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Things
to Consider for Retirees
These are important things
you need to consider before making your enrollment
decisions.
Eligibility
You are eligible for coverage
under the benefits plans if you were covered
when you retired and have been continuously
covered after retirement. If both you and your
spouse retired from the city, you may be covered
as a retiree or as a dependent — but
not both. Dependents may be enrolled under only
one parent or guardian.
Eligible Dependents are
your:
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Legal spouse, |
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Unmarried natural or
adopted children up to age 25, if they
qualify as dependents for federal income
tax purposes, |
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Children under age 25 over whom
you have legal guardianship or legal foster
care if they qualify as dependents for
federal income tax purposes, |
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Grandchildren under
age 25 if they qualify as your dependents
for federal income tax purposes, |
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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
covered before age 25. |
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Unmarried dependent
children who lose Medicaid coverage may
be enrolled under the retiree’s
medical plan within 31 days after Medicaid
coverage is lost. They do not need to
be full-time students, and they may be
covered to age 25 if they qualify as the
retiree’s dependent for federal
income tax purposes. |
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.
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Spouse
— copy of a certified marriage license.
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Common-law spouse —
copy of a Declaration and Registration
of an Informal Marriage Certificate. |
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Children under age 25 over whom
you have legal guardianship or legal foster
care. Copy of the legal documents that
gave custody, guardianship or foster care.
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Grandchild(ren) who
are your covered dependents for federal
income tax purposes. Copy of the Financial
Dependency of Children form and a birth
certificate. |
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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. |
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Children under age
25, if not added at time of birth or if
you are requesting reinstatement of their
coverage. Copy of a birth certificate
or legal document that establishes paternity
of the employee and a completed certification
of Financial Dependency of Children form. |
There is no waiting period
for dependents added during open enrollment.
You can get a status change form from the City
of Houston Benefits division. Call (713)
837-9300.
Dependent Audit
Later in the year, you will receive information about a dependent audit to be conducted by the city’s Benefits Division. The purpose of the audit is to verify the eligibility of each of your covered dependents. If you cover dependents, you will receive a letter listing:
Who can be covered by the city’s benefits plan, and
Whom you are currently covering on these plans.
Open enrollment is the time to review your family status and drop or add dependents. There’s no point in paying for someone who is ineligible. You will be asked to provide documentation to verify your relationship.
Qualified Family Status
Change
You may change your coverage
only if you have a qualified family status change.
Qualified family status changes include:
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marriage
or divorce, |
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birth or adoption of
a child, |
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death of a dependent, |
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a dependent child reaches
age 25, or marries, |
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a spouse’s loss
of employment, |
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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, |
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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.
See the "Required
Documentation” section.
How to make changes
If you want to make
changes to your current coverage, use the medical
or dental change form that is in your packet.
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