| (B) If the member does not comply with subparagraph
(A) of this subsection by the due date required, ERS will cancel all
coverage not fully funded by the state contribution. If the state
contribution is sufficient to cover the required insurance contribution
for such coverage, the member will retain member-only health and basic
life coverage. If the state contribution is not sufficient to cover
the member-only coverage in the health plan selected, the member will
be enrolled in the basic plan except as provided for in paragraph
(2)(B) of this subsection.
(2) An institution of higher education may contribute
a portion or all of the insurance required contribution for its part-time
employees described by §1551.101(e)(2) of the Act, if:
(A) the institution of higher education pays the contribution
with funds that are not appropriated from the general revenue fund;
(B) the institution of higher education electing to
pay the contribution for its part-time employees does so for all similarly
situated eligible part-time employees; and
(C) the contribution paid as provided in this paragraph
is paid beginning on the first day of the month following the part-time
employee's completion of any applicable waiting period.
(3) A participant who continues GBP health, dental
and vision coverage under COBRA as provided in §81.5(j) of this
chapter must pay his/her monthly insurance contributions on the first
day of each month covered.
(A) A participant's monthly insurance required contribution
is 102% of the monthly amount charged for other participants in the
same coverage category and in the same plan. 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. Subsequent insurance required contributions
are due on the first day of each month of the participant's coverage
and must be postmarked or received by ERS within 30 days of the due
date to avoid cancellation of coverage.
(B) A participant's monthly insurance required contribution
for continuing coverage as provided in §81.5(j)(3) of this chapter
is increased after the 18th month of coverage to 150% of the monthly
amount charged for other participants in the same coverage category
and in the same plan. The participant's monthly insurance required
contribution is due on the first day of each month covered, and must
be postmarked or received by ERS within 30 days of the due date.
(4) The full cost for GBP health, dental and vision
coverage is required to be paid for a member's unmarried child who
is over 26 years of age, whose coverage under COBRA expired, and who
has reinstated coverage in the GBP pursuant to §1551.158 of the
Act. No state contribution is paid for this coverage.
(5) Survivors of a paid law enforcement officer employed
by the state or a custodial employee of the institutional division
of the Texas Department of Criminal Justice who suffers a death in
the line of duty as provided by Chapter 615, Government Code, are
eligible for GBP coverage as provided in subparagraphs (A) - (C) of
this paragraph.
(A) The insurance required contribution due under this
paragraph for a surviving spouse's GBP coverage is the same amount
as a member-only contribution. The state contribution applicable to
member-only coverage is applied to the surviving spouse's contribution
for the coverage.
(B) The insurance required contribution due under this
paragraph for GBP coverage for a surviving spouse with dependent children
is the same amount as the member-with-children contribution. The state
contribution applicable to member-with-children coverage is applied
to the contribution of the surviving spouse with dependent children
for the coverage.
(C) The insurance required contribution due under this
paragraph for a surviving dependent child's GBP coverage, when there
is no surviving spouse, is the same amount as member-only contribution.
The state contribution applicable to member-only coverage is applied
to the surviving dependent child's contribution for the coverage.
(D) The surviving spouse or surviving dependent child
must timely pay his/her insurance required contributions for the GBP
coverage. The survivor's contribution must be either deducted by ERS
from the survivor's annuity payment, if any, or submitted to ERS via
direct payment. Any applicable state contribution will be paid directly
to ERS by the employer that employed the deceased law enforcement
officer or custodial employee.
(6) If a retiree whose eligibility for health insurance
is based on §§1551.102(i), 1551.111(e) or 1551.112(c) of
the Act, obtains interim health insurance as provided in §1551.323
of the Act, the retiree must pay the total contribution for such coverage
for as long as the retiree wants the coverage or until the first day
of the month following the retiree's 65th birthday. The amount of
contribution shall be determined by the Board of Trustees based on
an actuarial determination, as recommended by ERS' consulting actuary
for insurance, of the estimated total claims costs for individuals
eligible for such coverage. If a retiree who is eligible for coverage
under this paragraph is also eligible for COBRA coverage, then COBRA
coverage should be exhausted, if possible, before applying for the
coverage under this paragraph.
(7) A member's surviving spouse or surviving dependent
who is receiving an annuity shall authorize deductions for insurance
required contributions from the annuity as provided in paragraph (1)
of this subsection. A member's surviving spouse or surviving dependent
who is not receiving an annuity may make payments as provided in paragraph
(1)(A) of this subsection.
(i) The amount of state contribution for certain retirees
is determined in accordance with §1551.3196 of the Act.
(1) An individual is grandfathered at the time of retirement
and not subject to §1551.3196 of the Act, if on or before September
1, 2014, the individual has served in one or more positions for at
least five years for which the individual was eligible to participate
in the GBP as an employee.
(2) Records of ERS shall be used to determine whether
or not an individual meets the grandfathering requirements specified
in paragraph (1) of this subsection. ERS may, in its sole discretion,
require an individual to provide additional documentation satisfactory
to ERS that the individual meets the grandfathering requirements specified
in paragraph (1) of this subsection.
(j) Tobacco User Premium Differential.
(1) Assessment. Pursuant to §1551.3075 of the
Act, ERS shall assess a monthly tobacco user premium differential,
in an amount determined by the Board of Trustees or as set in the
General Appropriations Act, for participants enrolled in GBP health
coverage who are certified as tobacco users or are age eighteen or
older at the start of the current plan year and whose tobacco-use
status has not been certified. ERS shall assess a single premium differential
for each GBP member who is a tobacco user, a single premium differential
for the member's dependent spouse who is a tobacco user, and a single
premium differential for one or more of the member's dependent children
who are tobacco users. A participant will not be subject to a premium
differential assessment if the participant has been certified not
to be a tobacco user or ERS has approved the participant for a one-year
waiver under the Choose to Quit program.
(2) Payment. The GBP member responsible for paying
a tobacco user's insurance required contribution shall pay any assessed
premium differential for the member and the member's dependents.
(3) Certification of Tobacco-Use Status. Each GBP member
with GBP health coverage must certify the tobacco-use status of the
member and the member's enrolled dependents.
(A) If participants certify that they are not a tobacco
user, ERS shall not assess the premium differential.
(B) ERS shall assess the premium differential monthly
for any participant age eighteen or older at the start of the current
plan year whose tobacco-use status has not been certified.
(4) Choose to Quit Wellness Program. ERS may approve
a one-year waiver for a participant who completes the Choose to Quit
program for that plan year.
(A) The participant must complete all of the following
steps to have the premium differential waived:
(i) participate in an office visit with a licensed
physician to receive tobacco counseling and establish a tobacco cessation
course of treatment under that physician's recommendation and supervision;
(ii) complete the course of treatment, which may or
may not result in cessation of tobacco use;
(iii) participate in an office visit with the licensed
physician following completion of treatment and obtain the physician's
signature and the date of signature on the Choose to Quit certification
form; and
Cont'd... |
