Part 4.
EMPLOYEES RETIREMENT SYSTEM OF TEXAS
Chapter 81.
INSURANCE
34 TAC §§81.3, 81.5, 81.7
The Employees Retirement System of Texas (ERS) proposes amendments
to §§81.3, 81.5, and 81.7 concerning the Uniform Group Insurance
Program (UGIP or program). Section 81.3 is amended to clarify the terms of
eligibility for supplemental state contribution as authorized under §14A
of the Texas Employees Uniform Group Insurance Benefits Act (Act); §81.5
is amended to permit certain retirees not covered by optional life insurance
or dependent life insurance at the time of retirement to have an opportunity
to apply for minimum retiree optional life insurance and dependent life insurance
coverage; §81.5 is amended to reflect that former members and employees
of the legislature authorized by the Act to continue to participate in the
program are eligible for coverage, other than disability income insurance
coverage, in effect on the day before the member or employee terminates employment
or leaves office. Section 81.7 is amended to clarify that the coverages in
an approved HMO or in HealthSelect Plus become effective on the first day
of the month following the date on which the employee begins active duty.
Section 81.7 is amended to clarify that if the required premiums are paid
or deducted, health and dental insurance coverages of a surviving dependent
may continue on the death of the deceased employee or retiree if the dependent
is eligible for such coverage. Section 81.7 is also amended to clarify the
terms of reinstatement in the program, and continuation of coverages for a
former member or employee of the legislature. Also, §81.7 is amended
to provide that continuation coverage for a former board member's life insurance
will be reduced to the maximum amount for which the former member is eligible.
Paula A. Jones, General Counsel, has determined that for the first five-year
period the rules are in effect there will be no 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.
§81.3.Administration.
(a) - (c)
(No change.)
(d)
Payment of Premiums.
(1) - (2)
(No change.)
(3)
An employee whose dependent
child is eligible for coverage under Section 14A of the Act is eligible for
the supplemental state contribution as authorized by that section and provided
in this paragraph.
(A)
An employee becomes eligible for the supplemental
contribution on the first day of the month following the date on which the
system receives certification of the dependent child's eligibility for coverage
under that section. Eligibility for the supplemental contribution terminates
on the last day of the contract year. An employee may apply for the supplemental
contribution for an additional period of coverage during the annual enrollment
period applicable to that period of coverage.
(B)
A dependent child of an employee who is eligible
for the supplemental contribution is not required to provide evidence of insurability.
§81.5.Eligibility.
(a) - (b)
(No change.)
(c)
Retirees.
(1) - (2)
(No change.)
(3)
A retiree who is not enrolled in minimum retiree
optional life insurance or dependent life insurance coverage is eligible to
apply for such coverage.
[
(4) - (6)
(No change.)
(d) - (h)
(No change.)
(i)
Former members of the legislature.
A former member
of the legislature authorized by the Act to continue to participate in the
program is eligible for the coverage, other than disability income insurance
coverage, in effect on the day before the member leaves office.
[
(j)
Former employees of the legislature.
A former employee
of the legislature authorized by the Act to continue to participate in the
program is eligible for the coverage, other than disability income insurance
coverage, in effect on the day before the employee terminates employment.
[
(k)
(No change.)
(l)
Former board members.
Subject to the limitations of
this subsection, a
[
§81.7.Enrollment and Participation.
(a)
Full-time employees and their dependents.
(1)
A new employee who is eligible under the Act for automatic
insurance coverage shall be enrolled in the basic plan of health and life
insurance unless, on or before the date on which the employee begins active
duty, the employee completes [
(2)
To enroll eligible dependents, to elect to enroll
in an approved HMO or in HealthSelect Plus, and to elect optional coverages,
the employee shall complete [
(3) - (4)
(No change.)
(5)
Coverage for a newly eligible dependent, other than
a dependent referred to in paragraphs (6) or (8) of this subsection, will
be effective on the first day of the month following the date the person becomes
a dependent if an enrollment form is completed [
(6) - (9)
(No change.)
(b)
(No change.)
(c)
Retirees and their dependents.
(1)
(No change.)
(2)
A retiree may enroll in health, dental, and life insurance
coverages for which the retiree is eligible, including dependent coverages,
by completing [
(3)
A retiree who becomes eligible for
minimum retiree
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 by providing evidence of insurability
acceptable to the system.
