Part 4.
EMPLOYEES RETIREMENT SYSTEM OF TEXAS
Chapter 65.
EXECUTIVE DIRECTOR
34 TAC §65.3
The Employees Retirement System of Texas (System) proposes
amendments to §65.3, concerning Records of the System. The amendments
are being proposed in order for the amount of the charges allowed for providing
public information and copies of public information in the possession of the
System to conform with statewide standards.
Paula A. Jones, General Counsel, has determined that the first five years
the amendments are in effect there will be no fiscal implications for state
or local government as a result of enforcing or administering the amended
rule because the changes conform to established statewide standards.
Ms. Jones has also determined that for each year of the first five years
the amendments are in effect the public benefit anticipated as a result of
enforcing the amended rule will be continued understanding by the public of
how costs are calculated when the System responds to Public Information Act
requests. There will be no effect on small businesses. The anticipated economic
cost to persons who are required to comply with the amendments as proposed
will vary according to the amount and type of copies requested.
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 paula.jones@ers.state.tx.us. The
deadline for receiving comments is 10:00 a.m. on Monday, April 10, 2006.
The amendments are proposed under Texas Government Code §815.102,
which provides authorization for the Board of Trustees to adopt rules for
the transaction of any other business of the board.
No other statutes are affected by the proposed amendments.
§65.3.Records of the System.
(a)
The executive director
or her designee
is the
custodian of records of the Employees Retirement System
of Texas
.
(b)
(No change.)
(c)
The following guidelines are established for charges to
be made for providing public information and copies of public information
in the possession of the system.
(1)
Standard paper copy
[
(2)
Nonstandard-size [
(A)
Diskette
:
[
(B)
Magnetic tape:
actual cost;
[(i)
4 mm.--$13.50 each;]
[(ii)
8 mm.--$12 each;]
[(iii)
9-track--$11 each;]
(C)
Data cartridge: actual cost;
[
(D)
Tape cartridge: actual cost;
[
(E)
Rewritable CD (CD-RW)--$1.00;
[
(F)
Non-rewritable CD (CD-R)--$1.00
[
[(i)
250 MB--$38 each;]
[(ii)
525 MB--$45 each.]
(G)
Digital video disc (DVD)--$3.00;
[
[(i)
3 mil.--$.85/linear foot;]
[(ii)
4 mil.--$1.10/linear foot;]
[(iii)
5 mil.--$1.35/linear foot.]
(H)
JAZ drive--actual cost;
[
(I)
Other electronic media--actual cost;
(J)
VHS video cassette--$2.50;
(K)
Audio cassette--$1.00;
(L)
Oversize paper copy (e.g.: 11 inches by
17 inches, greenbar, bluebar, not including maps and photographs using specialty
paper)--$.50;
(M)
Specialty paper (e.g.: Mylar, blueprint,
blueline, map photographic)--actual cost.
(3)
Labor
[
(A)
For programming--$28.50 per hour;
[
(B)
For locating, compiling, and reproducing
[
(4)
Overhead charge--20% of
labor
[
(5)
Microfiche or microfilm charge
:
[
(A)
Paper copy--$.10 per page
;
[
(B)
(No change.)
(6)
(No change.)
(7)
Computer resource charge
:
[
(A)
Mainframe--$10 per
CPU
minute
;
[
(B)
Midsize--$1.50 per
CPU
minute
;
[
(C)
Client/server
system
--$2.20 per
clock
hour
;
[
(D)
PC or LAN--$1.00 per
clock
hour.
(8) - (9)
(No change.)
(10)
Photographs--actual cost as calculated in accordance
with 1 TAC §111.69(5)
[
(11)
Maps--actual cost as calculated in accordance with
1 TAC §111.69(4)
[
(12)
Other costs--actual cost.
[
(13)
Outsourced/Contracted Services--actual cost for the
copy or services. May not include development costs.
[
(14)
No Sales Tax--no Sales Tax shall be applied
to copies of public information.
(d)
No charge shall be made for one copy of any public record
requested by members of the
Legislature
[
(e)
(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 February 24, 2006.
TRD-200601017
Paula A. Jones
General Counsel
Employees Retirement System of Texas
Earliest possible date of adoption: April 9, 2006
For further information, please call: (512) 867-7421
34 TAC §73.17
The Employees Retirement System of Texas (ERS) proposes amendments
to 34 TAC Chapter 73, §73.17, concerning Disability Retirement--Eligibility.
The proposed amendment to 34 TAC §73.17 clarifies the executive director's
authority to request medical and other information in connection with Texas
Government Code §814.208 and related statutes from ERS disability retirees
to determine whether such retirees continue to meet the eligibility requirements
for disability retirement and associated health insurance benefits as provided
in Texas Government Code §§814.201 - 814.211 and Texas Insurance
Code Chapter 1551. The amendment also defines the term "comparable pay" and
affirms ERS staff's authority and practice in calculating and adjusting comparable
pay to reflect changes in state pay that a disability retiree would likely
have realized if he or she had not retired.
Paula A. Jones, General Counsel, has determined for the first five-year
period the amendments are in effect there will be no fiscal implications for
state or local government as a result of enforcing or administering the amended
rule.
Ms. Jones has also determined that for each year of the first five years
the proposed amendments are in effect, the public benefit anticipated as a
result of enforcing the amended rule will be that the ERS trust fund will
be protected through enforcement of the eligibility requirements for continuation
of ERS disability retirement benefits and associated health insurance benefits.
There will be no affect on small business. The anticipated economic cost
to persons who are required to comply with the amendments as proposed will
vary among individual ERS members or retirees according to the results of
periodic medical examinations and/or other information that may be requested
by ERS in order to determine whether or not the member or retiree is or remains
incapacitated for the further performance of duty.
Comments on the proposed amendments may be submitted to Paula A. Jones,
General Counsel, P.O. Box 13207, Austin, Texas 78711-3207, or e-mail Ms. Jones
at paula.jones@ers.state.tx.us. The deadline for receiving comments is 10:00
a.m. on Monday, April 10, 2006.
The amendments are proposed under Texas Government Code, §815.102
which provides authorization for the Board of Trustees to adopt rules relating
to the administration of the funds of the retirement system and for the transaction
of other business of the Board.
No other statutes are affected by the proposed amendments.
§73.17.Disability Retirement--Eligibility.
(a)
Incapacity from the further performance of duty
means that the member has demonstrably sought and been denied workplace accommodation
of the disability in accordance with applicable law, and that the member is
physically or mentally unable to continue to hold the position occupied and
to hold any other position offering comparable pay. The education, training,
and experience of the employee are to be considered when making this determination.
