| (i) A retiree who is not subject to the health insurance
waiting period on the effective date of retirement as provided in §81.5(b)
of this chapter, may enroll in GBP health, dental, vision and life
insurance coverage or waive GBP health coverage as provided in §81.8
of this chapter for which the retiree is eligible, including dependent
coverage, by completing an enrollment form or waiver of coverage as
applicable before, on, or within 30 days after, the retiree's effective
date of retirement.
(ii) A retiree who is subject to the health insurance
waiting period on the effective date of retirement as provided in §81.5(b)
of this chapter, may enroll in GBP health coverage or waive GBP health
coverage as provided in §81.8 of this chapter for which the retiree
is eligible, including dependent coverage, by completing an enrollment
form or waiver of coverage as applicable, before the first day of
the calendar month following 60 days after the date of retirement
or before the first day of the calendar month after the retiree's
65th birthday, whichever is later as appropriate. The effective date
for such coverage shall be the first day of the calendar month following
60 days after the date of retirement or the first day of the calendar
month following the retiree's 65th birthday, whichever is later as
appropriate.
(iii) A retiree who is ineligible for health insurance
on the effective date of retirement as provided in §81.5(b) of
this chapter, may enroll in GBP health coverage or waive GBP health
coverage as provided in §81.8 of this chapter for which the retiree
is eligible, including dependent coverage, by completing an enrollment
form or waiver of coverage as applicable, before the first day of
the calendar month after the retiree's 65th birthday. The effective
date for such coverage shall be the first day of the calendar month
following 60 days after the date of retirement or the first day of
the calendar month following the retiree's 65th birthday, whichever
is later.
(C) A retiree who becomes eligible for minimum retiree
optional life insurance coverage or dependent life insurance coverage
as provided in §81.5(b)(6) of this chapter, may apply for approval
of such coverage by providing evidence of insurability acceptable
to ERS.
(D) Enrollments in and applications to change coverage
become effective as provided in subparagraph (B) of this paragraph
unless other coverage is in effect at that time. If other coverage
is in effect at that time, coverage or waiver of coverage becomes
effective on the first day of the month following the date of approval
of retirement by ERS; or, if cancellation of the other coverage preceded
the date of approval of retirement, the first day of the month following
the date the other coverage was canceled.
(E) A retiree who seeks enrollment in GBP health coverage
after turning age 65 will be automatically enrolled in HealthSelect
of Texas until Medicare enrollment is confirmed by CMS. A retiree
who is enrolled in a health plan and turns age 65 will remain enrolled
in that health plan until the retiree's Medicare enrollment can be
confirmed by CMS. Once Medicare enrollment is confirmed, the retiree
will be automatically enrolled in the Medicare Advantage Plan unless
the retiree opts out of the Medicare Advantage Plan and enrolls in
other coverage by completing an enrollment form as specified in subparagraph
(B)(i) - (iii) of this paragraph. If the retiree is determined to
be ineligible for Medicare coverage, then he/she will be returned
to the coverage in place immediately before turning 65.
(F) A Medicare-eligible retiree who seeks enrollment
in GBP health coverage, or is retired and enrolled in a health plan
and becomes eligible for Medicare, will be automatically enrolled
in the HealthSelect of Texas Prescription Drug Program until Medicare
enrollment is confirmed by CMS. Upon confirmation of Medicare enrollment,
the retiree will be enrolled in HealthSelect Medicare Rx. A retiree
who declines HealthSelect Medicare Rx loses all GBP prescription drug
coverage. If the retiree is determined to be ineligible for Medicare
coverage, then he/she will be returned to the coverage in place immediately
before turning 65.
(4) Medicare-eligible Dependents.
(A) A dependent as defined in §81.1 of this chapter
(relating to Definitions) who becomes eligible for Medicare-primary
coverage as specified in §81.1 of this chapter, either through
disability, age, or other requirements as set forth by CMS, will be
automatically enrolled in the Medicare Advantage Plan, once Medicare
enrollment is confirmed by CMS, unless the retiree and his/her dependents
opt out of the Medicare Advantage Plan and enroll in other coverage
by completing an enrollment form as specified in paragraph (3)(B)(i)
- (iii) of this subsection. If the dependent is determined to be ineligible
for Medicare coverage, then he/she will be returned to the coverage
in place immediately before turning 65.
(B) A Medicare-eligible dependent eligible for GBP
health coverage will be automatically enrolled in HealthSelect Medicare
Rx, once Medicare enrollment is confirmed by CMS. A Medicare-eligible
dependent who declines HealthSelect Medicare Rx loses all GBP prescription
drug coverage. If the dependent is determined to be ineligible for
Medicare coverage, then he/she will be returned to the coverage in
place immediately before turning 65.
(5) Surviving dependents.
(A) Provided that the insurance required contributions
are paid or deducted, the health, dental, and vision insurance coverage
of a surviving dependent may be continued on the death of the deceased
employee/retiree if the dependent is eligible for such coverage as
provided by §81.5(e) of this chapter.
(B) A surviving spouse who is receiving an annuity
shall make insurance required contribution payments by deductions
from the annuity as provided in subsection (h)(7) of this section.
A surviving spouse who is not receiving an annuity may make payments
as provided in subsection (h)(7) of this section.
(C) A Medicare-eligible surviving dependent eligible
for GBP health coverage will be automatically enrolled in the Medicare
Advantage Plan, once Medicare enrollment is confirmed by CMS, unless
the surviving dependent opts out of the Medicare Advantage Plan and
enrolls in other coverage.
(D) A Medicare-eligible surviving dependent eligible
for GBP health coverage will be automatically enrolled in HealthSelect
Medicare Rx, once Medicare enrollment is confirmed by CMS. A Medicare-eligible
surviving dependent who declines HealthSelect Medicare Rx loses all
GBP prescription drug coverage.
(6) Former COBRA unmarried children. A former COBRA
unmarried child must provide an application to continue GBP health,
dental and vision insurance coverage within 30 days after the date
the notice of eligibility is mailed by ERS. Coverage becomes effective
on the first day of the month following the month in which continuation
coverage ends. Insurance required contribution payments must be made
as provided in subsection (h)(1)(A) of this section.
(b) Premium conversion plans.
(1) An eligible employee participating in the GBP is
deemed to have elected to participate in the premium conversion plan
and to pay insurance required contributions with pre-tax dollars as
long as the employee remains on active duty. The plan is intended
to be qualified under the Internal Revenue Code, §79 and §106.
(2) Maximum benefit available. Subject to the limitations
set forth in these rules and in the plan, to avoid discrimination,
the maximum amount of flexible benefit dollars which a participant
may receive in any plan year for insurance required contributions
under this section shall be the amount required to pay the participant's
portion of the insurance required contributions for coverage under
each type of insurance included in the plan.
(c) Special rules for additional coverage and plans
which include optional coverage.
(1) Only an employee/retiree or a former officer or
employee specifically authorized to join the GBP may apply for additional
coverage and plans. An employee/retiree may apply for or elect additional
coverage and plans for which he/she is eligible without concurrent
enrollment in GBP health coverage provided by the GBP. Additional
coverage and plans, as determined by the Board of Trustees, may include:
(A) dental coverage;
(B) optional term life;
(C) dependent term life;
(D) short- and long-term disability;
(E) voluntary accidental death and dismemberment;
(F) long-term care;
(G) health care and dependent care reimbursement;
(H) commuter spending account;
(I) vision;
(J) limited purpose flexible spending account; or
Cont'd... |