(4) - (5)
(No change.)
(d)
Surviving dependents
(1)
Provided that the required premiums are paid or deducted,
the health and dental insurance coverages of a surviving dependent may be
continued on the death of the deceased employee or retiree if the dependent
is eligible for such coverage as provided by §81.5(f) of this title (relating
to Eligibility).
[
(2)
(No change.)
(e) - (g)
(No change.)
(h)
Changes in coverage after the initial period for enrollment.
(1) - (3)
(No change.)
(4)
The evidence of insurability provision applies only
to:
(A) - (B)
(No change.)
(C)
employees, retirees, or eligible dependents who wish to
enroll in HealthSelect of Texas after the initial period for enrollment, except
as provided in subsections (a), (g)(5)-(6), and (h)(6)-(10) of this section
and §81.3(d)(3)(B) of this title (relating to Administration)
;
(D)
(No change.)
(E)
retirees who wish to enroll in
minimum
optional
life insurance coverage or dependent life insurance coverage as provided in
subsection (c)(3) of this section.
(5) - (11)
(No change.)
(i) - (j)
(No change.)
(k)
Reinstatement in the program.
(1)
(No change.)
(2)
Except as provided in subsection (h)(1) of this
section, an employee whose coverages are canceled during a period of leave
without pay shall, upon return to active duty, reinstate the coverages in
effect on the date of cancellation. 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 cancellation, no new preexisting
conditions exclusions will apply. If not, any remaining period of preexisting
conditions exclusions must be satisfied upon reinstatement.
[
(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 coverages are canceled during a period of leave without
pay 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.
[
[
[
(l)
Continuing coverage in special circumstances.
(1)
Continuation of [
(2)
Continuation of [
(A)
An employee in a leave without pay status may continue
the [
(B)
(No change.)
(3)
Continuation of [
(4)
Continuation of [
(5) - (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
are
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.
Life
insurance will be reduced to the maximum amount for which the former member
is eligible.
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 May 1, 2000.
TRD-200003058
Sheila W. Beckett
Executive Director
Employees Retirement System of Texas
Earliest possible date of adoption: June 11, 2000
For further information, please call: (512) 867-7125
34 TAC §§85.3, 85.5, 85.7
The Employees Retirement System of Texas (ERS) proposes amendments
to §§85.3, 85.5, and 85.7, concerning the Flexible Benefits Program.
Section 85.3 is amended to make changes to the effective date of elections; §85.5
is amended to clarify the rules concerning the payment of flexible benefit
dollars; and §85.7 is amended to conform to the amendments made to §85.3.
Paula A. Jones, General Counsel, has determined that for the first five-year
period the rules are in effect there will be no 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, Art. 3.50-2, §4A
and affect Insurance Code Art. 3.50-2, §13B.
No other statutes are affected by these amendments.
§85.3.Eligibility and Participation.
(a)
Dependent care reimbursement plans.
(1)
(No change.)
(2)
Participation.
(A)
An employee who is eligible under paragraph (1) of this
subsection may elect to participate by completing and submitting an election
form on, or within 30 days after, the date on which the employee begins active
duty.
An election made on the date on which the employee begins active
duty becomes effective on that date. An election made after the date on which
the employee begins active duty becomes effective on the first day of the
month following the date on which the employee begins active duty.
[
(B) - (D)
(No change.)
(3)
(No change.)
(b)
Health care reimbursement plan.
(1)
(No change.)
(2)
Participation.
(A)
An employee who is eligible under paragraph (1) of this
subsection may elect to participate by completing and submitting an election
form on, or within 30 days after, the date on which the employee begins active
duty.
An election made on the date on which the employee begins active
duty becomes effective on that date. An election made after the date on which
the employee begins active duty becomes effective on the first day of the
month following the date on which the employee begins active duty.
[
(B) - (D)
(No change.)
(3)
(No change.)
§85.5.Benefits.
(a)
(No change.)
(b)
Health care reimbursement plan.
(1)
(No change.)
(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 that an employee may receive in any plan
year for health care expenses under the health care reimbursement plan is
$5,000.
Except as otherwise provided in this paragraph,
[
(c)
Dependent care reimbursement plan.
(1)
(No change.)
(2)
Maximum benefit available.
