| (a) Employees.
(1) Full-time Employees. Eligibility for GBP health
coverage for full-time employees begins on the first day of the calendar
month following the employee's completion of the health insurance
waiting period. If the employee described in paragraphs (A) or (B)
does not enroll in GBP health coverage on or before becoming eligible,
he/she will automatically be enrolled in HealthSelect of Texas upon
becoming eligible.
(A) A full-time employee of an employer other than
an institution of higher education with existing, current, and continuous
GBP health coverage as of the date the employee begins active duty
or the elected or appointed officer is qualified for and begins to
hold office, is eligible for GBP health coverage under this subsection
without a waiting period provided there has been no break in coverage
in the GBP.
(B) A full-time employee of an institution of higher
education is eligible for GBP health coverage on the first day that
an employee performs services as an employee of an institution of
higher education only if:
(i) the full amount of insurance required contributions
are paid for the employee's coverage from the first date of employment
through the completion of the health insurance waiting period;
(ii) any insurance required contributions paid as provided
in clause (i) of this subparagraph shall not be paid using money appropriated
from the general revenue fund; and
(iii) any institution of higher education electing
to pay the insurance required contribution for any employee as described
in this subparagraph must do so for all eligible similarly situated
full-time employees.
(2) Part-time employees.
(A) A part-time employee or other employee of an employer
other than an institution of higher education who is not eligible
for automatic coverage becomes eligible for GBP health coverage upon
completion of the health insurance waiting period and upon application
to participate in the GBP, subject to the provisions of §81.7(a)(2)
of this chapter (relating to Enrollment and Participation). A rehired
part-time employee of the state of Texas, including a new part-time
employee, each with existing, current, and continuous GBP health coverage
as of the date the employee begins active duty or is qualified for
and begins to hold office, who is not eligible for automatic coverage
is eligible for coverage without a waiting period provided there has
been no break in coverage.
(B) A part-time employee of an institution of higher
education is eligible for GBP health coverage on the first day that
a part-time employee performs services as a part-time employee of
an institution of higher education only if:
(i) the full amount of insurance required contributions
are paid for the part-time employee's coverage from the first date
of employment through the completion of the health insurance waiting
period;
(ii) any insurance required contributions paid as provided
in clause (i) of this subparagraph shall not be paid using money appropriated
from the general revenue fund; and
(iii) any institution of higher education electing
to pay any portion of the insurance required contribution for any
part-time employee as described in this subparagraph or in §1551.101(e)(2)
of the Act, must do so for all eligible similarly situated part-time
employees.
(C) An institution of higher education is also not
prohibited from contributing a portion or all of the insurance required
contribution for certain part-time employees described by §1551.101(e)(2)
of the Act, only if:
(i) the insurance required contributions paid by the
institution of higher education shall not be paid with funds that
are appropriated from the general revenue fund;
(ii) any institution of higher education electing to
pay the insurance required contributions for any part-time employee
as described in §1551.101(e)(2) of the Act, must do so for all
eligible part-time employees described therein; and
(iii) any insurance required contributions paid as
provided in clause (i) of this subparagraph must be paid from the
first date of the part-time employee's initial enrollment.
(b) Retirees.
(1) A retiree who is at least 65 years of age with
a minimum of 10 years eligible service credit or a retiree whose age
and eligible service credit equals or exceeds 80 with a minimum of
10 years eligible service credit, is eligible for GBP health coverage
on the day he/she becomes an annuitant provided the individual retires
directly from state service. If the individual does not retire directly
from state service as described in §1551.1055(b) of the Act,
eligibility for GBP health coverage begins on the first day of the
calendar month following 60 days after the date of retirement.
(2) A retiree who is less than 65 years of age with
a minimum of 10 years eligible service credit is eligible for GBP
health coverage with the applicable state contribution on the first
day of the calendar month following the date on which the individual
reaches 65 years of age, subject to meeting the required health insurance
waiting period, if applicable.
(3) ORP Retirees.
(A) A participant in the ORP is eligible for GBP health
coverage on the day he/she receives or is eligible to receive an annuity
under the ORP program or would have been eligible to receive an annuity
had his/her membership been in TRS rather than the ORP, and meets
the age, length-of-service, any applicable health insurance waiting
period, and other requirements as provided in this subsection.
(B) A participant in the ORP is eligible for additional
coverage and plans, which include optional coverage in the GBP, as
long as he/she receives or is eligible to receive an annuity under
the ORP program or would have been eligible to receive an annuity
had his/her membership been in TRS rather than the ORP.
(4) Retirees eligible for interim insurance. A retiree
with at least 10 years of eligible service credit who is not eligible
for a state contribution for GBP health coverage at the time of retirement
is eligible for dental and vision coverage and, except as provided
in paragraph (5) of this subsection, optional life insurance and dependent
life insurance at the time of retirement. A retiree described by this
paragraph and by paragraph (2) of this subsection, is eligible for
GBP health coverage under the provisions described in §1551.323
of the Act, upon payment of the total cost, as determined by the Board
of Trustees. For purposes of §1551.323, the total cost 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 interim insurance
pursuant to §1551.323 of the Act. If an individual who is eligible
for this interim insurance is also eligible for COBRA coverage, then
COBRA coverage should be exhausted, if possible, before the interim
insurance begins as described by this subsection.
(5) A retiree is eligible for optional life insurance
and dependent life insurance coverage if the retiree was enrolled
in such coverage on the day before becoming an annuitant. Except as
provided in paragraph (6) of this subsection, a retiree may not increase
the amount of life insurance for which the retiree was enrolled on
the day before becoming an annuitant, but may cancel life insurance
coverage at any time. Canceled life insurance coverage may never be
reinstated. A retiree is not eligible for disability or AD&D coverage.
(6) A retiree who is not enrolled in retiree optional
life insurance or dependent life insurance coverage is eligible to
apply for minimum retiree optional life insurance or dependent life
insurance coverage. Submission of evidence of insurability acceptable
to ERS shall be required for enrollment in such coverage.
(7) A retiree who was not enrolled in dependent life
insurance coverage on the day before becoming an annuitant becomes
eligible for dependent life insurance coverage of a newly acquired
dependent on the first day of the month following the date on which
the individual becomes a dependent of the retiree.
(8) A retiree who returns to work for an employer may
continue coverage for which he/she is eligible as a retiree, or, subject
to subsection (a) of this section, elect to participate in the GBP
as a full-time or part-time employee. Time spent in an eligible position
as a return to work retiree may not be used to meet eligibility requirements
for retiree health insurance coverage. A return to work retiree who
elected active employee coverage will be re-enrolled in retiree coverage
for which he/she is eligible and may elect new retiree coverage for
which he/she is eligible at the time of separation from active duty.
Cont'd... |