"Comparable pay" means eighty (80) percent or more of the member's final state
base pay prior to deductions for taxes or deferred compensation as provided
or allowed by state and federal law; and it includes longevity and hazardous
duty pay. Comparable pay may be adjusted by retirement system staff to account
for realized state pay rate changes over time. The term excludes the monetary
value of insurance and retirement benefits.
(b)
In addition to the periodic medical examinations
provided for in Texas Government Code §814.208(a), the executive director
may direct a disability retiree to undergo additional medical examinations
and to provide additional information satisfactory to the retirement system
relevant to determining whether or not the retiree remains incapacitated for
the further performance of duty. Absent a showing of good cause, a disability
retiree who fails to respond to the request in a timely manner may have his
or her disability retirement benefits and associated health insurance benefits
suspended until the retiree has fully complied with the request. If the retiree
fails to comply with the request for one year from the date the information
was first requested by the retirement system, then all disability retirement
benefits shall be terminated.
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 February 24, 2006.
TRD-200601018
Paula A. Jones
General Counsel
Employees Retirement System of Texas
Earliest possible date of adoption: April 9, 2006
For further information, please call: (512) 867-7421
34 TAC §§81.1, 81.3, 81.5, 81.7 - 81.9, 81.11
The Employees Retirement System of Texas (ERS) proposes amendments
to Texas Administrative Code, Title 34, Chapter 81, §§81.1, 81.3,
81.5, 81.7, 81.9, and 81.11, and new §81.8.
New §81.8 and amendments to §§81.1, 81.3, 81.7, and 81.9
concern the establishment of an incentive credit to waive health coverage,
an optional TRICARE Supplemental health plan under the Texas Employees Group
Benefits Program (GBP), and non-substantive administrative modifications of
the rules. The TRICARE Supplemental health plan is contingent upon the selection
of a qualified Carrier by the ERS Board of Trustees. The new rule and amendments
are needed to update and clarify the rules and to comply with and conform
to House Bill 417 and Senate Bill 1863, 79th Legislature, Regular Session,
as they may be harmonized in light of changes made to the same section of
the law. Both bills authorize a TRICARE Supplement for those eligible participants
who waive health coverage, and Senate Bill 1863 creates an incentive credit
to be applied toward the premium of either optional coverage or the TRICARE
Supplement for those eligible participants who waive health coverage.
Section 81.1 is amended to add definitions for TRICARE and the TRICARE
Supplement. This amendment defines TRICARE as the United States Department
of Defense health care program for active and retired members of the uniformed
services and their dependents, and the TRICARE Supplement as the plan of health
care coverage designed to be secondary coverage to the TRICARE program. This
section is further amended to clarify that TRICARE Supplement premiums are
included in the definition of Insurance premium expense.
Section 81.3 is amended by adding subsection (c) to provide statutory references
for board approval of one or more TRICARE Supplement Carrier(s) to offer supplemental
health benefits to eligible GBP participants who waive health coverage.
Section 81.7 is amended to: (1) reference new §81.8 regarding the
participation and enrollment requirements for those new employees and retirees
who are eligible to waive health coverage and receive an incentive credit;
(2) allow an annual opportunity to waive health coverage; (3) add the TRICARE
Supplement as an optional coverage; and (4) make conforming reference changes.
Section 81.7(g)(1) is amended to remove a reference to the cancellation
of health coverage by a participant who is assigned to active military duty.
This provision is no longer needed because a GBP participant may apply for,
elect, or continue enrollment in optional coverage without concurrent enrollment
in health coverage.
Section 81.7(h)(8)(C) is amended to remove a reference that allowed an
employee to re-enroll after the close of the annual enrollment opportunity.
This provision is no longer needed due to the automation of the annual enrollment
opportunity.
New §81.8(a) is added to establish who is eligible to waive health
coverage and the events that permit an election to waive health coverage.
New §81.8(b) is added to clarify that an individual who waives health
coverage and later elects to apply for health coverage is subject to the applicable
provisions of this chapter.
New §81.8(c) is added to clarify the amount of and the eligibility
requirements to receive the incentive credit, and to delineate that: (1) the
incentive credit may only be used for optional coverage specified by the system
or the TRICARE Supplement; (2) coverage under the TRICARE Supplement ends
when the participant attains age 65; however, the incentive credit will be
applied toward eligible optional coverage; and (3) optional coverage is not
considered voluntary coverage for the purposes of the incentive credit.
New §81.8(d) is added to clarify that the offering of a TRICARE Supplement
is contingent upon the selection of a qualified Carrier by the ERS Board of
Trustees.
Section 81.9(a) is amended to include those enrolled in the TRICARE Supplement
plan as an exempted group under the ERS grievance procedures. This section
is further amended to add the terms "carrier" and "administering firm" as
entities that may formally deny an insurance claim and mail notice of the
denial and right of appeal to a person. These changes are needed to update
and clarify the rules with regard to grievance procedures. The section is
also amended to clarify that the grievance procedures apply to both a denial
of benefits and other adverse decisions by an insurance carrier or administering
firm.
Section 81.9(d) is amended to clarify existing practice that a notice of
appeal to the Board regarding a decision by the Executive Director must be
in writing and filed with ERS within the specified time period.
Throughout Chapter 81, including §81.5 and §81.11, the words
"legislature" and "program" have been capitalized, and the word "State" in
State of Texas has been changed to lower case. These changes are needed for
consistency in the rules, and these words are either proper nouns or refer
to definitions. The word "title" has been changed to "chapter" for correct
reference purposes.
Paula A. Jones, General Counsel, has determined that for the first five-year
period the new and amended rules are in effect, a positive fiscal implication
has been forecast for the state. There will be no fiscal implication for local
government as a result of enforcing or administering the new and amended rules;
and small businesses and individuals will not be affected.
Ms. Jones also determined that for each year of the first five years the
new and amended rules are in effect the public benefit anticipated as a result
of enforcing the new and amended rules will be new options for participants
in the GBP, including an incentive credit for waiving health coverage and
the availability of an optional TRICARE Supplemental health plan upon selection
of a Carrier by the Board. There are no known anticipated economic costs to
persons who are required to comply with the new and amended rules as proposed.
Comments on the proposed new and amended rules 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 paula.jones@ers.state.tx.us.
The deadline for receiving comments is 10:00 a.m. on Monday, April 10, 2006.
The new rule and rule amendments are proposed under Texas Insurance
Code, §§1551.009, 1551.052, and 1551.221.
No other statutes beyond Chapter 1551, Insurance Code, are affected by
these 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) - (2)
(No change.)
(3)
Active duty--The expenditure of time and energy in the
service of the
state
[
(4) - (9)
(No change.)
