Rules of the Game for Retirees

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

		Who is Eligible
		Eligible Dependents
		Required Documentation
		How to Make Changes
		City of Houston Health Fair

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.
	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 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.

	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) 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.

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