INSURANCE

 

How do I log in to ERS OnLine / What is my ERS password?

Contact ERS at 1-877-275-4377 or follow the steps on their website at http://www.ers.state.tx.us. 

 

I am not eligible for the employee health insurance plan.  What can I do to get insurance?

To search for coverage online, you may try one of the following free services, which are not endorsed by TWU but simply provided for your convenience.

Texas Health Insurance Risk Pool: http://www.txhealthpool.com/

BlueCross BlueShield individual policy: http://bcbstx.com 

http://www.ehealthinsurance.com 

 

Are pre-existing conditions covered under the health plan?

Yes. The health plan does not deny coverage due to a pre-existing condition provided a person is enrolled when initially eligible for coverage. However, disability income coverage does have a pre-existing conditions limitation.

 

When does insurance coverage start for a new employee?

Health insurance coverage for a new employee starts the first of the month following the employee’s first 90 days.  The new employee has only 30 days from the date of hire to make insurance elections such as adding dental or adding dependent coverage. After the initial eligibility window, approval for coverage is not always guaranteed.

 

When does insurance coverage start for other enrollees?

The start date depends on the situation, but in most cases one of the following applies:

A dependent added during an employee’s first 30 days can be covered the first of the following month for optional coverages and the first of the month after the employee’s first 90 days for health coverage.

If a newly acquired dependent is added within 30 days of initial eligibility, their coverage begins the first of the following month.

A newborn or newly adopted child have can have coverage from the date of birth or placement for adoption, provided the employee adds the new dependent within 30 days of birth or placement.

Most eligible summer enrollment changes are effective the following September 1st.

Most changes made following a recent Qualifying Life Event are effective the first of the month after the event.

 

How long does it take to receive an insurance ID card?

Normally, the ID arrives at your home address within two weeks of the effective date of coverage.

 

Do I have to select and designate a Primary Care Physician (PCP)?

You are required to do so to receive network benefits. You are strongly encouraged to make your PCP designation right away in order to save yourself and your family money. You can change your PCP at any time.

 

What happens if I see my PCP when I am covered but before I have received my ID card?

It is possible that your PCP will see you and collect only your co-payment. However, because they are not required to charge you less than full charge without proof of your coverage, you may have to pay for the visit in full and file a claim for reimbursement. For other options, contact your insurance company.

 

What happens if I obtain a prescription drug when I am covered but before I have my ID card?

In most cases, you will have to pay full price for the prescription and file a claim for reimbursement with your prescription drug administrator once you receive your ID.

 

When do I have to get a referral from my PCP?

When you wish to see a specialist and receive network benefits. A few exceptions apply:

For mental or behavioral health specialists, your insurance plan has a special phone number and department to start the process for seeing a network behavioral health provider.

You may go directly to a network eye specialist for an annual eye exam.

Females may go directly to a network OB/GYN for any female-related medical issue.

 

Can I change my PCP?

Yes, whenever you like.  Call your insurance company directly to make a change of primary doctor.

 

Are glasses or contacts covered?

Vision coverage under the health plan is limited to an annual eye exam at the same co-payment for a specialist office visit.  Vision discount benefits for percentage discounts on glasses, contacts, and LASIK are also available through a discount provider.

 

Am I required to enroll in health insurance?

No. You can elect in writing on or before your first day of hire to decline/waive health insurance coverage. Otherwise, health coverage is automatic from the date of eligibility (the first of the month after a 90-day waiting period) in an insurance-eligible position. Effective September 2003, you can enroll in dental or other optional coverages even if you decline/waive health coverage.  A new employee has only 30 days from the date of hire to make insurance elections on optional coverages such as dental or to add dependents to such coverages.  A new employee may elect or waive health coverage for employee only and/or dependents during the first 90 days of eligible employment.

 

When can I make changes to my insurance?

Outside of a new employee’s initial enrollment period, changes can only be made either within 30 days of a qualifying life event or during summer enrollment. However, past the initial new hire enrollment window, evidence of insurability or EOI (proof of good health) is required for most coverage, and acceptance for coverage is not guaranteed. Dental, AD&D, and TexFlex enrollment are examples of true summer enrollment opportunities without the EOI approval requirement—all other coverages require EOI approval, which is not guaranteed.