(10)
Department--Commission, board, agency, division, institution
of higher education, or department of the
state
[
(11) - (12)
(No change.)
(13)
Employee--A person authorized by the Act to participate
in the
Program
[
(14)
Employing office--For a retiree covered by this
Program
[
(15)
Evidence of insurability--Such evidence required by a
qualified carrier for approval of coverage or changes in coverage pursuant
to the rules of §81.7(h) of this
chapter
[
(16) - (17)
(No change.)
(18)
HMO--A health maintenance organization approved by the
board to provide health care benefits to eligible participants in the
Program
[
(19)
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
[
(20) - (22)
(No change.)
(23)
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
chapter
[
(24) - (25)
(No change.)
(26)
Retiree--An employee who retires or is retired and who:
(A)
is authorized by the Act to participate in the
Program
[
(B)
(No change.)
(C)
on the date of retirement, meets the service credit requirements
of the Act for participation in the
Program
[
(i)
on August 31, 2001, was an eligible employee with a department
whose employees are authorized to participate in the
Program
[
(ii)
on August 31, 2001, had three years of service as an eligible
employee with a department whose employees are authorized to participate in
the
Program
[
(iii)
(No change.)
(27)
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 members of
the
Legislature
[
(28)
(No change.)
(29)
TRICARE--(formally call CHAMPUS)--The
United States Department of Defense (DOD) military health system program for
eligible active duty and retired members of the uniformed services, their
families, and survivors.
(30)
TRICARE Supplement--A supplemental health
care coverage plan designed specifically to be secondary coverage to the TRICARE
program.
(31)
[
§81.3.Administration.
(a)
Health maintenance organizations.
(1)
(No change.)
(2)
In order to seek approval, an HMO must:
(A)
submit an application to provide health benefits in the
areas within the
state
[
(B) - (C)
(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
[
(B) - (G)
(No change.)
(4)
An HMO, seeking board approval in response to an application
in one or more of the non-bidding areas, must satisfy the following conditions:
(A)
The HMO must be licensed by the Texas Department of Insurance
to operate in the
state
[
(B) - (G)
(No change.)
(b)
Payment of Premiums.
(1)
Premiums for coverage provided under the
Program
[
(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)
An employee or annuitant who applies for coverage for which
the monthly premium exceeds the state or employing department and the system
contributions must authorize on a form prescribed by the system a deduction
from his or her monthly compensation or annuity to pay the difference. If
the compensation or annuity is insufficient to provide for the appropriate
deduction, the participant must pay premiums directly as provided 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 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 will be enrolled in the basic plan except as
provided for in §81.7(l)(2)(B) of this
chapter
[
(B)
A participant shall pay premiums directly, as provided
in this subparagraph, if the participant is not on a payroll or is in a leave
without pay status, is not receiving an annuity from a state retirement system
from which the appropriate premiums may be deducted, or is not receiving a
salary or annuity sufficient to allow for a full required premium deduction.
(i)
An employee 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. 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
chapter
[
(ii)
A person who continues group health and dental benefits
as provided in §81.5(k) of this
chapter
[
(iii)
A person who continues group health and dental benefits
as provided in §81.5(k)(3) of this
chapter
[
(3)
(No change.)
(c)
TRICARE Supplement. In accordance with
§1551.221 of the Act, the Board may contract for one or more Carriers
as that term is defined under §1551.007 of the Act to offer a TRICARE
supplemental health coverage plan to eligible program participants who waive
health coverage as described in §81.8 of this chapter.
§81.5.Eligibility.
(a)
Full-time employees. A full-time employee, elected officer,
or appointed officer of the
state
[
(1) - (3)
(No change.)
(b)
Part-time employees. A part-time employee or other employee
who is not eligible for automatic coverage becomes eligible for coverage upon
completion of the waiting period established in
§1551.1055
[
(1) - (2)
(No change.)
(c)
Retirees.
(1) - (6)
(No change.)
(7)
A retiree who returns to work for a department may continue
coverages for which he is eligible as a retiree, or, subject to subsection
(a) or subsection (b) of this section, elect to participate in the
Program
[
(8)
(No change.)
(d)
Dependents of employees and retirees.
(1)
(No change.)
(2)
Except as otherwise provided in this paragraph, double
coverage is not permitted for any participant in the
Program
[
(A) - (B)
(No change.)
(e)
(No change.)
(f)
Surviving dependents.
(1)
(No change.)
(2)
Dependent children of a deceased active employee or retiree
are eligible to continue coverage in the health and dental benefits plans
in which the dependent children were enrolled on the day of death of the employee/retiree
provided, however, the deceased active employee must have had, at the time
of death, at least 10 years of service credit, including at least 3 years
on August 31, 2001 or at least 10 years after August 31, 2001 of service as
an eligible employee with a Program participating department, as long as the
surviving spouse is eligible and continues to participate in the
Program
[
(3)
If an active employee/retiree does not have a spouse covered
in the
Program
[
(4) - (5)
(No change.)
(g)
Retiree under ORP.
(1)
A member of the ORP is eligible for health coverage on
the day he or she receives or is eligible to receive an annuity under the
ORP program or would have been eligible to receive an annuity had his or her
membership been in the Teacher Retirement System rather than the ORP, and
meets the age, length-of-service, and other requirements as provided in §81.5(c)
of this
chapter
[
(2)
A member of the ORP is eligible for additional coverages
and plans which include optional and voluntary coverages in the
Program
[
(h)
Disability retirement. An applicant who is approved for
disability retirement is entitled to retiree insurance coverages as provided
in §81.7(c) of this
chapter
[
(1)
An ORP participant is eligible for ORP disabled retiree
status in the
Program
[
(2)
If a licensed physician designated by the system finds
that the ORP participant is mentally or physically disabled from the further
performance of duty and that the disability is probably permanent, the physician
will certify the disability. The Executive Director is authorized to approve
ORP disabled retiree status in the
Program
[
(A) - (B)
(No change.)
(3)
The effective date of coverage for an ORP disabled retiree
in the
Program
[
(i)
Former members of the
Legislature
[
(j)
Former employees of the
Legislature
[
(k)
Continuation of health and dental coverages only for certain
spouses and dependent children of employee/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)
(No change.)
(2)
An employee whose employment has been terminated voluntarily
or involuntarily (other than for gross misconduct), whose work hours have
been reduced such that the employee is no longer eligible for the
Program
[
(3) - (9)
(No change.)
(l)
(No change.)
§81.7.Enrollment and Participation.
(a)
Full-time employees and their dependents.
(1)
A new employee:
(A)
who is not subject to the health insurance waiting period
and is eligible under the Act and as provided for in §81.5(a) of this
chapter
[
(B)
who is subject to the health insurance waiting period and
is eligible under the Act and as provided for in §81.5(a) of this
chapter
[
(2) - (4)
(No change.)
