Part 4.
EMPLOYEES RETIREMENT SYSTEM OF TEXAS
Chapter 81.
INSURANCE
34 TAC §§81.1, 81.3, 81.5, 81.7
The Employees Retirement System of Texas (ERS) proposes amendments
to §§81.1, 81.3, 81.5, and 81.7, concerning the Uniform Group Insurance
Program (UGIP). Section 81.1 is amended to clarify the definition of accelerated
life benefit and the definition of a person authorized by the Act to participate
in the program; §81.3 is amended to update the rules regarding payment
of premiums; §81.5 is amended to update eligibility rules concerning
retirees and to permit former board members to continue coverage; and §81.7
is amended to update the rules concerning enrollment and participation.
Paula A. Jones, General Counsel, has determined that for the first five-year
period the rules are in effect there will be no known fiscal implications
for state or local government as a result of enforcing or administering the
rules.
Ms. Jones also determined that for each year of the first five years the
rules are in effect the public benefit anticipated as a result of enforcing
the rules will be updated information and clarification of the rules. There
will be no affect on small businesses. There are no known anticipated economic
costs to persons who are required to comply with the rules as proposed.
Comments on the proposed rule amendments may be submitted to Paula A. Jones,
General Counsel, Employees Retirement System of Texas, P. O. Box 13207, Austin,
Texas 78711-3207, or e-mail Ms. Jones at pjones@ers.state.tx.us.
The amendments are proposed under Insurance Code, Article 3.50-2, §4.
No other statutes are affected by these proposed amendments.
§81.1.Definitions.
The following words and terms, when used in this chapter, shall have
the following meanings, unless the context clearly indicates otherwise.
(1)
Accelerated life benefit-An amount of term life insurance
to be paid in advance of the death of an insured employee, annuitant, or dependent,
as requested by the employee or annuitant and approved by the carrier, in
accordance with the terms of the group term life plan as permitted by Article
3.50-6, Insurance Code. Accelerated life benefit payment may be requested
only upon diagnosis of a terminal condition and only once during the lifetime
of the insured employee, annuitant, or dependent. A terminal condition is
a non-correctable health condition that with reasonable medical certainty
will result in the death of the insured within 12 months.
[
(2)-(5)
(No change.)
(6)
Annuitant - A person
authorized by the Act to
participate in the program as an annuitant
[
(7)-(10)
(No change.)
(11)
Department - Commission, board, agency, division,
institution of higher education, or department of the State of Texas created
as such by the constitution or statutes of this state
, or other governmental
entity whose employees or retirees are authorized by the Act to participate
in the program.
(12)
Dependent - The spouse of an employee or retiree
and unmarried children under 25 years of age, including:
(A)-(H)
(No change.)
(I)
any such child, regardless of age, who lives with or whose
care is provided by an employee or retiree on a regular basis if such child
is mentally retarded or physically incapacitated to such an extent as to be
dependent upon the employee or retiree for care or support, as the trustee
shall determine. Mentally retarded or physically incapacitated means any medically
determinable physical or mental condition which prevents the child from engaging
in self-sustaining employment, provided that the condition commences prior
to such child's attainment of age 25, the child was eligible and covered under
the plan immediately prior to reaching age 25, and that satisfactory proof
of such condition and dependency is submitted by the employee/retiree within
31 days following such child's attainment of age 25
and at such intervals
thereafter as may be required by the system
. [
(13)
(No change.)
(14)
Employee -
A person authorized by the Act to
participate in the program as an employee.
