on September 1 to the first of the month following
their initial ninety (90) day waiting period. New insurance-eligible
faculty and staff members hired after September 1, 2003 will be subject
to the ninety (90) day waiting period.
5.2 A new part-time insurance eligible employee beginning
September 1, 2003 or later will automatically have coverage waived.
The employee will have an initial eligibility period to enroll in basic
health and term life coverage. The intial eligibility period will begin
on the employees hire date and will last until the first of the month
following a 90-day waiting period.
5.3 New insurance-eligible employees have an "initial
period of eligibility". The eligibility period begins on their
first active duty date and ends on their health coverage date (ninety
plus days). During this initial eligibility period, employees may enroll
eligible dependents without evidence of insurability. Thereafter, evidence
of insurability will be required, and coverage is never guaranteed.
Additional restrictions on enrollment may be imposed by the Employees
Retirement System (ERS) and because of the tax break provided through
premium conversion.
5.4 Newly acquired dependents (through marriage, birth,
or adoption) may be enrolled without evidence of insurability within
31 days of becoming eligible.
5.5 After dropping coverage, evidence of insurability
must be provided by an employee, retiree, or dependent to re-enroll.
5.6 Full-time employees (working 40 hours a week)
will receive a state contribution of 100 percent of the cost of the
employee basic health and term life coverage, and 50 percent of the
cost of dependent coverage. Part-time employees (working 20 or more
hours a week up to less than 40 hours a week) will receive a state contribution
of 50 percent of the cost of the employee basic health and term life
coverage, and 25 percent of the cost of dependent coverage. Insurance
eligible, part-time graduate students are eligible to receive an additional
employer contribution from local funds of the University up to the full
cost of the employee basic health and term life coverage, and 50 percent
of the dependent coverage.
5.7 For new insurance eligible faculty and staff members
who start employment on September 1, 2003 the University will provide
the employer contribution from local (non-appropriated) funds for the
months from their hire date, September 1, 2003, to the first of the
month following ninety (90) days of employment.
6. Enrollment Eligibility - Optional Coverage and TexFlex:
New insurance-eligible employees may enroll in Optional Life, Dependent
Life, Disability, and Dental optional coverage and TexFlex within thirty-one
(31) days of employment. Thereafter, application for coverage may be made
only with evidence of insurability. ERS administrative rules restrict
application with evidence of insurability for these coverages to the annual
Summer Enrollment Period unless an eligible Qualifying Life Event has
occurred. Voluntary AD&D does not require evidence of insurability,
but election of Voluntary AD&D after an employee's first thirty-one
(31) days is limited to the Summer Enrollment period unless an eligible
Qualifying Life Event occurs.
Application with evidence of insurability for the University’s
Long Term Care insurance may be made at any time during the plan year.
Employees may apply for ERS’s Long Term Care program during summer
enrollment. Employees may enroll in dental coverage during their initial
31 days of eligibility or during the annual Summer Enrollment period.
7. Making changes to Insurance or Tex Flex coverage:
Outside of the employee's first 31 days of employment, coverage changes
can only be made during the annual Summer Enrollment period. If an employee
has an eligible Qualifying Life Event as defined by ERS, the employee
may be able to make certain changes during the plan year, provided the
applicable form is completed in Human Resources within 31 days of the
event.
8. Employment for Less than Twelve (12) Months/Leaves of Absence:
All individuals employed less than 12 months are expected to arrange advance payments for all insurance programs with the Human Resources Department for the summer months. Employees who are on leave of absence, or who are not on the payroll for any month, are required to make advance payment.
Employees on approved leave without pay can maintain UGIP coverage for
a maximum period of 12 continuous calendar months for any reason. An additional
12 months (for a total of 24 months) may be allowed for those on Leave
Without Pay for educational purposes as certified by the institution.
Employees who are on leave without pay, except for the purpose of Family
and Medical Leave without pay, are not eligible to receive the state insurance
contribution.
Individuals employed prior to 9/1/01 with nine-month appointments may
elect to receive their nine-month salary over a period of 12 months by
electing the 9/12 Pay Option on the Payroll Options form prior to August
31 of any fiscal year thereby ensuring that premiums are deducted during
the summer months.
Individuals with nine month appointments must assure payment of summer insurance premiums. These employees must elect to receive their nine month salary over a period of 12 months by electing the 9/12 Pay Option, or pre-pay summer insurance premiums by electing the 12 over 9 Premium Reserve Option. If 9/12/ pay is not elected, Premium Reserve enrollment is mandatory.
9. Insurance Programs for Reservists/Employees Called to Active
Duty:
Reservists/employees called to active duty may continue insurance coverage
during their military leave of absence without pay for up to 12 months.