(5)
An eligible employee who enrolls in the
Program
[
(6) - (11)
(No change.)
(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 as provided in §81.5(c)
of this
chapter
[
(2)
A retiree may enroll in health, dental, and life insurance
coverages for which the retiree is eligible as provided in §81.5(c) of
this
chapter
[
(A)
A retiree who is not subject to the health insurance waiting
period on the effective date of retirement as provided in §81.5(c) of
this
chapter
[
(B)
A retiree who is subject to the health insurance waiting
period on the effective date of retirement as provided in §81.5(c) of
this
chapter
[
(C)
A retiree who is ineligible for health insurance on the
effective date of retirement as provided in §81.5(c) of this
chapter
[
(3)
A retiree who becomes eligible for minimum retiree optional
life insurance coverage or dependent life insurance coverage as provided in
§81.5(c)(5) of this
chapter
[
(4)
Enrollments and applications to change coverage become
effective as provided in paragraph (2) of this subsection unless other coverages
are in effect at that time. If other coverages are 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 the Employees
Retirement System of Texas; or, if cancellation of the other coverages preceded
the date of approval of retirement, the first day of the month following the
date the other coverages were canceled.
(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
chapter
[
(2)
A surviving spouse who is receiving an annuity shall make
premium payments by deductions from the annuity as provided in §81.3(b)(2)(A)
of this
chapter
[
(e)
Former COBRA unmarried children. A former COBRA unmarried
child must provide an application to continue health and dental insurance
coverage within 30 days after the date the notice of eligibility is 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(b)(2)(B)
of this chapter
(relating to
Administration).
(f)
Premium conversion plans.
(1)
An eligible employee participating in the
Program
[
(2)
(No change.)
(g)
Special rules for additional coverages and plans which
include optional and voluntary coverages.
(1)
Only an employee or retiree or a former officer or employee
specifically authorized to join the
Program
[
(A) - (E)
(No change.)
(F)
long-term care; [
(G)
health care and dependent care reimbursement
; or
[
(H)
TRICARE Supplement.
(2)
An eligible participant in the
Program
[
(3) - (5)
(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)(4)-(5), and (h)(6)-(9) of this section
and §81.3(b)(3)(B) of this
chapter
[
(D)
employees enrolled in the
Program
[
(E)
(No change.)
(5)
(No change.)
(6)
A participant who is enrolled in
an
[
(A)
(No change.)
(B)
if the participant and all covered dependents are not eligible
to enroll in an approved HMO; either:
(i)
(No change.)
(ii)
enroll in an approved HMO if the participant is eligible,
and drop any ineligible covered dependent, unless not in compliance with §81.11(a)(2)
of this
chapter
[
(7)
When a covered dependent of a participant permanently moves
out of the participant's HMO service area, the participant shall make one
of the following elections, to become effective on the first day of the month
following the date on which the dependent moves out of the HMO service area:
(A)
drop the ineligible dependent, unless not in compliance
with §81.11(a)(2)
of this chapter
(relating to Termination
of Coverage);
(B) - (C)
(No change.)
(8)
An eligible participant will be allowed an annual opportunity
to make changes in coverages.
(A)
A participant will be allowed to:
(i) - (viii)
(No change.)
(ix)
enroll themselves and their eligible dependents in an
eligible HMO and in a dental plan from a
waived
[
(x)
add, decrease or cancel eligible coverage, unless prohibited
by §81.11(a)(2)
of this chapter
(relating to Termination of
Coverage); [
(xi)
apply for coverage for which evidence of insurability
is required as provided in paragraph (3) of this subsection
; and
[
(xii)
waive health coverage as provided in
§81.8 of this chapter (relating to Waiver of Health Coverage).
(B)
Surviving dependents and former COBRA unmarried children
are not eligible for the provisions in subparagraph (A)(iv), (vii), [
(C)
Such opportunity will be scheduled prior to September 1
of each year at times announced by the system. Coverage selected during the
annual enrollment period will be effective September 1. [
(9)
(No change.)
(i)
Preexisting conditions exclusion. The preexisting conditions
exclusion shall apply to employees who enroll in disability coverage. The
exclusion for benefit payments shall not apply after the first six consecutive
months that the employee has been actively at work or after the employee's
disability coverage has been continuously in force for 12 months for a preexisting
condition, as defined in §81.1 of this
chapter
[
(j)
(No change.)
(k)
Re-enrollment in the
Program
[
(1) - (3)
(No change.)
(l)
Continuing coverage in special circumstances.
(1)
(No change.)
(2)
Continuation of coverages for employees in a leave without
pay status.
(A)
An employee in a leave without pay status may continue
the 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(b)(2)(B)(i) of this
chapter
[
(B)
An employee whose leave without pay is a result of the
Family and Medical Leave Act of 1993 will continue to receive the state contribution
during such period of leave without pay. The employee must pay premiums directly
as defined in §81.3(b)(2)(B)(i) of this
chapter
[
(3)
Continuation of coverages for a former member or employee
of the
Legislature
[
(4)
Continuation of coverages for a former judge. A former
state
[
(5)
Continuation of health and dental coverage for a surviving
spouse and/or dependent child/children of a deceased employee or retiree.
The surviving spouse and/or dependent child/children of a deceased employee/retiree,
who, in accordance with §81.5(k)(1) of this
chapter
[
(6)
Continuation of health and dental coverage for a covered
employee whose employment has been terminated, voluntarily or involuntarily
(other than for gross misconduct), whose work hours have been reduced such
that the employee is no longer eligible for the
Program
[
(7)
Continuation of health and dental coverage for a spouse
who is divorced from an employee/retiree and/or the spouse's dependent child/children.
The divorced spouse and/or the spouse's dependent child/children (not provided
for by §81.5(a) of this
chapter
[
(8)
Continuation of health and dental coverage for a dependent
child under 25 years of age who marries. A dependent child under 25 years
of age who marries and who, in accordance with §81.5(k)(5) of this
chapter
[
(9)
Continuation of health and dental coverage for a dependent
child who has attained 25 years of age. A 25-year-old dependent child (not
provided for by §81.5(d) of this
chapter
[
(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
chapter
[
(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
chapter
[
(C)
A dependent child under 25 years of age who marries, who,
in accordance with §81.5(k)(7)(C) of this
chapter
[
(D)
A dependent child who has attained 25 years of age, who,
in accordance with §81.5(k)(7)(D) of this
chapter
[
(11)
Continuation coverage defined. Continuation coverage as
provided for in paragraphs (5)-(10) of this subsection means the continuation
of only health and dental coverage benefits which meet the following requirements.