[
[
who is retired or retires
and is an annuitant as defined in the Act;]
[
who receives his compensation
for services rendered to the State of Texas on a warrant issued pursuant to
a payroll certified by a department or by an elected or duly appointed officer
of this state;]
[
who receives payment for the
performance of personal services on a warrant issued pursuant to a payroll
certified by a department and drawn by the state Comptroller of Public Accounts
against appropriations made by the Texas legislature from any state funds
or against any trust funds held by the state or who is paid from funds of
an official budget of a state department, rather than from funds of the General
Appropriations Act;]
[
who is appointed, subject
to confirmation of the senate, as a member of a board or commission with administrative
responsibility over a statutory agency having statewide jurisdiction whose
employees are covered by the Act;]
[
who is a member of the governing
body of an institution of higher education;]
[
who is a member of the State
Board of Education;]
[
who receives compensation
for services rendered to an institution of higher education on a warrant or
check issued pursuant to a payroll certified by an institution of higher education
or by an elected or duly appointed officer of this state, and who is eligible
for participation in the Teacher Retirement System of Texas; or,]
[
who receives compensation
for services rendered to an institution of higher education but is not permitted
to be a member of the Teacher Retirement System of Texas because the person
is solely employed by an institution of higher education that, as a condition
of employment, requires the person to be enrolled as a student in the institution
of higher education in graduate-level courses and who is employed by the institution
at least 20 hours a week.]
(15)-(16)
(No change.)
[
Extended sick leave
without pay - The status of an employee who is certified monthly by an agency
administrator to be absent from duty as a result of a disabling condition
which prevents the employee from performing the employee's usual duties, and
who has not received a refund of retirement contributions based upon the most
recent term of employment. Such leave is limited to a maximum period of duration
in the current Appropriations Act.]
(17)
[
(18)
[
(19)
[
(20)
[
(21)
[
(22)
[
(23)
[
(24)
[
(25)
[
(26)
[
(27)
[
(28)
[
(29)
[
(30)
[
(31)
[
§81.3.Administration.
(a)
Group Benefits Advisory Committee (GBAC).
(1)-(6)
(No change.)
(7)
The Executive Director of the Employees Retirement
System of Texas shall file a notice of the GBAC's meetings with the
Secretary of State
[
(8)
(No change.)
(b)
(No change.)
(c)
Health maintenance organizations.
(1)-(2)
(No change.)
(3)
An HMO seeking board approval in response to a request
for bid in one or more of the RBAs, must satisfy the following conditions:
(A)
The HMO must be licensed by the Texas Department of Insurance
to operate in the State of Texas.
(B)
The HMO must have been providing services in the RBA for
at least 6 months prior to September 1 of the fiscal year in which the bid
response is due to be filed with the system. Also, the HMO must demonstrate
the capacity
to
[
(C)-(G)
(No change.)
(4)
(No change.)
(d)
Payment of Premiums
[
(1)
[
(2)
A participant's share of premiums shall be paid
through deductions from monthly compensation or annuities or by direct payment,
as provided in this paragraph.
[
(A)
[
(B)
[
(i)
An employee who is in a leave without pay status or
whose salary is insufficient, or who is a non-salaried board member, shall
pay monthly premiums in advance through the employing department. Any other
participant to whom this subparagraph applies shall pay monthly premiums in
advance to the system.
[
(ii)
A person who continues group health and dental benefits
as provided in §81.5(k) of this title (relating to Eligibility) must
pay premiums in advance on a monthly basis. Premiums for such a person will
be 102% of the rates charged for other participants in the same coverage category
and with the same plan. All premiums due for the election/enrollment period
must be postmarked or received by the Employees Retirement System
of
Texas
on or before the date indicated on the continuation of coverage
enrollment form. Subsequent premiums are due on the first day of the month
covered and must be postmarked or received by the Employees Retirement System
of Texas
within 30 days of the due date to avoid cancellation of coverage.
(iii)
(No change.)
§81.5.Eligibility.
(a)-(b)
(No change.)
(c)
Retirees.
(1)-(2)
(No change.)
(3)
A covered retiree [
(4)
A covered retiree who was not
enrolled
[
(5)-(6)
(No change.)
(d)-(j)
(No change.)
(k)
Continuation of health and dental coverages only for certain
spouses and dependent children of employees/retirees, and for certain terminating
employees, their spouses, and dependent children (as provided by the Consolidated
Omnibus Budget Reconciliation Act, Public Law 99-272).
(1)-(6)
(No change.)
