Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 4 - EMPLOYEES RETIREMENT SYSTEM OF TEXAS › Chapter 81 - INSURANCE › Section 81.1 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
				  shall have the following meanings, unless the context clearly indicates
				  otherwise.
(1) Accelerated life
				benefit--A term life insurance benefit to be paid in advance of the death of an
				insured member or dependent, as requested by the insured member and approved by
				the carrier or administering firm, in accordance with the terms of the group
				term life insurance plan as permitted by §1551.254 of the Act. An
				accelerated life benefit payment may be requested only if the insured person is
				diagnosed with a terminal condition and only once during the lifetime of the
				insured person. For purposes of this definition, a terminal condition is an
				incurable health condition that the administering firm or carrier determines
				with reasonable medical certainty will result in the death of the insured
				within 12 months.
(2) Act--The
				Texas Employees Group Benefits Act, Insurance Code, Chapter 1551, as
				amended.
(3) Active duty--An
				employee's expenditure of time and energy in the service of his/her employer,
				including elected officials of the state of Texas who are eligible for coverage
				under the Act. An employee is on active duty on each day of a regular paid
				vacation or regular paid sick leave or on a non-working day, if the employee
				was on active duty on the last preceding workday.
(4) AD&D--Voluntary accidental death and
				dismemberment coverage.
(5) Age of
				employee--The age to be used for determining optional term life and AD&D
				insurance required contributions. For these purposes, the age of the employee
				is the employee's attained age on September 1.
(6) Annuitant--A retired person who is
				eligible under §1551.102 of the Act to participate in the GBP and meets
				all requirements for retirement from a state retirement program or the Optional
				Retirement Program.
(7) Basic
				plan--The plan of group insurance, including prescription drug coverage,
				determined by the Board of Trustees, currently HealthSelect or HealthSelect
				Medicare Advantage participant-only, as applicable, and basic term life
				insurance coverage, in which every eligible full-time employee and annuitant,
				is automatically enrolled after meeting any applicable waiting period or unless
				participation is expressly waived.
(8) Benefits Coordinator--A person employed
				by an employer to provide assistance to its employees and their dependents with
				all aspects of GBP participation. The benefits coordinator for all other GBP
				participants is ERS.
(9) Board of
				Trustees or Board--The Board of Trustees of the Employees Retirement System of
				Texas.
(10) CHIP--Children's Health
				Insurance Program.
(11)
				CMS--Centers for Medicare and Medicaid Services or its successor
				agency.
(12) COBRA--Consolidated
				Omnibus Budget Reconciliation Act of 1985, Public Law 99-272, and any
				subsequent amendments.
(13)
				Consumer Directed HealthSelectSM --The self-funded
				high deductible health benefit plan offered through the GBP and administered by
				the Employees Retirement System of Texas and qualified carriers or
				administering firms.
(14)
				Dependent--With respect to an eligible member, means the member's:
(A) spouse, as recognized by applicable law,
				which includes only a married spouse as evidenced by a properly issued and
				completed marriage license or an informally married spouse whose marriage is
				memorialized by a Declaration of Informal Marriage and filed of record with an
				appropriate governmental authority. Absent clear and compelling evidence of an
				informal marriage existing at the time of enrollment and deemed sufficient by
				ERS, it is a plan design requirement that the licensed marriage or Declaration
				of Informal Marriage must occur, or be filed, as applicable, prior to the
				effective date of the dependent spouse's enrollment in the GBP;
(B) child under 26 years of age;
(C) child age 26 and older whom the Board of
				Trustees or its designee determines is certified by an approved practitioner to
				be mentally or physically incapacitated from gainful employment, and earns less
				than the monthly wage standard for enrolling in CHIP in Texas for a family of
				one at the time of application or reevaluation. If the child earns more than
				this wage standard for a period of six months or longer in any calendar year,
				then the child must demonstrate to ERS his/her continued eligibility for
				dependent coverage by proving he/she is dependent on the member for care or
				support and either lives with the member or has care provided by the member on
				a regular basis; and
(D) child
				under age 26 who is the member's ward, as that term is defined by
				§1002.030, Texas Estates Code.
(E) In this section, "child" includes:
(i) a natural child, adopted child,
				stepchild, foster child; or a child in the possession of a participant who is
				designated as managing conservator of the child under an irrevocable or
				unrevoked affidavit of relinquishment under Texas Family Code, Chapter 161;
				or
(ii) a child who is related to
				the member by blood or marriage and was claimed as the member's dependent on
				his/her federal income tax return for the tax year preceding the plan year in
				which the child is first enrolled as the member's dependent in the GBP, and for
				each subsequent year in which the child is enrolled as the member's dependent.
				The federal income tax return must have been filed when first due or before any
				timely extensions expired.
(F) The requirement in subparagraph (E)(ii)
				of this paragraph that a child must be claimed as the member's dependent on
				his/her federal income tax return preceding the child's enrollment does not
				apply if:
(i) the child is born in the year
				in which the child is first enrolled; or
(ii) the member can demonstrate good cause
				for not claiming the child as a dependent in the preceding tax year.