(A)
(No change.)
(B)
Period of coverage. The coverage shall extend for at least
the period beginning on the first day of the month following the date of the
cessation of coverage event and ending not earlier than the earliest of the
following:
(i)
(No change.)
(ii)
in the case of loss of coverage due to termination of
an employee's employment, reduction in work hours, or end of maximum period
of leave without pay, if the employee, spouse, or dependent child has been
certified by the Social Security Administration as being disabled as provided
in §81.5(k)(3) of this
chapter
[
(iii) - (iv)
(No change.)
(v)
the date on which coverage ceases under the plan due to
failure to make timely payment of any premium required as provided in §81.3(b)(2)(B)(ii)
and (iii) of this
chapter
[
(vi) - (viii)
(No change.)
(C)
Premium requirements. The premium for a participant during
the continuation coverage period will be 102% of the employee's/retiree's
health and dental coverages only rate and is payable as provided in §81.3(b)(2)(B)(ii)
of this
chapter
[
(i)
The premium for a participant eligible for 36 months of
coverage will be 102% of the employee's/retiree's health and dental coverages
only rate for the 19th through 36th months of coverage and is payable as provided
in §81.3(b(2)(B)(ii) of this
chapter
[
(ii)
The premium for a participant eligible for 29 months of
coverage will be 150% of the employee's/retiree's health and dental coverages
only rate for the 19th through 29th months of coverage and is payable as provided
in §81.3(b)(2)(B)(iii) of this
chapter
[
(D)
No requirement of insurability. No evidence of insurability
is required for a participant who elects to continue coverage under the provisions
of §81.5(k)(1)-(6) of this
chapter
[
(E)
(No change.)
(12)
(No change.)
§81.8.Waiver of Health Coverage.
(a)
Eligibility. An individual eligible to participate in the
Program may elect to waive health coverage in the method and form specified
by the System:
(1)
during the initial period of eligibility;
(2)
after a qualifying life event; or
(3)
during annual enrollment.
(b)
Re-enrollment in health coverage. An individual who has
waived health coverage is subject to the eligibility and enrollment provisions
of this chapter, including evidence of insurability requirements, should the
individual elect to apply for health coverage in the Program.
(c)
Incentive Credit.
(1)
An employee or retiree eligible to participate in the Program
and who waives health coverage may be eligible for an incentive credit in
lieu of the state contribution up to the amount specified in the General Appropriations
Act if the individual:
(A)
would otherwise have been eligible to receive the state
contribution; and
(B)
demonstrates, in a manner specified by the System, coverage
by another health benefit plan with substantially equivalent coverage to the
basic plan; or
(C)
is eligible for and enrolled in the TRICARE military health
system.
(2)
The incentive credit may be applied only toward the cost
of:
(A)
eligible optional coverage, as determined by the System;
or
(B)
TRICARE Supplement for participants under age 65.
(3)
Coverage under the TRICARE Supplement will be canceled
at the end of the month in which the participant reaches the age of 65. A
participant whose TRICARE Supplement is canceled will have the incentive credit
applied, if applicable, toward eligible optional coverage in which the participant
is currently enrolled.
(4)
Notwithstanding any other provisions of this chapter, optional
coverage is not considered voluntary coverage for purposes of the incentive
credit in lieu of the state contribution.
(d)
Solely with regard to eligible participants waiving health
coverage to enroll in the TRICARE Supplement, this Section shall become effective
only after the Board has contracted with one or more Carriers to make a TRICARE
Supplement health coverage plan available pursuant to §81.3(c) of this
chapter (relating to Administration).
§81.9.Grievance Procedure.
(a)
Except for persons enrolled in an HMO
or the TRICARE
Supplement plan
, any person participating in the insurance program,
who is denied payment of insurance benefits,
or otherwise receives an
adverse decision,
may request the carrier
or administering firm
to reconsider the claim. Any additional documentation in support of
the claim may be submitted with the request for reconsideration. If the claim
is again denied, the claim, accompanied by all related documents and copies
of correspondence with the insurance
carrier or administering firm
[
(b)
Any participant with a grievance regarding eligibility
or other matters involving the
Program
[
(c)
(No change.)
(d)
Any participant that does not accept the Executive Director's
decision may appeal the decision to the board provided the decision grants
a right of appeal. A notice of appeal to the board must be [
(e) - (g)
(No change.)
§81.11.Termination of Coverage.
(a)
Cancellation of coverage.
(1)
(No change.)
(2)
Court ordered health coverage for a dependent cannot be
canceled unless the dependent is no longer eligible as a dependent as defined
in §81.1 of this
chapter
[
(3) - (5)
(No change.)
(b)
(No change.)
(c)
Sanctions for Insurance Program Violations.
(1)
(No change.)
(2)
Any person with a grievance regarding eligibility or other
matters involving the
Program
[
(3) - (6)
(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 February 24, 2006.
TRD-200601019
Paula A. Jones
General Counsel
Employees Retirement System of Texas
Earliest possible date of adoption: April 9, 2006
For further information, please call: (512) 867-7421
Chapter 329.
ELIGIBILITY CRITERIA FOR STATEWIDE FEDERATIONS/FUNDS AND AFFILIATED ORGANIZATIONS
34 TAC §329.1
The State Employee Charitable Campaign Policy Committee (SPC)
proposes an amendment to §329.1, concerning audit and review requirements.
The proposed amendment to §329.1 requires certain charitable organizations
to include a copy of an IRS Form 990 with their applications. The SPC requires
the IRS Form 990 to assist in determining the percentage of a charitable organization's
budget that was used for administrative expenses during the time period being
reported in the application.
The proposed amendment to §329.1, provides a similar requirement for
organizations participating in the statewide SECC campaign that §330.1
provides for the local SECC campaigns and requires an IRS Form 990 from all
organizations applying to participate in the statewide SECC campaign. The
SPC seeks to adopt rules that allow for consistent campaign practices at the
local level and the statewide level to the extent that is feasible. The SPC
is charged with ensuring a fair and equitable campaign. The IRS Form 990 is
a broadly recognized and accepted form used for determining administrative
costs of most non-profit charitable organizations, including those with small
budgets and those with larger budgets. The SPC may adopt a requirement that
all organizations submit an IRS Form 990 to ensure all organizations are reviewed
fairly and consistently and to ensure that organizations that are approved
to participate in the SECC spend donations within the statutory limits.
Mr. Kevin Van Oort, designated Certifying Officer for the State Employee
Charitable Campaign Policy Committee, has determined that for the first five-year
period the rules will be in effect, there will be no significant fiscal impact
on the state or units of local government.
