How to enroll
Enroll by calling and requesting a form. Or download the form, print, complete and return by April 13.
- Retiree Medical-Dental-Vision Election Form (Non-Medicare)
- Retiree Medical-Dental-Vision Election Form (Medicare)
Medicare Plan Enrollment
Open enrollment for medicare started in January of this year, but you are allowed to apply all year long. If your are happy with your plan, don't do anything. If you need to choose a plan here are the options for this year's enrollment:
Eligibility for retireesYou are eligible for retiree coverage if:
- You’re a retiree now covered by a city medical plan.
- You’re a survivor of a deceased city employee or retiree, up to dependent children 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.
- You’re a retiree who opted out of your city health-care plan after Jan. 1, 2010.
- Legal spouse
- Natural or adopted children to age 26
- Children to age 26, over whom you have legal guardianship or legal foster care
- Grandchildren and stepchildren to age 26 if they qualify as your dependents for federal income-tax purposes and live with you
- Disabled dependents over age 26 who are incapable of self-sustainingemployment 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 26
- Dependents (children and grandchildren) for whom a court order has been received requiring the retiree to provide healthcare coverage, provided HR benefits receives the court order within 31 days after issuance. After a divorce, an ex-spouse is not eligible, except by court order issued at the time of a divorce. A divorce decree may not be amended to require a retiree to cover an ex-spouse under a city medical plan.
Where to send forms
Please complete forms and submit by one of the following:
CITY OF HOUSTON
P.O. Box 248, Houston, TX 77001-0248
Email to: email@example.com
Fax: (832) 395 - 9409
ATTEN: Retiree Unit
Please include cover letter with NAME and EMPLOYEE ID