> May 20, 2015
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May 20, 2015
Welcome to this edition of HR & Benefit News . Always feel free to send us your comments and questions.
Required Waiting Period for Retired Employees
Under Chapter 1601 of the Texas Insurance Code and OEB Administrative Policy 141 , Retired Employees who are returning to claim benefits after a break from active employment are subject to the waiting period before they are eligible for UT SELECT Medical coverage. By law, this waiting period may not be reduced or eliminated for Retired Employees in this situation, even through the use of local or institutional funds.
Optional benefits may begin immediately upon enrollment, but coverage under the UT SELECT Medical plan cannot begin until the waiting period has been satisfied, which is when eligibility for state-appropriated premium sharing begins. Please ensure that the administration of Retired Employee benefits at your institution is consistent with this requirement going forward.
Background on the Waiting Period
Because of federal ACA provisions there has been some recent discussion around the waiting period as it applies to Employees, but not a lot of discussion about Retired Employees. For administrative consistency, beginning on September 1, 2015 the waiting period for both Employees and Retired Employees should be applied in compliance with the federal maximum of 90 days (i.e. eligibility for medical coverage begins on the first of the month following the 60 th day of employment or retirement). In general, OEB Administrative Policy 141 outlines the details of the waiting period and when it applies based on applicable state law, including for Retired Employees returning after a gap in coverage.*
The waiting period as it is established in Chapter 1601 applies to all new Employees and Retired Employees as well as to Employees and Retired Employees who are returning to the program after a gap in coverage. This same chapter of state law also includes an authorization for the waiting period to be reduced or eliminated for Employees, provided that no state-appropriated funds are used to pay the employer contribution toward premiums during the regular waiting period. This provision is what allows each institution to shorten or do away with the waiting period for Employees using available local and institutional funds for premium sharing.
What’s Different about Retired Employees?
There is no provision included in Chapter 1601 for reducing or eliminating the waiting period for Retired Employees. As you know, for those who move directly from employment to retirement, the waiting period does not apply because there is no gap in coverage under the UT Benefits program. This is similar to the way that transfer employees are handled.
However, the waiting period must be considered for any Retired Employee who terminates employment without retiring and later returns to claim benefits after a gap in coverage. Keep in mind that the waiting period should always be measured from the official date of retirement through TRS (or another state program), which may be different from the date on which a Retired Employee returns to claim benefits.
*PLEASE NOTE: An incorrect reference to the waiting period that was included in an example within OEB Administrative Policy 220 , Retired Employee Eligibility and Enrollment, was recently brought to our attention and has been updated to correct the inconsistency.
Recently the Office of Employee Benefits unveiled the newly redesigned Incapacitated Overage Dependent Application. The updated application provides better guidance on the specific clinical information needed by the UT Medical Directors in order to ensure the most accurate determination is made regarding the dependent’s eligibility to continue coverage beyond the usual age. The primary updates were made in the Attending Physician’s section where there are now more specific questions relating to the dependent’s physical capacity.
The same policies and procedures still apply for all applications. Complete details can be found in OEB Administrative Policy 230 . The new 2014-2015 Incapacitated Dependent Form is available in the Insurance Files Library in our System Wide HR Central SharePoint site in the Insurance Enrollment folder . You should use the redesigned application for all new Incapacitated Overage Dependent coverage requests going forward. Please ensure that you dispose of any digital or hard copies of the old application form that you may have. As a reminder, the primary contact for these applications is Kristina Henderson, Benefits Specialist, who may be reached via email at email@example.com or by phone at (512) 499-4616.
The Waiver of Premium (WOP) process for Voluntary Group Term Life (VGTL) participants who become disabled can be a bit confusing, especially since it doesn’t come up on a frequent basis. Because of that, OEB has been working closely with Dearborn National to develop some additional resources that we hope will help clarify the details. Two separate sets of Frequently Asked Questions (FAQs) have been developed, a simplified version for participants and a more detailed version for use by HR and Benefits staff in administering the process.
These two new documents are both available online. The simplified version can be found on the UT website maintained by Dearborn National on the Employee Life Insurance page . The more detailed FAQs intended for you can be found in the Insurance Documents Library in our Systemwide HR Central SharePoint site within the Dearborn National folder .
Please contact a member of the OEB Benefits Team if you have any trouble locating these new resources or have any additional questions that we can assist with.
New Contracts Awarded for Disability and Vision Plans
As you probably know, the UT System Office of Employee Benefits (OEB) is required under state law to request and evaluate competitive proposals at least once every six years for each insurance plan offered as part of the UT Benefits program. This process ensures that the costs and features of the insurance plans and related administrative services remain competitive with the current marketplace. And, most importantly, it ensures that UT System plan participants continue to receive the best possible benefits at the lowest possible overall cost.
Last fall OEB posted RFPs for Fully Insured Disability Insurance (both Short Term and Long Term Disability plans) and Fully Insured Vision Insurance plans. OEB is extremely pleased with the results of the competitive bid process. The effective date of the new contracts will be September 1, 2015.
The contract for Short Term (STD) and Long Term Disability (LTD) Insurance was awarded to Dearborn National Life Insurance Company. Dearborn National agreed to meet or exceed all requirements specified in the RFP including agreeing to offer STD and LTD insurance to employees during the upcoming Annual Enrollment period without the requirement of satisfying Evidence of Insurability (EOI). Dearborn National’s proposed premium rates also represent a slight decrease from the current rates, so the savings will be passed along directly to participants.
The contract for Vision Insurance was awarded to Superior Vision. Superior Vision has demonstrated a willingness and ability to comply with UT System’s contractual, data processing and administrative requirements and has a history of providing excellent customer service to our members. The Superior network of providers was unmatched by other vendors and Superior’s proposed premium rates will decrease by more than 16% effective September 1, 2015. This will allow members to continue to receive uninterrupted services from their current providers and experience savings at every level of coverage in both the Regular Vision Plan and the Vision Plus plan.
The results of the RFP process were also communicated to employees and retirees in the regular edition of the May 2015 “A Matter of Health” newsletter. More specific information including plan rates and the waived EOI requirement during Annual Enrollment for Long and Short Term Disability will be communicated in greater detail in the July Special Annual Enrollment Edition newsletters set to go out in July 2015, in both electronic and printed versions (for those Employees and Retired Employees without a valid email address on file).
BHRC Program & Registration Info
We hope to see many of you at our annual Benefits & Human Resources Conference beginning on June 22 right here in Austin. Keep an eye on your email. More information about this year’s program will be headed your way soon!
Annual Enrollment Planning
As we quickly make our way through May, it’s time to start firming up plans for your Annual Enrollment (AE) events! Our office recently sent information to the designated AE contacts at each of your institutions so that we could begin coordinating resources, including arrangements to have OEB staff and vendor representatives at your key AE fairs and presentations. We look forward to working with each of your institutions and visiting with your Employees and Retired Employees during July – and in August for UTRGV Employees as they prepare for the launch of our newest institution!