| (i) change or enroll themselves and any eligible dependents
in an eligible health, dental or vision plan;
(ii) enroll themselves and their eligible dependents
in an eligible health, dental or vision plan from a waived or canceled
status;
(iii) add, decrease or cancel eligible coverage, unless
prohibited by §81.11(c)(3) of this chapter;
(iv) apply for coverage as provided in paragraph (3)
of this subsection; and
(v) waive any or all GBP coverage including health
as provided in §81.8 of this chapter.
(B) Surviving dependents and former COBRA unmarried
children are not eligible to add dependents to coverage through annual
enrollment. A surviving dependent or former COBRA unmarried child
may enroll an eligible dependent in dental or vision insurance coverage
if the dependent is enrolled in health insurance coverage.
(C) Annual enrollment opportunities will be scheduled
each year at times announced by ERS.
(9) A participant who is a retiree or a surviving dependent,
or who is in a direct pay status, may decrease or cancel any coverage
at any time unless such coverage is health insurance coverage ordered
by a court as provided in §81.5(c) of this chapter.
(10) A member and his/her dependents who are enrolled
in the Medicare Advantage Plan may collectively enroll in HealthSelect
of Texas, Consumer Directed HealthSelect or an HMO.
(A) Such opportunity will be scheduled on at least
an annual basis each year, at times announced by ERS.
(B) Additional opportunities will occur each month
prior to an annual enrollment period. Coverage selected during these
opportunities will be effective on the first of the month following
processing by CMS.
(11) If a member drops coverage for his/her dependent
because the dependent gained other coverage effective the first day
of a month, then the effective date of the qualifying life event can
be either the last day of the month preceding the gained coverage
or on the first day of the month in which the gained coverage is effective.
(e) Special provisions relating to term life benefits
(1) An employee or annuitant who is enrolled in the
group term life insurance plan may file a claim for an accelerated
life benefit for himself or his covered dependent in accordance with
the terms of the plan in effect at that time. An accelerated life
benefit paid will be deducted from the amount that would otherwise
be payable under the plan.
(2) An employee or annuitant who is enrolled in the
group term life insurance plan may make, in conjunction with receipt
of a viatical settlement, an irrevocable beneficiary designation in
accordance with the terms of the plan in effect at that time.
(f) Re-enrollment in the GBP.
(1) The provisions of subsection (a)(1) of this section
shall apply to the enrollment of an employee who terminates employment
and returns to active duty within the same fiscal year, who transfers
from one employer to another, or who returns to active duty after
a period of LWOP during which coverage is canceled.
(2) An employee to whom paragraph (1) of this subsection
applies shall be subject to the same requirements as a newly hired
employee to re-enroll in the coverage in which the employee was previously
enrolled. Provided that all applicable preexisting conditions exclusions
were satisfied on the date of termination, transfer, or cancellation,
no new preexisting conditions exclusions will apply. If not, any remaining
period of preexisting conditions exclusions must be satisfied upon
re-enrollment.
(3) If an employee is a member of the Texas National
Guard or any of the reserve components of the United States armed
forces, and the employee's coverage is canceled during a period of
LWOP or upon termination of employment as the result of an assignment
to active military duty, the period of active military duty shall
be applied toward satisfaction of any period of preexisting conditions
exclusions remaining upon the employee's return to active employment.
(g) Continuing coverage in special circumstances.
(1) Continuation of coverage for terminating employees.
A terminating employee is eligible to continue all coverage through
the last day of the month in which employment is terminated.
(2) Continuation of coverage for employees on LWOP
status.
(A) An employee in LWOP status may continue the coverage
in effect on the date the employee entered that status for the period
of leave, but not more than 12 months. The employee must pay insurance
required contributions directly as provided in subsection (h)(1)(A)
of this section.
(B) An employee whose LWOP is a result of the Family
and Medical Leave Act of 1993 will continue to receive the state contribution
during such period of LWOP. The employee must pay insurance required
contributions directly as defined in subsection (h)(1)(A) of this
section. Failure to make the payment of insurance required contributions
by the due date will result in the cancellation of all coverage except
for member-only health and basic life coverage. The employee will
continue in the health plan in which he/she was enrolled immediately
prior to the cancellation of all other coverage.
(3) Continuation of coverage for a former member or
employee of the Legislature. Provided that the insurance required
contributions are paid, the GBP health, dental, vision and life insurance
coverage of a former member or employee of the Legislature may be
continued on conclusion of the term of office or employment.
(4) Continuation coverage for a former board member.
Provided that the insurance required contributions are paid, the GBP
health, dental, vision and life insurance coverage of a former member
of a board or commission, or of the governing body of an institution
of higher education, as both are described in §1551.109 of the
Act, may be continued on conclusion of service if no lapse in coverage
occurs after the term of office. Life insurance will be reduced to
the maximum amount for which the former board member is eligible.
(5) Continuation of coverage for a former judge. A
former state of Texas judge, who is eligible for judicial assignments
and who does not serve on judicial assignments during a period of
one calendar month or longer, may continue the coverage that was in
effect during the calendar month immediately prior to the month in
which the former judge did not serve on judicial assignments. This
coverage may continue for no more than 12 continuous months during
which the former judge does not serve on judicial assignments as long
as, during the period, the former judge continues to be eligible for
assignment.
(6) Continuation of coverage for a surviving spouse
and/or dependent child/children of a deceased employee/retiree. The
surviving spouse and/or dependent child/children of a deceased employee/retiree,
who, in accordance with §81.5(j)(1) of this chapter, elects to
continue coverage may do so by submitting the required election notification
and enrollment forms to ERS. The enrollment form, including all insurance
required contributions due for the election/enrollment period, must
be postmarked or received by ERS on or before the date indicated on
the continuation of coverage enrollment form. Continuing coverage
will begin on the first day of the month following the month in which
the employee/retiree dies, provided all insurance required contributions
due for the month in which the employee/retiree died and for the election/enrollment
period have been paid in full.
(7) Continuation of coverage for a covered employee
whose employment has been terminated, voluntarily or involuntarily
(other than for gross misconduct), whose work hours have been reduced
such that the employee is no longer eligible for the GBP as an employee,
or whose coverage has ended following the maximum period of LWOP as
provided in paragraph (2)(A) of this subsection. An employee, his/her
spouse and/or dependent child/children, who, in accordance with §81.5(j)(2)
of this chapter, elect to continue GBP health, dental and vision coverage
may do so by submitting the required election notification and enrollment
forms to ERS. The enrollment form, including all insurance required
contributions due for the election/enrollment period, must be postmarked
or received by ERS on or before the date indicated on the continuation
of coverage enrollment form. Continuing coverage will begin on the
first day of the month following the month in which the employee's
coverage ends, provided all insurance required contributions due for
the month in which the coverage ends and for the election/enrollment
period have been paid in full.
Cont'd... |