(7)
Extension of continuation of coverage for certain
spouses and/or dependent child/children of former employees who are continuing
coverage under the provisions of paragraph (2) of this subsection is governed
by the following provisions.
(A)
The surviving spouse and/or dependent child/children of
a deceased former employee whose death occurred during the period of continuation
coverage, who satisfy the provisions of paragraph (1) of this subsection and
who notify the Employees Retirement System
of Texas
within 60 days
of the date of death of the former employee are entitled to a total of 36
months of continuation coverage.
(B)-(F)
(No change.)
(8)
A person who continues benefits under the provisions
of paragraphs (1)-(7) of this subsection may change coverage levels or plans
during the continuation period on the same basis as an employee/retiree participant,
provided, however, that health and dental coverages which are canceled during
the continuation period may not be reestablished.
(9)
In all situations deemed applicable by the Employees
Retirement System
of Texas
where state or federal laws or regulations
mandate specific terms or provisions which are omitted or conflict with specific
terms or provisions of the group contracts or trustees' rules, the appropriate
contracts and rules shall be interpreted and administered to comply with such
laws or regulations.
(l)
Former board members. A former member
of a board or commission or of the governing body of an institution of higher
education, as both are described in Section 3(a)(5) of the Act, is eligible
to continue the coverage, other than disability income insurance coverage,
in effect on the day before the member leaves office if no lapse in coverage
occurs after the end of the term of office.
§81.7.Enrollment and Participation.
(a)-(b)
(No change.)
(c)
Retirees and their dependents.
(1)
Provided the required premiums are paid or deducted, an
employee's health, dental and term life insurance coverage (including eligible
dependent coverages) may be continued upon retirement. The life insurance
will be reduced to the maximum amount which the retiree is permitted to retain
under the insurance contract as a retiree. All other coverages in force for
the active employee, but not available to the retiree, will automatically
be discontinued concurrently with the commencement of retirement status.
If a retiree is not covered as an active employee on the day before becoming
an annuitant, the retiree will be enrolled in the basic plan.
(2)
A retiree may enroll in health, dental, and life insurance
coverages for which the retiree is eligible, including dependent coverages,
by completing and signing an enrollment form before, on, or within 30 days
after, the retiree's effective date of retirement.
For the purposes of
this paragraph, the effective date of retirement of a retiree who is eligible
to receive, but who is not actually receiving, an annuity is the date on which
the system receives written notice of the retirement.
Except as otherwise
provided in this paragraph and paragraph (4) of this subsection, coverage
becomes effective on the first day of the month following the effective date
of retirement. A change in coverage for which the retiree applies after initial
enrollment as a retiree, but within 30 days after the effective date of retirement,
becomes effective on the first day of the month following the date of the
application. An application received after the initial period for enrollment
as provided in this paragraph is subject to the provisions of subsection (h)
of this section.
(3)
A retiree who becomes eligible for optional life insurance
coverage or dependent life insurance coverage as provided in §81.5(c)(3)
of this title (relating to Eligibility), may apply for approval of such coverage
[
(4)-(5)
(No change.)
(d)
(No change.)
(e)
Former COBRA unmarried children. A former COBRA unmarried
child must provide an application to continue health and dental insurance
coverage [
(f)-(g)
(No change.)
(h)
Changes in coverage after the initial period for enrollment.
(1)-(2)
(No change.)
(3)
An eligible participant who wishes to add or increase
coverage, add eligible dependents to HealthSelect of Texas, or change coverage
from an HMO to HealthSelect of Texas after the initial period for enrollment
must make application for approval by providing evidence of insurability acceptable
to the system. Unless not in compliance with paragraph (1) of this subsection,
coverage will become effective on the first day of the month following the
date approval is received by the employee's benefits coordinator or by the
system, if the applicant is a retiree or an individual in a direct pay status.
