Things to Consider for Retirees

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

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:

	Legal spouse,
	Unmarried natural or adopted children up to age 25, if they qualify as dependents for federal income tax purposes,
	Children under 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 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.
	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.

	Important note: When your dependents become ineligible they will be dropped from coverage. You must submit a status change form within 31 days. You will receive a refund of the premiums you paid for coverage only from the date of your notification. If they are not dropped on time, they are still ineligible for coverage. You will not get a full refund, and you may be responsible for any claims incorrectly paid on their behalf.

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:

	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 or PPO 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 of the month following the waiting period.

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.

	Important note: Your completed forms must be given to the benefits division by the last day of the enrollment period. The open enrollment period ends April 6, 2005. Any changes you make will be effective May 1, 2005.

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