|
Rules of the game
Who is eligible?
You are eligible for coverage under the benefits plans if you meet the following guidelines:
- You’re a full-time employee or part-time employee regularly scheduled to work at least 30 hours a week.
- You’re a retiree who was covered by a city medical plan on the date of retirement from the city.
- You’re a survivor of a covered city employee or retiree, up to age limits and application of other plan rules.
- You’re a deferred-retired employee who will become eligible to receive a pension within five years after termination, and you continuously pay the monthly retiree contribution for health coverage.
If both you and your spouse work for the city, you may be covered as an employee or as a dependent – but not both. Dependents may be enrolled under only one parent or guardian.
Eligible dependents
Eligible dependents are defined as the following:
- Legal spouse
- Unmarried natural or adopted children to age 25, if they qualify as dependents for federal income-tax purposes
- Children to age 25, over whom you have legal guardianship or legal foster care if they qualify as dependents for federal income-tax purposes
- Grandchildren to age 25 if they qualify as your dependents for federal income tax purposes
- Disabled dependents over age 25 who are incapable of self-sustaining employment because of mental retardation or physical handicap. The dependent must be primarily dependent on you for more than 50 percent of financial support and approved for coverage after age 25
- Unmarried dependent children who lose Medicaid coverage may be enrolled under the employee’s medical plan within 31 days after Medicaid coverage is lost. They may be covered to age 25 if they qualify as your dependents for federal income-tax purposes
Changes to your benefits are limited to open-enrollment periods, unless you have a qualified change in family status. The change in benefits must be consist with the status change.
Qualified family-status changes
Qualified family-status changes include the following:
- Marriage or divorce
- Birth or adoption of a child
- Death of a dependent
- A dependent child reaches age 25 or marries
- A spouse’s loss of employment
- A spouse becomes employed and enrolls in that employer’s benefits program
- You or your spouse change from full-time to part-time employment or vice-versa, or you experience a significant change in your spouse’s benefits or premium payments
- A dependent loses Medicaid medical coverage
If you have a family-status change, you must submit a status-change form and documentation within 31 days of the change.
Required documentation
To add dependents for coverage, you must submit the required documents. The following is a list of documents you must provide with your medical/dental election or change form by the open-enrollment deadline.
- Spouse: copy of a certified marriage license
- Common-law spouse: declaration and registration of an Informal Marriage Certificate
- Children under age 25, if not added at time of birth or if you are requesting reinstatement of their coverage: birth certificate or legal document that establishes your paternity and a completed Certification of Financial Dependency form
- Children to age 25, over whom you have legal guardianship or legal foster care: copy of the legal documents granting custody, guardianship or foster care
- Grandchild(ren) to age 25, who are your covered dependent for federal income-tax purposes: Certification of Financial Dependency form and a birth certificate
- Disabled dependents over age 25 if they were covered before age 25 and are primarily dependent on you for more than 50 percent of their financial support: medical documentation of the disability or mental handicap
There is no waiting period for dependents added during open enrollment.
More rules of the game
How to enroll or make changes
Employees: If you want to enroll or make changes to your current coverage, ask your department human resources liaison for an enrollment or change form.
Retirees: Use the medical- or dental-change forms in your enrollment packet and mail them to the address below:
Benefits Division
P.O. Box 248
Houston, TX 77001
If you don’t enroll now — active employees only
If you do not enroll for benefits during open enrollment, you may apply during the year for coverage in the HMO plan by completing a medical/dental election form. Your coverage will be effective on the first or the 16th of the month following the 90-day waiting period from the date you submit your enrollment form. You may not enroll in the PPO or dental plan until open enrollment in 2010, unless you have a qualifying family-status change through loss of other group coverage.
Active Employees
- life insurance only
You may apply for voluntary group life insurance at any time. If you apply for first-time coverage or increase your coverage during this enrollment period, you must complete a personal-health statement. You will begin paying premiums after the insurance company approves your application.
|