Mr. Van Oort also has determined that for each year of the first five years
these rules are in effect, the public benefit anticipated as a result of enforcing
the rules will be to help ensure that the donations of state employees to
participating charitable organizations are going to the programs for which
they are intended and not to unreasonably high administrative costs. There
will be no effect on small or micro businesses. There are no significant anticipated
economic costs to persons who are required to comply with the proposed rules.
Comments on the proposal may be submitted to Kevin Van Oort, c/o SECC State
Campaign Manager, United Ways of Texas, 3724 Executive Center Drive, Suite
210, Austin, Texas 78731.
These amendments are proposed under Government Code, §659.139,
which provides that the State Employee Charitable Campaign (SECC) must be
managed fairly and equitably in accordance with the SECC law and the policies
and procedures established by the state policy committee. The SPC interprets
this statute to authorize the adoption of rules to the extent that the policies
and procedures adopted are of general applicability and affect the rights
of third parties, namely charitable organizations, local campaign managers,
local employee committees, the state advisory committee, the state campaign
manager, and state employees.
The other statute, article, or section affected by the proposed rule is
Government Code, §659.146, regarding eligibility criteria for charitable
organizations to participate in the state employee charitable campaign and
the authority of the SPC to use outside expertise and resources to determine
an organization's eligibility to participate in the SECC.
§329.1.Audit and Review Requirements.
(a)
To be eligible to participate in the state employee charitable
campaign, if the charitable organization's budget:
(1)
is not more than $100,000, the organization shall provide
a completed Internal Revenue Service (IRS) Form 990 and an accountant's review
that offers full and open disclosure of the organization's internal operations;
or
(2)
is greater than $100,000,
the organization
shall
be audited annually in accordance with generally accepted auditing standards
of the American Institute of Certified Public Accountants. A copy of the report
of such audit shall be provided with the application
along with a completed
Internal Revenue Service (IRS) Form 990
.
(b)
When a charitable organization submits an audit or accountant's
review, a copy of the organization's most recent annual audit or accountant's
review must be included with the application. The audit or accountant's review
must cover the fiscal year ending not more than 18 months prior to the January
of the campaign year in which the organization is applying for participation.
The IRS Form 990 and audit or accountant's review must cover the same fiscal
period. If the revenue and expenses on these two documents differ, the reconciliation
must be included in the IRS Form 990 itself or be included in a letter of
reconciliation submitted by the certified public accountant who completed
the audit or accountant's review.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on February 24, 2006.
TRD-200600990
Kevin Van Oort
Certifying Officer, State Policy Committee
State Employee Charitable Campaign
Earliest possible date of adoption: April 9, 2006
For further information, please call: (512) 475-0387
Standard-size paper
copy
]--$.10 per page.
paper
] copy
:
[
--
]
--
]$1.00
;
[
each.
]
VHS video
cassette--$2.50 each.
]
Audio cassette--$1.00
each.
]
Oversized
paper copy--$.50 each.
]
Tape Cartridge:
]
Mylar
(36-inch, 42-inch, and 48-inch):
]
Other--actual
cost.
]
Personnel
] charge:
Programming
personnel--$26 per hour.
]
Other personnel
]--$15 per hour.
personnel
] charge.
--
]
.
]
--
]
.
]
.
]
.
]
Access to information in other than
standard-size form where no copies are made and the information is not readily
available-$15 per hour/personnel cost.
]
Outsourced/contracted services--actual cost.
]
No Sales Tax--No
Sales Tax shall be applied to copies of public information.
]
Other costs--actual
cost.
]
legislature
]
in the performance of their
legislative
duties or if the system
determines that furnishing the records without cost can be considered as primarily
benefiting the
trust fund
[
general public
].
Chapter 73.
BENEFITS
Chapter 81.
INSURANCE
State
] of Texas. An employee will
be considered to be on active duty on each day of a regular paid vacation
or regular paid sick leave or on a non-working day, if the employee was on
active duty on the last preceding working day.
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
[
program
].
program
] as an employee.
program
], the office of the Employees Retirement
System of Texas in Austin, Texas or the retiree's last employing department;
for an active employee, the employee's employing department.
title
]
(relating to Enrollment and Participation).
program
] in lieu of participation in the
Program's
[
program's
] HealthSelect of Texas plan.
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
and TRICARE Supplement
premiums), AD&D,
and dental, but do not include out-of-pocket premium for long or short term
disability or dependent term life.
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.
program
] as a retiree;
program
]
as an annuitant; and
program
] and, on the date of retirement has three years of service with
such a department;
program
]; or
legislature
] may use the salary of
a state district judge or their actual salary as of September 1 of each year.
(29)
] TRS--The Teacher Retirement
System of Texas.
State
] of Texas determined by
the board to be non-bidding areas;
State
] of Texas.
State
] of Texas.
program
] are funded from three sources: state contributions, system
contributions, and participant contributions. The
Legislature
[
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. A participant 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.
title
].
title
].
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.
title
]
(relating to Eligibility) must pay premiums in advance on a monthly basis.
Premiums for such a person for each month of coverage after the 18th month
of coverage will be 150% of the rates charged for other participants in the
same coverage category and with the same plan. All premiums are due on the
first day of the coverage month 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.
State
] of Texas is
eligible for automatic coverage upon completion of the waiting period established
in
§1551.1055
[
Section 1551.1055
] of the Act. A
rehired full-time employee, reelected officer, or reappointed officer of the
state
[
State
] of Texas, including a new full-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, is eligible for automatic coverage without a waiting period provided
there has been no break in coverage in the GBP. However, an employee of an
institution of higher education and the employee's eligible dependents are
eligible for coverage on the first day that an employee performs services
as an employee of an institution of higher education only if:
Section 1551.1055
] of the Act and upon application to participate in
the
Program
[
program
], subject to the provisions of
§81.7(b) of this
chapter
[
title
] (relating to Enrollment).
