> November 13, 2015
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November 13, 2015
Welcome to this edition of HR & Benefit News. Always feel free to send us your comments and questions.
UT Benefits Billing for COBRA Coverage
On September 1, 2015 COBRA billing was transitioned away from our third party administrators to be managed internally by the UT Benefits Billing for COBRA Coverage team here at OEB. Important COBRA enrollment resources for this plan year can be found on the Systemwide HR Central SharePoint site in the following folder: Document Libraries / Insurance / COBRA.
The only valid enrollment form is the current 2015-16 COBRA Enrollment Form (available through the link listed above). Older forms are invalid and the outdated information causes confusion and significant delays in enrollment. Please delete, discard, or otherwise dispose of any prior COBRA enrollment forms that you have kept in either electronic or hard copy. Use only the 2015-2016 COBRA Enrollment Form for the remainder of this plan year.
Subscriber information and other key details, including the coverage termination and COBRA effective dates, should be completed before providing any COBRA Enrollment Form to an individual experiencing a qualifying event. Providing blank forms or forms with incorrect information, such as listing the employee name and/or BID for a dependent who is aging out, causes confusion and can delay enrollment.
Under COBRA rules, and because continuation only makes sense in certain limited circumstances, there are specific criteria that must be met to continue participation in the Health Care Reimbursement Account (HCRA) upon leaving employment. You must confirm that an employee’s account balance meets the eligibility criteria before offering a COBRA enrollment form for UT FLEX.
For eligible participants, all COBRA Enrollment forms as well as initial premium payments and UT FLEX contributions must be submitted prior to the applicable deadlines to maintain access to the benefits
Stay tuned for a training session that will offer a few helpful tips about how to use SGELIG to gather details necessary for the completion of the COBRA Enrollment Form.
For additional information regarding COBRA requirements and other details, please review OEB Administrative Policy 250 .
Contact Information for UT Benefits Billing for COBRA Team: Email: firstname.lastname@example.org Phone: (844) 579-8683 Fax: (512) 852-3204 Mail: Office of Employee Benefits UT Benefits Billing for COBRA Coverage 210 W. 6 th Street Suite B. 140E Austin, TX 78701 Online Payment Website: http://www.texas.gov/UTCOBRA
UT FLEX Account Type
Deadline to Incur Expenses
Deadline to Submit Claims
Health Care Reimbursement Account (HCRA)
November 15, 2015
November 30, 2015
Dependent Day Care Reimbursement Account (DCRA)
August 31, 2015
November 30, 2015
REMINDER UT Select Medical Appeals
Employees, dependents, and retirees have the right to appeal a determination, including claims and preauthorizations, made by BCBSTX regarding their UT SELECT Medical benefits. The formal appeal process is structured to provide the opportunity for a fair and comprehensive review of a UT SELECT participant’s specific situation.
An appeal may be filed by the participant or by a person authorized to act on their behalf. If the participant wishes to designate a representative for purposes of an appeal, completion of the Standard Authorization Form to Use or Disclose Protected Health Information (PHI) will be required. Important Note: Healthcare providers are exempt from the completion of the Standard Authorization PHI form.
Below is a high-level overview of the appeal process.
Any time a claim or preauthorization is denied, the participant will receive notice of their appeal rights and the filing deadlines. For guidance and tips on submitting the first level appeal, participants should work directly with BCBSTX customer service.
Should your office receive questions about step 2 in the appeal process, we’ve compiled a few tips that you may want to pass along to the participant about submitting appeals to OEB. As a reminder, due to privacy issues you should avoid sending appeal correspondence on behalf of your employees, retirees, and their dependents. The individual participant should initiate all appeal requests and correspondence with the appropriate office. Following the tips below will help participants avoid unnecessary delay in the appeal review process.
Tips for Submitting Second-level UT SELECT Medical Appeals to OEB:
- Gather all required documents for the appeal process with OEB, including:
- An appeal letter explaining the situation and what action you are requesting (e.g. an exception to allow benefits, a network exception, additional or higher level of benefits, etc.);
- The Appeal Determination Letter from BCBSTX;
- Related Explanation(s) of Benefits (EOBs);
- Documentation from your healthcare provider(s) including any information relevant to the appeal; and
- Any additional documents you want considered in support of the appeal request.