If the applicant is an employee
whose coverage was canceled while the
employee was
in a leave without pay status, the approved change in coverage
will become effective on the date the employee returns to active duty if the
employee returns to active duty within 30 days of the approval letter. If
the date the employee returns to active duty is more than 30 days after the
date on the approval letter, the approval is null and void; and a new application
shall be required. An employee or retiree may withdraw the application at
any time prior to the effective date of coverage by submitting a written notice
of withdrawal.
(4)
The evidence of insurability provision applies only
to:
(A)
employees who wish to enroll in Elections III or IV
optional term life insurance, except as otherwise provided in subsection (k)
of this section
[
(B)
employees who wish to enroll in or increase
optional
term life insurance or disability income insurance
[
(C)-(E)
(No change.)
(5)-(9)
(No change.)
(10)
An eligible participant will be allowed an annual
opportunity to make changes in coverages.
(A)
A participant will be allowed to:
(i)-(xi)
(No change.)
(xii)
enroll themselves and their eligible dependents in an
eligible HMO, in HealthSelect Plus (if they are eligible), and in a dental
plan from a declined or canceled status; [
(xiii)
decrease or cancel coverage, unless prohibited by §81.11(a)(2)
(relating to Termination of Coverage)
; and
[
(xiv)
apply for coverage for which evidence
of insurability is required as provided in paragraph (3) of this subsection.
(B)-(C)
(No change.)
(11)
(No change.)
(i)
(No change.)
(j)
Special provisions relating to term life benefits
(1)
An employee
or annuitant
who is enrolled in
the
group term life insurance plan
[
(2)
An employee or
annuitant
[
(k)
Reinstatement in the program.
(1)
Except as provided in subsection (h)(1) of this section,
an employee who terminates employment and returns to active duty within the
same contract year shall reinstate the coverages in effect on the date employment
was terminated. Except as provided in subsection (h)(1), coverage becomes
effective on the date on which the employee returns to active duty. To reinstate
canceled coverages, submission of evidence of insurability acceptable to the
carrier will not apply.
Provided that all applicable preexisting conditions
exclusions were satisfied on the date of termination, no new preexisting conditions
exclusions will apply. If not, any remaining period of preexisting conditions
exclusions must be satisfied upon reinstatement.
(2)-(5)
(No change.)
(l)
Continuing coverage in special circumstances.
(1)
Continuation of health, dental, and optional coverages
for terminating employees. A terminating employee is eligible to continue
all coverages through the last day of the month in which employment is terminated.
(2)
Continuation of health, dental, and life coverages
for employees in a leave without pay status.
(A)
An employee in a leave without pay status may continue
the [
(B)
(No change.)
(3)-(9)
(No change.)
(10)
Extension of continuation of health and dental coverages
for certain spouses and/or dependent child/children of former employees who
are continuing coverage under the provisions of paragraph (6) of this subsection.
(A)
The surviving spouse and/or dependent child/children of
a deceased former employee, who, in accordance with §81.5(k)(7)(A) of
this title (relating to Eligibility), elects to extend continuation coverage
may do so by submitting the required election notification and enrollment
forms to the Employees Retirement System
of Texas
. The enrollment
form, including all premiums due for the election/enrollment period, must
be postmarked or received by the Employees Retirement System
of Texas
on or before the date indicated on the continuation enrollment form.
The election/enrollment period begins on the first day of the month following
the month in which the former employee died.
(B)
A spouse who is divorced from a former employee and/or
the divorced spouse's dependent child/children, who, in accordance with §81.5(k)(7)(B)
of this title (relating to Eligibility), elects to extend continuation coverage
may do so by submitting the required election notification and enrollment
forms to the Employees Retirement System
of Texas
. The enrollment
form, including all premiums due for the election/enrollment period, must
be postmarked or received by the Employees Retirement System
of Texas
on or before the date indicated on the continuation enrollment form.
The election/enrollment period begins on the first day of the month following
the month in which the divorce decree was signed.