A rehired part-time employee, reelected part-time officer, or reappointed
part-time officer of the
state
[
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.
program
] 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 may elect retiree coverages for which he is eligible at the time
of separation from department service.
program
].
program
]. A deceased active employee described by §1551.114
of the Act must have had at least 10 years of eligible service credit, as
determined by ERS, before his or her dependent children are eligible to continue
coverage. Dependent children of deceased employees or retirees will be considered
as dependents of the deceased employee's or retiree's surviving spouse for
purposes of the
Program
[
program
]. Participants continuing
coverage as surviving dependents are not eligible for life insurance coverage.
program
] at the time of his or her death,
dependent children of the deceased active employee/retiree are eligible to
continue coverage in the health and dental benefits plans in which the dependent
children were enrolled on the day of death of the employee/retiree provided,
however, the deceased active employee must have had at least 10 years of service
credit, including at least 3 years on August 31, 2001 or at least 10 years
after August 31, 2001 of service as an eligible employee with a Program participating
department, at the time of death. A deceased active employee described by
§1551.114 of the Act must have had at least 10 years of eligible service
credit, as determined by ERS, before his or her dependent children are eligible
to continue coverage. A surviving dependent child may continue such coverage
until the dependent child becomes ineligible as defined in §81.1 of this
chapter
[
title
] (relating to Definitions). Participants continuing
coverage as surviving dependents are not eligible for life insurance coverage.
title
] (relating to Eligibility).
program
] as long as he or she receives or is eligible to
receive an annuity under the ORP program or would have been eligible to receive
an annuity had his or her membership been in the Teacher Retirement System
rather than the ORP.
title
] (relating to
Enrollment and Participation). An ORP participant authorized by the Act with
at least 10 years of eligible service credit, and granted ORP disabled retiree
status in the Program, as established by the disability test used by the system,
is eligible to participate in the Program. Initial or continued eligibility
for insurance coverage for an ORP disabled retiree will be determined by the
system under the following provisions.
program
] if the ORP participant
is not otherwise eligible to participate in the
Program
[
program
] as an employee or retiree and is certified by a licensed physician
designated by the system as disabled as provided in paragraph (2) of this
subsection. An ORP participant may apply for disabled retiree status in the
Program
[
program
] by filing a written application for ORP
disabled retiree status in the
Program
[
program
] or
having an application filed with the system by the ORP participant's spouse,
employer, or legal representative. In addition to an application for ORP disabled
retiree status in the
Program
[
program
], an ORP participant
must file with the system the results of a medical examination of the ORP
participant. After an ORP participant applies for ORP disabled retiree status
in the
Program
[
program
], the system may require the
ORP participant to submit additional information about the disability. The
system will prescribe forms for the information required by this section.
program
]
after a certification of disability is made. Once each year during the first
five years after an ORP participant enrolls in the
Program
[
program
] as an ORP disabled retiree, and once in each three-year period
after that, the system may require an ORP disabled retiree to undergo a medical
examination by a physician the system designates. If an ORP disabled retiree
refuses to submit to a medical examination as provided by this section, the
system will suspend the ORP disabled retiree's enrollment in the
Program
[
program
] until the ORP disabled retiree submits to an examination.
The system will terminate the ORP disabled retiree's coverage in the
Program
[
program
] and notify the ORP participant in writing
if:
program
] is the first of the month following
the date the application for ORP disabled retiree status in the
Program
[
program
] is received by the system, or the first of the
month following the date employment is terminated, whichever is later.
legislature
]. A former member of the
Legislature
[
legislature
]
authorized by the Act to continue to participate in the
Program
[
program
] is eligible for the coverage, other than disability income
insurance coverage, in effect on the day before the member leaves office.
legislature
]. A former employee of the
Legislature
[
legislature
] authorized by the Act to continue to participate in the
Program
[
program
] is eligible for the coverage, other than disability
income insurance coverage, in effect on the day before the employee terminates
employment.
program
] as an employee, or whose coverage has ended following
the maximum period of leave without pay as provided for in §81.7(1)(2)(A)
of this
chapter
[
title
], except for those persons not
eligible pursuant to §81.11(c) of this
chapter
[
title
] (relating to Termination of Coverage), and/or his or her spouse and/or
dependent child/children who are not eligible to continue coverage under the
provisions of the Act or subsection (h) or (i) of this section, who are not
entitled to benefits under the Social Security Act, Title XVIII, who are not
covered under any other group health plan, or who were covered by a plan that
subjects them to a preexisting conditions limitation or exclusion that was
not satisfied by the service credit provisions of Public Law 104-91 (HIPAA),
may continue for up to 18 months the health and dental coverages only without
the basic term life that were in effect immediately prior to the date of the
loss of coverage. A formal election must be made to continue coverage by the
employee and/or his or her spouse and/or dependent child/children. The formal
election must be postmarked or received by the system within 60 days of the
date of notice contained in the notice of right to continue coverage form
or by the date coverage terminated, whichever is later.
title
] (relating to Eligibility) for automatic insurance
coverage, shall be enrolled in the basic plan of health and life insurance
unless the employee completes an enrollment form to elect other coverages
or to
waive
[
decline
] health coverage
as provided
in §81.8 of this chapter (relating to Waiver of Health Coverage)
.
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.
title
] (relating to Eligibility) for automatic insurance
coverage, shall be enrolled in the basic plan of health and life insurance
beginning on the first day of the calendar month following 90 days of employment
unless, before this date, the employee completes an enrollment form to elect
other coverages or to
waive
[
decline
] health coverage
as provided in §81.8 of this chapter (relating to Waiver of Health Coverage)
.
program
] is eligible to participate in premium conversion and shall
be automatically enrolled in the premium conversion plan. The employee shall
be automatically enrolled in the plan for subsequent plan years as long as
the employee remains on active duty.
title
] (relating to Eligibility). 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 a retiree, will automatically
be discontinued concurrently with the commencement of retirement status. If
a retiree retires directly from department service and is not covered as an
active employee on the day before becoming an annuitant, the retiree will
be enrolled in the basic plan.
title
] (relating to Eligibility), including
dependent coverages, by completing an enrollment form as specified in paragraph
(2)(A) - (2)(C) of this subsection. 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. An application/enrollment form
received after the initial period for enrollment as provided in this paragraph
is subject to the provisions of subsection (h) of this section.
title
(relating to Eligibility), may enroll
in health, dental, and life insurance coverages
or waive health coverage
as provided in §81.8 of this chapter (relating to Waiver of Health Coverage)
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.
title
] (relating to Eligibility), may
enroll in health coverage
or waive health coverage as provided in §81.8
of this chapter (relating to Waiver of Health Coverage)
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 90 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 coverages shall be the
first day of the calendar month following 90 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.
title
] (relating to Eligibility), may enroll in health
coverage
or waive health coverage as provided in §81.8 of this chapter
(relating to Waiver of Health Coverage)
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 coverages shall
be the first day of the calendar month following 90 days after the date of
retirement or the first day of the calendar month following the retiree's
65th birthday, whichever is later.
title
] (relating to
Eligibility), may apply for approval of such coverage by providing evidence
of insurability acceptable to the system.
title
] (relating to Eligibility).
title
] (relating to Administration).
A surviving spouse who is not receiving an annuity may make payments as provided
in §81.3(b)(2)(B) of this
chapter
[
title
].
program
] is deemed to have elected to participate in the
premium conversion plan and to pay insurance premium expenses 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.
program
]
may apply for additional coverages and plans. An employee/retiree may apply
for or elect additional coverages and plans without concurrent enrollment
in health coverage provided by the
Program.