See Extended Military Leave Policy No. 1.4.9. (Disability insurance is
suspended while on leave of absence without pay.) Reservists/Employees
are not eligible to receive the monthly state insurance contribution while
on leave when the leave encompasses the month. To continue coverage the
reservist/employee must pay the total monthly premium.
9.1 Reservists/Employees called to active duty may
drop coverage on themselves and/or their dependents while on leave of
absence. The reservist/employee may reinstate all insurance coverages
that were in effect immediately prior to the commencement of the active
duty without evidence of insurability and/or pre-existing conditions
or limitations, provided the reservist/employee returns to work within
90 days of discharge and reinstates coverages within 30 days from the
date the reservist/employee returns to work.
9.2 Covered dependents of the Reservists/Employees
who drop coverage while on a leave of absence may apply for continuation
of coverage for up to 12 months under the provisions of COBRA. Dependent
coverage may be reinstated as indicated in 8.1. when the reservist/employee
returns to work.
10. Insurance Programs for Retirees:
Upon retirement from the University, a regular faculty or staff member
may be eligible to continue membership in the Uniform Group Insurance
Program (UGIP) for Retirees. Eligible retirees may enroll in health, basic
life, optional life, dependent life, and dental coverage by completing
the appropriate TRS/ORP Retiree Enrollment Form within 31 days of retirement
eligibility. To be eligible for retiree insurance an individual must be
at least 65 years of age and have a minimum of ten years of creditable
service with the Teacher Retirement System (TRS) or equivalent service
in the Texas Optional Retirement Program (ORP) or qualify for retirement
benefits based on age plus years of service totaling 80 or more, and must
be eligible to receive a retirement annuity from either TRS or ORP. In
addition, a minimum number of years of UGIP participation is required:
3 years if hired before September 1, 2001 or 10 years if hired September
1, 2001 or later. Retirees may continue dependent life and optional life
coverage within limits established by the Employees Retirement System.
10.1 Once enrolled in the retiree insurance program,
the retiree's coverage is administered by the Employees Retirement System
of Texas.
10.2 The State of Texas contributes each month toward
the cost (premium) of each regular retired faculty or staff member's
group medical insurance program. The amount is set by state law.
10.3 Employees who become disabled may be eligible
for continued coverage in accordance with the rules and regulations
of the Employees Retirement System of Texas.
11. Insurance Coverage Continuation:
11.1 A surviving spouse and/or dependents who are
covered by the group at the time of the death of a retiree or an employee
who meets the eligibility criteria for retiree insurance may, at their
option, continue such coverage indefinitely, subject to continued payment
of group premiums for the surviving spouse and/or dependents. Upon leaving
the group, the spouse and/or dependents have the right to convert to
an individual policy without evidence of insurability, if applied for
within 31 days of termination of group status.
11.2 Under the Consolidated Omnibus Budget Reconciliation
Act (COBRA) of 1986 the University offers a continuation option for
certain employees and their dependents whose coverage under the group
medical plan program would otherwise end. This continuation option is
available to persons whose coverage would end on or after October 1,
1986.
11.2.1 Employees and/or their dependents may elect
an 18-month continuation if terminating employment (except for gross
misconduct) or if reducing the number of hours worked would result in
a loss of coverage.
11.2.2 For the purposes of continuation of coverage
under COBRA, gross misconduct is defined as, but not limited to, the
following:
a. Theft, misappropriation of unauthorized use of
University funds or property.
b. Carrying firearms or other dangerous weapons
on University premises.
c. Assault of a University employee or student.
d. Conviction of a felony or conviction of a misdemeanor
involving moral turpitude.
e. Sexual harassment.
f. Bringing liquor, marijuana, or narcotics onto
the University campus; or consuming liquor or using marijuana or narcotics
on University premises.
11.2.3 Dependents may elect a 36-month continuation
if:
a. Coverage would otherwise end because of the death
or divorce or legal separation from the covered employee;
b. A dependent child would lose coverage due to
plan provisions (for example, reaching a maximum age or due to marriage);
or
c. If coverage would end due to the employee reaching
Medicare eligibility.
11.3 In the case of 10.1 or 10.2 the surviving spouse
or dependents of COBRA continuations are not eligible for premium sharing
contributions.
REFERENCES:
Texas Insurance Code, Chapter 1551, Texas Employees Group Benefits Act
(House Bill No. 2, Seventy-Second Legislature of Texas, as amended, 1991.)
Senate Bill 1370, Seventy-Eighth Legislature of Texas, 2003.
Rules and Regulations of the Uniform Group Insurance Program administered
by the Employees Retirement System of Texas.
|