(C)
A dependent child under 25 years of age who marries, who,
in accordance with §81.5(k)(7)(C) of this title (relating to Eligibility),
elects to extend continuation coverage may do so by submitting the required
election notification and enrollment forms to the Employees Retirement System
of Texas
. The enrollment form, including all premiums due for the election/enrollment
period, must be postmarked or received by the Employees Retirement System
of Texas
on or before the date indicated on the continuation enrollment
form. The election/enrollment period begins on the first day of the month
following the month in which the dependent child marries.
(D)
A dependent child who has attained 25 years of age, who,
in accordance with §81.5(k)(7)(D) of this title (relating to Eligibility),
elects to extend continuation coverage may do so by submitting the required
election notification and enrollment forms to the Employees Retirement System
of Texas
. The enrollment form, including all premiums due for the election/enrollment
period, must be postmarked or received by the Employees Retirement System
of Texas
on or before the date indicated on the continuation enrollment
form. The election/enrollment period begins on the first day of the month
following the month in which the dependent child attained age 25.
(11)
(No change.)
(12)
Continuation coverage for a former
board member. Provided that the required premiums are paid, the health, dental,
and life insurance coverages of a former member of a board or commission,
or of the governing body of an institution of higher education, as both described
in Section 3(a)(5) of the Act, may be continued on conclusion of service if
no lapse in coverage occurs after the term of office.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State on January
10, 2000.
TRD-2000000130
Sheila W. Beckett
Executive Director
Employees Retirement System of Texas
Earliest possible date of adoption: February 20, 2000
For further information, please call: (512) 867-7125
Accelerated
Life Benefit - An amount of Term Life Insurance requested by the insured employee
and approved by the carrier to be paid in advance of the employee's or covered
dependent's actual death in accordance with the terms of the Group Term Life
Plan, as permitted by Article 3.50-6, Texas Insurance Code. Accelerated Life
Benefit payment can be requested only upon diagnosis of a terminal condition
and only once during the lifetime of the employee or covered dependent. A
terminal condition is a non-correctable health condition that with reasonable
medical certainty will result in the death of the insured within 12 months.
]
as defined in the Act
].
As a condition to
the continued coverage of a child as a mentally retarded or physically incapacitated
dependent beyond the age of 25, the carrier or health maintenance organization
shall have the right to require periodic certification of the child's physical
or mental condition, but not more frequently than annually following the child's
attainment of age 25.
]
Any appointive or elective
state officer or employee in the service of the State of Texas, including
an employee of an institution of higher education as defined in the Act, except
a person performing personal services for the State of Texas or an institution
of higher education as an independent contractor:
]
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(17)
(18)
] Former COBRA unmarried
child - a child of an employee or retiree who is unmarried; whose UGIP coverage
as a dependent has ceased; and who upon expiration of continuation coverage
under the Consolidated Omnibus Budget Reconciliation Act, Public Law 99-272
(COBRA) reinstates UGIP coverage.
(19)
] HealthSelect of Texas
- The statewide point-of-service plan of health coverage fully self-insured
by the Employees Retirement System of Texas and administered by a qualified
carrier or HMO.
(20)
] HealthSelect Plus -
The optional managed care plan of health coverage fully self-insured by the
Employees Retirement System of Texas and administered by a qualified carrier
or HMO on a regular basis.
(21)
] HMO - A health maintenance
organization approved by the board to provide health care benefits to eligible
participants in the program in lieu of participation in the program's HealthSelect
of Texas plan or HealthSelect Plus plan.
(22)
] Insurance premium expenses
- Any out-of-pocket premium incurred by a participant, or by a spouse or dependent
of such participant, as payment for coverage provided under the
program
[
Program
] that exceeds the state's or institution's contributions
offered as an employee benefit by the employer. The types of premium expense
covered by the premium conversion plan include out-of-pocket premium for group
term life, health (including HMO premiums), AD&D, and dental, but do not
include out-of-pocket premium for long or short term disability or dependent
term life.
(23)
] Leave without pay -
The status of an employee who is certified by a department administrator to
be absent from duty for an entire calendar month, who does not receive any
compensation for that month, and who has not received a refund of retirement
contributions based upon the most recent term of employment.
(24)
] ORP - The Optional
Retirement Program as provided in the Government Code, Chapter 830.