[
program. A member
of the Texas National Guard or any of the reserve components of the United
States armed forces who is assigned to active military duty and who is enrolled
in additional coverages and plans may cancel health coverage and retain all
other coverages and plans during the period of such assignment.
] Additional
coverages and plans, as determined by the board, may include:
or
]
.
]
program
] and eligible dependents may participate in an approved HMO
if they reside in the approved service area of the HMO and are otherwise eligible
under the terms of the contract with the HMO.
title
] (relating
to Administration);
program
] whose coverage was
waived,
dropped or canceled, except
as otherwise provided in subsection (k) of this section; and
a
] approved HMO and who permanently moves out of the HMO service area
shall make one of the following elections, to become effective on the first
day of the month following the date on which the participant moves out of
the HMO service area:
title
] (relating to Termination of
Coverage).
declined
] or canceled status;
and
]
.
]
or
] (viii)
, (ix), or (xii)
of this paragraph, except that
a surviving dependent or former COBRA unmarried child may enroll an eligible
dependent in dental insurance coverage if the dependent is enrolled in health
insurance coverage.
An employee
who re-enrolled after the close of the annual opportunity but prior to September
1 of the same calendar year shall have until August 31 of that calendar year
to make changes as allowed above to be effective September 1.
]
title
] (relating to Definitions). The preexisting conditions exclusion will
not apply to a medical condition resulting from congenital or birth defects.
program
].
title
] (relating to Administration).
title
]. Failure to make the required payment of premiums by the due date
will result in the cancellation of all coverages except for member only health
and basic life coverage. The employee will continue in the health plan in
which he or she was enrolled immediately prior to the cancellation of all
other coverages. If a premium beyond the state contribution for member only
health and basic life coverage is owed, the employee must make the required
payment of premiums directly to the employing department upon return to active
duty.
legislature
]. Provided that the
required premiums are paid, the health, dental, and life insurance coverages
of a former member or employee of the
Legislature
[
legislature
] may be continued on conclusion of the term of office or employment.
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 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.
title
], elects to continue coverage may do so by submitting the required
election notification and enrollment forms to the system. The enrollment form,
including all premiums due for the election/enrollment period, must be postmarked
or received by the system on or before the date indicated on the continuation
of coverage enrollment form. Continuing coverage will begin on the first day
of the month following the month in which the employee/retiree dies, provided
all group insurance premiums due for the month in which the employee/retiree
died and for the election/enrollment period have been paid in full.
program
] as an employee, or whose coverage has ended following the maximum
period of leave without pay as provided in paragraph (2)(A) of this section.
An employee, his or her spouse and/or dependent child/children, who, in accordance
with §81.5(k)(2) of this
chapter
[
title
], elects
to continue health and dental coverages may do so by submitting the required
election notification and enrollment forms to the system. The enrollment form,
including all premiums due for the election/enrollment period, must be postmarked
or received by the system on or before the date indicated on the continuation
of coverage enrollment form. Continuing coverage will begin on the first day
of the month following the month in which the employee's coverage ends, provided
all group insurance premiums due for the month in which the coverage ends
and for the election/enrollment period have been paid in full.
title
]) of an
employee/retiree who, in accordance with §81.5(k)(4) of this
chapter
[
title
], elects to continue coverage may do so by submitting
the required election notification and enrollment forms to the system. The
enrollment form, including all premiums due for the election/enrollment period,
must be postmarked or received by the system on or before the date indicated
on the continuation of coverage enrollment form. Continuing coverage will
begin on the first day of the month following the month in which the divorce
decree is signed, provided all group insurance premiums due for the month
in which the divorce decree is signed and for the election/enrollment period
have been paid in full.
title
], elects to continue coverage may do so by
submitting the required election notification and enrollment forms to the
system. The enrollment form, including all premiums due for the election/enrollment
period, must be postmarked or received by the system on or before the date
indicated on the continuation of coverage enrollment form. Continuing coverage
will begin on the first day of the month following the month in which the
dependent child's marriage occurred, provided all group insurance premiums
due for the month in which the dependent child's marriage occurred and for
the election/enrollment period have been paid in full.
title
]
of an employee/retiree who, in accordance with §81.5(k)(6) of this
chapter
[
title
], elects to continue coverage may do so by
submitting the required election notification and enrollment forms to the
system. The enrollment form, including all premiums due for the election/enrollment
period, must be postmarked or received by the system on or before the date
indicated on the continuation of coverage enrollment form. Continuing coverage
will begin on the first day of the month following the month in which the
dependent child of the employee/retiree attains 25 years of age, provided
all group insurance premiums due for the month in which the dependent child
attained age 25 and for the election/enrollment period have been paid in full.
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.
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.
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.
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.
title
], the last
day of the 29th calendar month of the continuation period;
title
] (relating to Administration);
title
] (relating to Administration).
title
] (relating
to Administration).
title
]
(relating to Administration).
title
] (relating
to Eligibility).
company
], may be submitted by the person to the Executive Director of
the Employees Retirement System of Texas for review. A request for review
must be filed by the person in writing within 90 days from the date the insurance
carrier or administering firm
[
company
] formally denies the
claim
, or provides notice of other adverse decision,
and mails
notice of this denial and right of appeal to the person.
program
], including
eligibility for participation in the premium conversion plan, may submit a
written request to the Executive Director to make a determination on the matter
in dispute.
filed
]
in writing
and filed with ERS
30 days from the date the Executive
Director's decision is mailed by certified or first class mail.
title
], the court order
is no longer valid, or comparable coverage has been obtained.
program
] may submit a
written request to the Executive Director to make a determination on the matter
in dispute. Any person who disputes a rescission of coverage, a denial of
benefits or other sanctions imposed in connection with a determination made
under Insurance Code, Chapter 1551, may appeal the determination in accordance
with §81.9 of this
chapter
[
title
] (relating to
Grievance Procedure). A timely appeal of a determination made pursuant to
Insurance Code, Chapter 1551 shall automatically stay the imposition of sanctions.
However, at the time such a determination is made pursuant to Insurance Code,
Chapter 1551, no further claims will be paid until the agency decision is
final. Upon final agency action, all eligible claims will be processed subject
to any offsets for overpayments made by the carrier.
Part 12.
STATE EMPLOYEE CHARITABLE CAMPAIGN
Chapter 330.
ELIGIBILITY CRITERIA FOR LOCAL FEDERATIONS/FUNDS, AFFILIATED ORGANIZATIONS, AND LOCAL CHARITABLE ORGANIZATIONS