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TITLE 34PUBLIC FINANCE
PART 4EMPLOYEES RETIREMENT SYSTEM OF TEXAS
CHAPTER 81INSURANCE
RULE §81.7Enrollment 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 (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 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.

    (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 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 health coverage as provided in §81.8 of this chapter.

  (2) A new employee with existing, current, and continuous GBP health coverage as of the date the employee begins active duty is not subject to the health insurance waiting period established in §1551.1055, Insurance Code, and is eligible to enroll as a new employee in health insurance and additional coverages and plans which include optional and voluntary coverages by completing an enrollment form before the first day of the calendar month after the date the employee begins active duty. Health and additional coverages selected before the first day of the calendar month after the date the employee begins active duty are effective the first day of the following month.

  (3) Dependent enrollment and optional coverages:

    (A) To enroll eligible dependents, to elect to enroll in an approved HMO, and to elect additional coverages and plans which include optional and voluntary coverages, an employee not subject to the health insurance waiting period shall complete an enrollment form within 30 days after the date on which the employee begins active duty. Coverages selected within 30 days after the date on which the employee begins active duty become effective on the first day of the month following the date on which the enrollment form is completed. An enrollment form completed after the initial period for enrollment as provided in this paragraph is subject to the provisions of subsection (i) of this section.

    (B) To enroll eligible dependents or to elect to enroll in an approved HMO, an employee subject to the health insurance waiting period shall complete an enrollment form before the first day of the month following 90 days of employment. Coverages selected before the first day of the month following 90 days of employment become effective on the first day of the month following 90 days of employment. An employee completing an enrollment form after the initial period for enrollment as provided in this paragraph is subject to the provisions of subsection (i) of this section. The provisions of paragraph (2) of this subsection apply to the election of additional coverages and plans, which include optional and voluntary coverages, for an employee subject to the health insurance waiting period.

  (4) Except as otherwise provided in this section, an employee may not change coverage during a contract year.

  (5) An eligible employee who enrolls in the 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.

  (6) Coverage for a newly eligible dependent, other than a dependent referred to in paragraph (7) or (9) of this subsection, will be effective on the first day of the month following the date the person becomes a dependent if an enrollment form is completed on or within 30 days after the date the person first becomes a dependent. If the enrollment form is completed and signed after the initial period for enrollment as provided in this paragraph, the enrollment form will be governed by the rules in subsection (i) of this section.

  (7) A newborn natural child will be covered immediately and automatically from the date of birth in the health plan in effect for the employee or retiree. A newly adopted child will be covered immediately and automatically from the date of placement for adoption in the health plan in effect for the employee or retiree. To continue coverage for more than 30 days after the date of birth or placement for adoption, an enrollment form for health coverage must be submitted within 30 days after the date of birth or placement for adoption.

  (8) The effective date of a newborn natural child's life and AD&D insurance will be the date of birth, if the child is born alive, as certified by an attending physician. The effective date of a newly adopted child's life and AD&D insurance will be the date of placement for adoption. The effective date of all other eligible dependents' life and AD&D insurance coverages will be as stated in paragraph (6) of this subsection.

  (9) Health insurance coverage of an eligible child for whom a covered employee or retiree is court-ordered to provide medical support becomes effective on the date on which the department receives a valid copy of the court order.

  (10) The effective date of HealthSelect of Texas coverage for an employee's or retiree's dependent, other than a newborn natural child or newly adopted child, will be as stated in paragraph (6) of this subsection.

  (11) For purposes of this section, an enrollment form is completed when all information necessary to effect an enrollment has been transmitted to the system in the form and manner prescribed by the system.

(b) Part-time employees. A part-time employee or other employee who is not automatically covered must complete an application/enrollment form provided by the Employees Retirement System of Texas, authorizing necessary deductions for premium payments for elected coverage. All other rules for enrollment stated in subsection (a) of this section, other than the rule as to automatic coverage, apply to such employee:

  (1) If the employee is not subject to a health insurance waiting period, this form must be submitted to the Employees Retirement System of Texas through his or her employing department on, or within 30 days after, the date on which the employee begins active duty.

  (2) If the employee is subject to a health insurance waiting period, this form must be submitted to the Employees Retirement System of Texas through his or her employing department before the first day of the month following 90 days of employment.

  (3) If the employee has existing, current, and continuous GBP health coverage as of the date the employee begins active duty, the employee is not subject to the health insurance waiting period established in §1551.1055, Insurance Code, and is eligible to enroll as a new employee in health insurance and additional coverages and plans which include optional and voluntary coverages by completing an enrollment form before the first day of the calendar month after the date the employee begins active duty. Health and additional coverages selected before the first day of the calendar month after the date the employee begins active duty are effective the first day of the following month.

(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. 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. Except as provided in subsection (a)(6) of this section, 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.

  (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, including dependent coverages, by completing an enrollment form as specified in subparagraphs (A) - (C) of this paragraph. 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 (i) of this section.

    (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, may enroll in health, dental, and life insurance coverages or waive health coverage as provided in §81.8 of this chapter 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.

    (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, may enroll in health coverage or waive health coverage as provided in §81.8 of this chapter 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.

    (C) A retiree who is ineligible for health insurance on the effective date of retirement as provided in §81.5(c) of this chapter, may enroll in health coverage or waive health coverage as provided in §81.8 of this chapter 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.

  (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, may apply for approval of such coverage by providing evidence of insurability acceptable to the system.

  (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) All other enrollment rules stated in subsections (a), (h), and (m) of this section apply to retirees.

  (6) A retiree who seeks enrollment in health coverages after turning age 65 or is retired and enrolled in the basic plan and turns age 65 will be automatically enrolled in the Medicare Advantage Plan unless the retiree opts out of the Medicare Advantage Plan and enrolls in other coverage by completing an enrollment form as specified in paragraph (2)(A) - (C) of this subsection.

  (7) ERS may determine that a Medicare-eligible retiree who seeks enrollment in GBP health coverages or is retired and enrolled in the basic plan and becomes eligible for Medicare may be automatically enrolled in HealthSelect Medicare Rx. A retiree who declines HealthSelect Medicare Rx loses all GBP prescription drug coverage.

(d) Medicare-eligible Dependents.

  (1) A dependent as defined in §81.1(11)(A) - (I) and (12)(A) - (D) of this chapter (relating to Definitions) who becomes eligible for Medicare primary coverage as specified in §81.1(23) of this chapter, either through disability or age or other requirements as set forth by CMS or its successor agency, will be automatically enrolled in the Medicare Advantage Plan unless the retiree and his/her dependents opt out of the Medicare Advantage Plan and enroll in other coverage by completing an enrollment form as specified in subsection (c)(2)(A) - (C) of this section.

  (2) ERS may determine that a Medicare-eligible dependent eligible for health coverages under the GBP may be automatically enrolled in HealthSelect Medicare Rx. A Medicare-eligible dependent who declines HealthSelect Medicare Rx loses all GBP prescription drug coverage.

(e) Surviving dependents.

Cont'd...

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