(25)
] Placement for adoption
- A person's assumption and retention of a legal obligation for total or partial
support of a child in anticipation of the person's adoption of such child.
(26)
] Preexisting condition
- Any injury or sickness, for which the employee received medical treatment,
or services, or took prescribed drugs or medicines during the three-month
period immediately prior to the effective date of such coverage. However,
if the evidence of insurability requirements set forth in §81.7(h) of
this title must first be satisfied, the three-month period for purposes of
determining the preexisting conditions exclusion will be the three-month period
immediately preceding the date of the employee's completed application for
coverage.
(27)
] Premium conversion
plan - A separate plan, under the Internal Revenue Code, §79 and §106,
adopted by the board of trustees and designed to provide premium conversion
as described in §81.7(f) of this title.
(28)
] Program - The Texas
Employees Uniform Group Insurance Program as established by the board.
(29)
] Retiree -
A person
authorized by the Act to participate in the program as a retiree or a retired
employee who, as of August 31, 1992, was a participant in a group insurance
program administered by an institution of higher education.
[
A
retired employee who is eligible, under the terms of the Act, for benefits
under this program and retired employees who, as of August 31, 1992, were
eligible participants in a group insurance program administered by an institution
of higher education.
]
(30)
] Salary - The salary
to be used for determining optional term life and disability income limitations
will be the employee's regular salary, including longevity, shift differential,
hazardous duty pay, and benefit replacement pay, received by the employee
as of the employee's first day of active duty within a contract year. No other
component of compensation shall be included. Non-salaried elective and appointive
officials
and
[
or
] members of the legislature may use
the salary of a state district judge or their actual salary as of September
1 of each year.
(31)
] System - The Employees
Retirement System of Texas.
(32)
] TRS - The Teacher Retirement
System of Texas.
secretary of state
] for publication in
the Texas Register.
for
] provide adequate services, as
determined by the system, to the program participants.
Funding
].
Contributions.
] Premiums for coverage provided
under the program are funded from three sources: state contributions, system
contributions, [
employee
] and
participant
[
retiree
] contributions. The legislature appropriates monies to fund group insurance
benefits for all employees as defined in the Act. Monies for employees compensated
from funds other than the General Appropriations Act are appropriated from
the official operating budget of the respective department. In addition, the
system may contribute an additional amount, as determined by the trustee,
for payment of premiums for
participants
[
employees and retirees
].
A participant
[
An employee or retiree
] who
applies for coverage for which the monthly premium exceeds the state's or
employing department's and the system's contribution must pay the excess amount.
Payment of premiums. Deductions
from monthly compensation or annuities and direct payment of premiums are
two methods of payments used for the employee's, retiree's, or other participant's
share of premiums.
]
Employee deductions.
] An employee or
annuitant
[
retiree
] who applies for coverage for which the
monthly premium exceeds the state or employing department and the system contributions
must authorize [
in writing
] on a form prescribed by the system
a deduction from his or her monthly compensation or annuity to pay the difference.
If
the
[
an employee's monthly
] compensation or [
retiree's
] annuity is insufficient to provide for the appropriate deduction,
the
participant
[
employee or retiree
] must pay premiums
directly as
provided
[
explained
] in subparagraph (B)(i)
of this paragraph. Failure to make the required payment of premiums by the
due date will result in the cancellation of all coverages not fully funded
by the state contribution. A
participant
[
person
] entitled
to the state contribution will retain member only health and basic life coverage
provided the state contribution is sufficient to cover the premium for such
coverage. If the state contribution is not sufficient for member only coverage
in the health plan selected
, the participant
[
by the employee
or retiree, the employee or retiree
] will be enrolled in the basic plan
except as provided for in §81.7(l)(2)(B) of this title.
Direct payment of premiums.
] Persons who are
eligible participants in the program and who are not on a payroll or who are
not receiving an annuity from a state retirement system from which the appropriate
premiums may be deducted or whose salary or annuity are insufficient to allow
for a full required deduction must pay premiums directly as indicated in the
following.