- Clearly state your desired outcome in the Appeal Letter.
- Since appeal documentation can be lengthy and complex, it is highly recommended that you send all information in a single package to avoid unnecessary delays or confusion.
- You may submit your appeal package to OEB via mail, fax, or email:
- Mail: Office of Employee Benefits The University of Texas System 210 W. 6th Street, Suite B.140E Austin, TX 78701
- Fax: (512) 499-4620
- Email: email@example.com
For additional information regarding the appeals process please review the 2015-2016 UT SELECT Medical Guide or contact the OEB Benefits Team.
Below you will find contact information for the Retired Employee Associations by institution. The list is comprised of information available to our office at this time. To add your institution’s Retiree organization to this list please share your information with Laura Garlock at firstname.lastname@example.org . All available information will be included in the upcoming Insurance Enrollment Guide for New Retirees.
UT MD Anderson Cancer Center
RETIREES CLUBFrank Gault, President email@example.com
MD ANDERSON RETIREES ASSOCIATION
UT Medical Branch at Galveston
RETIRED FACULTY-STAFF ASSOCIATION
UTMB RETIREE ASSOCIATION(409)763-5615
UT San Antonio
RETIRED FACULTY ASSOCIATION
UT El Paso
UTEP ALUMNI ASSOCIATION
UT Health Science Center Houston
UT Health Science Center San Antonio
UT HOUSTON RETIREE ORGANIZATION http://www.uthro.org/
Cindi Adcock AdcockC@uthscsa.edu
A video of the training is available on our Systemwide OEB SharePoint site. This an internal training session specific to HR & Benefits staff which will not be displayed publicly on our OEB YouTube channel. We encourage you to share the SharePoint location with any new and existing staff within your office who handle personal health information (PHI) or may do so in the future. To access the HIPAA video please visit our Systemwide OEB SharePoint site in the following folder: Videos / HIPAA / HIPAA_2015.
If you have any additional questions, please contact a member of the OEB Benefits Team.
The 2015-2016 Enrollment Guide for New Employees is available on our OEB YouTube webpage. This video provides an overview of the insurance, retirement, and wellness benefits offered by UT System OEB. Access the video >
REVISED OEB Policy Updates
The following policies in the OEB Administrative Manual were recently revised:
Summary of Revisions
|September 2015||130||Office of Employee Benefits Terms and Definitions||Revised definition of “dependent” to cite applicable state and federal law. Updated definitions of full-time and part-time employees to address ACA requirements.|
|September 2015||140||Funding for Group Insurance Coverage||Clarified information about benefits-eligibility for employees who have previously retired under TRS. Added language to address ACA requirements.|
|September 2015||142||Premium Sharing for Part-Time Employees and Graduate Student Employees||Revised to indicate enrollment in a UT institution’s Student Health Insurance Plan may be considered as enrollment in comparable coverage for purposes of waiving UT SELECT Medical coverage. Added language to address ACA requirements.|
|September 2015||210||Employee Eligibility and Enrollment||Clarified information about benefits-eligibility for employees who have previously retired under TRS. Added language to address ACA requirements.|
|July 2015||230||Dependent Eligibility and Enrollment||Updated eligibility requirements based on federal Supreme Court ruling requiring recognition of same-sex marriages. Replaced inline documentation chart with link to external chart to avoid duplication.|
|July 2015||230 Chart||Dependent Eligibility and Enrollment||Updated documentation requirements for spouses following changes in eligibility described in Policy 230.|
The current OEB Administrative Manual is available on the OEB website on the Forms and Publications page.
For specific policy revisions, please review the internal versions on the OEB SharePoint site : Document Libraries / OEB Administrative Policy Manual.
If you have any additional questions, please contact a member of the OEB Benefits Team .
SUMMARY UT FLEX Participant Enrollment Report for Plan Year 2015-2016
The UT FLEX Activity Report for Plan Year 2015-2016 is now available. The report displays a snapshot of contributions and participation by institution.
Did you know…Plan Year 2016 has a 4.5% participation increase (in comparison to Plan Year 2015) with contributions over $40 million, yielding a system-wide FICA tax savings of $3.1 million. To learn more about the activity report visit the link below.