(A)
Subject to any limitations imposed by these rules and the
plan, to avoid discrimination, the maximum amount that an employee may receive
in any plan year in the form of payment of or reimbursement for dependent
care expenses under the dependent care reimbursement plan, is the lesser of:
(i) - (ii)
(No change.)
(iii)
$5,000. ($2,500 in the case of a married employee who
files a separate federal income tax return.)
Except as otherwise provided
in this clause,
[
(B)
(No change.)
§85.7.Enrollment.
(a)
Election of benefits.
(1)
An eligible employee may elect to or not to participate
in the flexible benefits plan by making an election and executing an election
form [
(2) - (5)
(No change.)
(b) - (f)
(No change.)
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 May 1, 2000.
TRD-200003059
Sheila W. Beckett
Executive Director
Employees Retirement System of Texas
Earliest possible date of adoption: June 11, 2000
For further information, please call: (512) 867-7125
A covered retiree 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.
On application to the trustee and on arrangement for the payment of contributions,
a person who has at least eight years of creditable legislative service, as
defined in the Government Code, §812.002, on ending his or her service
in the legislature, continues to be eligible for participation in the program
under the Act. Except as provided in this section, former members of the legislature
will be subject to the same eligibility rules and effective dates that apply
to active members of the legislature.
]
On application to the trustee and on arrangement for the payment
of contributions, a person who has at least 10 years of creditable service
in the system, as defined in the Government Code, §812.003, as an employee
of the legislature, on ending his or her service for the legislature, continues
to be eligible for participation in the program under the Act. Except as provided
in this section, a former legislative employee will be subject to the same
eligibility rules and effective dates that apply to an active employee of
the State of Texas.
]
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.
Life insurance coverage may not exceed Election II.
and signs
] an enrollment form to
elect other coverages or to decline any and all coverages. Coverage of an
employee under the basic plan, and other coverages selected as provided in
this paragraph, become effective on the date on which the employee begins
active duty.
and sign
] an enrollment form within
30 days after the date on which the employee begins active duty. Coverages
selected on or before the date on which the employee begins active duty become
effective on the date on which the employee begins active duty. Coverages
selected within 30 days after the date on which the employee begins active
duty become effective on the first day of the month following the
date
on which the employee begins active duty
[
signature date on the
enrollment form
]. An enrollment form completed [
and signed
]
after the initial period for enrollment as provided in this paragraph is subject
to the provisions of subsection (h) of this section.
and signed
] on
or within 30 days after the date the person first becomes a dependent. If
the enrollment form is completed and signed after the initial period for enrollment
as provided in this paragraph, the enrollment form will be governed by the
rules in subsection (h) of this section.
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.
A surviving dependent eligible to continue health
and dental insurance coverage as provided in §81.5(f) of this title (relating
to Eligibility) may apply to continue such coverage upon written notification
of eligibility to apply. Application shall be made on, or within 30 days after,
written notification of eligibility to apply. Coverage becomes effective on
the first day of the month following the date of death of the deceased employee
or retiree.
]
Except
as provided in paragraphs (3) - (5) of this subsection and subsection (h)(1)
of this section, an employee whose coverages were canceled during a period
of leave without pay shall, upon return to active duty, be enrolled in the
basic plan without evidence of insurability, provided the employee is eligible
for the full state contribution. Except as provided in subsection (h)(1),
coverage becomes effective on the date on which the employee returns to active
duty.
]
Except as provided
in subsection (h)(1) of this section, an employee who is a member of the Texas
National Guard or any of the reserve components of the United States Armed
Forces and who is in a military leave without pay status or who must terminate
employment as the result of an assignment to active military duty shall, upon
return to active employment, reinstate all canceled coverages that were in
effect immediately prior to the commencement of active military duty, as long
as the return to active employment occurs within 90 days of the release from
active military duty. An employee shall also reinstate the coverage of the
employee's dependent, who is a member of the Texas National Guard or any of
the reserve components of the United States Armed Forces and whose coverage
is terminated as the result of an assignment to active military duty. Except
as provided in subsection (h)(1) of this section, coverage becomes effective
on the date of return to active employment. To reinstate canceled coverages,
submission of evidence of insurability acceptable to the carrier will not
apply. Provided all applicable preexisting conditions exclusions were satisfied
at the time coverages were canceled, no additional preexisting conditions
exclusions will apply upon reinstatement of coverages. If not, any remaining
period of preexisting conditions exclusions must be satisfied upon reinstatement,
except that the period of active military duty shall be applied toward satisfaction
of the remaining period of preexisting conditions exclusions.