A person who is eligible to receive but
is not actually receiving a TRS annuity, a retiree who is eligible to receive
an annuity whose benefit is assigned to an alternate payee, a person whose
retirement annuity is temporarily suspended, a person whose annuity is insufficient,
a person who is receiving or eligible to receive an annuity under the ORP,
a former elected official, a former employee of the legislature, a surviving
spouse and/or dependent child/children of a deceased employee or retiree,
and a former COBRA unmarried child must pay monthly premiums in advance directly
to the system. A person in a leave without pay status, a person whose salary
is insufficient, and a non-salaried board member must pay monthly premiums
in advance through the employee's employing department.
] Premium payments
are due on the first day of the month covered and must be postmarked or received
by the system or the employing department, whichever is appropriate, within
30 days of the due date to avoid cancellation of coverage. Failure to make
the required premium payment by the due date will result in cancellation of
all coverages not fully funded by the state contribution, if applicable. A
person entitled to the state contribution will retain member only health and
basic life coverage provided the state contribution is sufficient to cover
the premium for such coverage. If the state contribution is not sufficient
for member only coverage in the health plan selected by the employee or retiree,
the employee or retiree will be enrolled in the basic plan except as provided
for in §81.7(l)(2)(B) of this title.
whose effective date of retirement
is on or after September 30, 1999, and
] who was not enrolled in optional
life insurance or dependent life insurance coverage on the day before becoming
an annuitant[
,
] becomes eligible for minimum retiree optional life
insurance and dependent life insurance coverage on the date the retiree becomes
an annuitant. Submission of evidence of insurability acceptable to the system
shall be required for enrollment in such coverage.
enrollment
] 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.
before, on, or within 30 days after, the effective date of retirement
] by providing evidence of insurability acceptable to the system.
on, or
] within 30 days after[
,
] the date the
notice of eligibility
is
[
was
] mailed by the system.
Coverage becomes effective on the first day of the month following the month
in which continuation coverage ends. Premium payments may be made as provided
in §81.3(d)(2)(B) (relating to Administration).
Optional Term Life insurance
];
Optional Term
Life insurance, Short Term Disability, or Long Term Disability
] after
the initial period for enrollment;
and
]
.
]
Group Term Life Plan
]
may file a claim for an accelerated life benefit for himself or his covered
dependent in accordance with the terms of the [
group term life insurance
] plan in effect at that time. [
A retiree who is enrolled in the
plan is eligible to file a claim for an accelerated life benefit for himself
or his covered dependent only if the retiree or dependent was determined,
in a written statement by his attending physician, prior to the effective
date of the retirement, to have had a terminal condition as defined in these
rules.
] An accelerated life benefit paid will be deducted from the amount
that would otherwise
be
[
by
] payable under the
plan
[
Group Term Life Plan
].
retiree
] who is enrolled in the
group term life insurance plan
[
Group Term Life Plan
] may make
, in conjunction with receipt of
a viatical settlement,
an irrevocable beneficiary designation [
and enter into a viatical settlement
] in accordance with the terms of
the [
group term life insurance
] plan in effect at that time.
types and amounts of
] health, life, and dental coverages in
effect on the date the employee entered that status for
the period of
leave, but not more than
[
a maximum period of up to
] 12 months.
[
The maximum period may be extended for up to 12 additional months for
a total of 24 continuous months, provided the extension is certified by the
department to be for educational purposes.
] The employee must pay premiums
directly as
provided
[
defined
] in §81.3(d)(2)(B)(i)
of this title (relating to Administration). Disability income coverage for
an employee in a leave without pay status will be suspended beginning on the
first day of the month in which the employee enters the leave without pay
status and continuing for those months in which the employee remains in that
status. Suspended disability income coverage for an employee returning to
active duty from a leave without pay status will be reactivated effective
on the date on which the employee returns to active duty if the entire period
of unpaid leave was certified by the department as approved leave without
pay.
Chapter 85.
FLEXIBLE BENEFITS