Rules of the Game for Employees

These are important things you need to consider before making your enrollment decisions.

You are eligible for coverage under the benefits plans if you are:

	A full-time employee or a part-time employee regularly scheduled to work at least 30 hours a week;
	A retiree who was covered by a city medical plan on the date of retirement from the city;
	A survivor of a covered city employee or retiree, up to age limits and application of other plan rules; or,
	A deferred retired employee who will become eligible to receive a pension within 5 years after termination and continously pays the monthly 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 are your:

	Legal spouse, or a former spouse entitled to support from you under a court order when a request for enrollment has been made within 31 days after issuance of the court order,
	Unmarried natural or adopted children up to age 25, if they qualify as dependents for federal income tax purposes,
	Children up to age 25, over whom you have legal guardianship or legal foster care if they qualify as dependents for federal income tax purposes,
	Grandchildren under 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 covered before 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 the employee’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.

	Spouse — copy of a certified marriage license
	Common-law spouse — copy of a Declaration and Registration of an Informal Marriage Certificate
	Children up to age 25, over whom you have legal guardianship or legal foster care — copy of the legal documents that gave custody, guardianship or foster care
	Grandchild(ren) under age 25, who are your covered dependents for federal income tax purposes — copy of the Financial Dependency of Children 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
	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.

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Qualified Family Status Change

If you are an active employee and pay for coverage with pretax dollars, you may change your coverage during the year only if you have a qualified family status change.
Qualified family status changes include:

	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. See the "Required Documentation” section.

		Important note: If you are enrolled in the HMO plan, and you do not add a new dependent within 31 days of the event, you may add the dependent later, but there will be a 90-day waiting period. Coverage will be effective on the first or the 16th of the month following the waiting period. You may add a dependent to the PPO within 31 days of the event or during annual open enrollment. You can get a status change form from the City of Houston Benefits division. Call (713) 837-9400.

How to 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 to the:

Benefits Division
P.O. Box 248
Houston, TX 77001

If you don't enroll now - Active Employees

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 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 2008, unless you have a qualifiying family staus change through loss of other group coverage.

Life Insurance - Active Employees

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.