]
(4)
Except as provided in subsection
(h)(1) of this section, an employee whose coverages were canceled during a
period of leave without pay due to a certified work-related disability shall,
upon return to active duty status, reinstate all coverages that were in effect
on the day immediately prior to entering the leave without pay status. Except
as provided in subsection (h)(1) of this section, 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 all applicable preexisting conditions exclusions
were satisfied at the time coverages were canceled, no additional preexisting
conditions exclusions will apply upon reinstatement of coverages. If not,
any remaining period of preexisting conditions exclusions must be satisfied
upon reinstatement.
]
(5)
Except as provided in subsection
(h)(1) of this section, an employee whose coverages were canceled during a
period of leave without pay as a result of the Family and Medical Leave Act
of 1993 shall, upon return to active duty, reinstate all coverages that were
in effect on the day immediately prior to entering the leave without pay status.
Except as provided in subsection (h)(1) of this section, 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 all applicable preexisting conditions exclusions
were satisfied at the time coverages were canceled, no additional preexisting
conditions exclusions will apply upon reinstatement of coverages. If not,
any remaining period of preexisting conditions exclusions must be satisfied
upon reinstatement.
]
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.
health, dental, and life
]
coverages for employees in a leave without pay status.
health, life, and dental
] coverages 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 premiums directly as provided 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.
]
health, dental, and life
] coverages for a former member or employee of the legislature.
Provided that the required premiums are paid, the health, dental, and life
insurance coverages of a former member or employee of the legislature may
be continued on conclusion of the term of office or employment.
[
A former member or employee of the legislature, who is eligible to continue
to participate in the program, must notify the system within 30 days after
leaving office or employment of the employee's intent to continue the coverage
in effect. Coverage will be canceled if a premium is not received within 30
days of the due date. A former member or employee of the legislature is not
eligible to continue disability insurance coverage.
]
health, dental, and life
]
coverages 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
coverages
[
types and amounts of coverages, other than disability income,
] that were in effect during the calendar month immediately prior to
the month in which the former judge did not serve on judicial assignments.
These coverages 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.
[
Disability income coverage during the period will be canceled on the
first day of the month during which the former judge does not serve on a judicial
assignment. To reinstate canceled disability income coverage once service
on judicial assignments is resumed, a former judge must submit evidence of
insurability acceptable to the system. If approved, disability income coverage
will become effective on the first day of the month following the date approval
is received by the employing department.
]
Chapter 85.
FLEXIBLE BENEFITS
The election becomes effective on the first day of the month following the
date on which the employee makes the election.
]
The election becomes effective on the first day of the month following the
date on which the employee makes the election.
]
In no event shall
] the monthly maximum salary reduction amount, exclusive
of any administrative fees,
may not
exceed $416 per month [
, except an employee may prepay the health care election amounts for the remainder
of the plan year by accelerating payroll deductions prior to or in anticipation
of going on leave without pay or terminating (including retirement) employment,
or an employee who is classified as a nine-month faculty member, and who elects
to receive annual compensation in fewer than 12 months, shall redirect the
annual election amount in nine equal monthly amounts
].
An employee
may prepay the health care election amounts for the remainder of the plan
year in anticipation of termination, retirement, or a period of leave without
pay. An employee classified as a nine-month employee and who receives compensation
in fewer than 12 months shall redirect the annual election amount in nine
equal monthly amounts.
In no event shall
] the monthly maximum salary
reduction amount, exclusive of any administrative fees,
may not
exceed $416 per month or $208 per month in the case of a married employee
who files a separate federal income tax return [
, except an employee
who is classified as a nine-month faculty member who elects to receive annual
compensation in fewer than 12 months shall redirect the annual election amount
in nine equal monthly amounts
].
An employee classified as a nine-month
employee and who receives annual compensation in fewer than 12 months shall
redirect the election amount in nine equal monthly amounts.
prior to the first day of an applicable period of coverage
].
Chapter 87.
DEFERRED COMPENSATION