 

Who is listed as my beneficiary for the free basic and/or optional term life insurance through ERS?

ERS mails an annual statement of benefits to your home mailing address on file with them once a year.  Your beneficiary information is confirmed on this annual statement. To check on or change your ERS beneficiary designation online, go to www.ers.state.tx.us, ERS OnLine.

 

What happens to my insurance if I go on a leave of absence without pay?

Options depend upon the type of leave and the duration. If an employee does not physically work at least one day in a particular month, the employee is responsible for paying the state contribution to insurance plus his own contribution, if any, unless approved Family Medical Leave (FMLA) applies to any part of the month. An employee on an approved leave of absence without pay must mail premium payments directly to ERS.

 

When does my insurance end?

Insurance ends on the last day of the last month in which an employee is physically at work, provided the required premium for the month is paid.

 

How do I qualify for retiree health insurance?

Current Texas state statute allows for enrollment in lifetime state-paid health and prescription drug coverage for employees who meet all the criteria for the ERS Retiree Insurance Program as defined in State law and ERS rules. Because State law is always subject to change, an employee is advised to check with ERS and the TWU Office of Human Resources for updates.

 

RETIREMENT

 

Why do I have to participate in either the Teacher Retirement System (TRS) or Optional Retirement Program (ORP)?

Texas state law requires all benefits-eligible employees of Texas public higher education and independent school districts to participate in the Teacher Retirement System or TRS by default.  Full-time faculty and certain other employees of higher education institutions can elect the Optional Retirement Program or ORP in lieu of TRS.

 

How do I find out if I am in Teacher Retirement System (TRS) or the Optional Retirement Program (ORP)?

Your paycheck stub will indicate either TRS or the abbreviation of a name of an ORP company with a deduction equal to either 6.4% (TRS) or 6.65% (ORP) of your gross salary. TRS members had to complete a TRS-5 form at hire and receive an annual statement of account from TRS.  ORP participants had to officially select an ORP vendor along with completing other forms at the time of enrollment and should receive ORP company statements from their ORP company on a quarterly basis.

 

How much is the employee contribution to the Teacher Retirement System (TRS)? Is there an employer contribution?

6.4% of your gross salary. Yes, however, the employer contribution is a required near-matching amount that helps fund the TRS trust fund and not the participant's individual account specifically.

 

How much is the employee contribution to the Optional Retirement Program (ORP)?  Is there an employer contribution?

6.65% of your gross salary. Yes, the employer contributes 6.0%; however, the employer contributions are not the ORP participant's vested right unless/until the employee contributes to ORP for at least a year and a day (13 months).

 

Can I choose any company to invest with for the Optional Retirement Program (ORP)?  You may choose any company from the list of TWU authorized ORP vendors.

 

Can I contribute more to my retirement than the Teacher Retirement System/Optional Retirement Program (TRS/ORP) allows?

Yes, you can contribute more towards your retirement than the TRS or ORP percentage allows on a tax-deferred basis through a voluntary Tax Sheltered Annuity or Tax Deferred Account (TSA/TDA).

 

What is a Tax Sheltered Annuity / Tax Deferred Account (TSA/TDA)?

A TSA/TDA is a supplemental voluntary retirement savings account as allowed by the provisions of the Internal Revenue Service Code (IRC) Section 403(b). A TDA allows an employee to set aside money tax-free in addition to the Teacher Retirement System (TRS) or Optional Retirement Program (ORP) set percentage amount. The TDA participant determines a monthly dollar amount to defer from their gross salary, within IRS limits, and the company from TWU's authorized list to whom TWU sends the money for your account.

 

Can I choose any company to invest with through a Tax Deferred Account (TDA)?

You may choose any company from the list of TWU authorized TDA vendors.

 

What type of plan is Teacher Retirement System (TRS)?

TRS is an IRC Section 401(a) qualified retirement pension defined benefit plan.

 

What type of plan is the Texas Optional Retirement Program (ORP)?

ORP is an IRC Section 403(b) qualified retirement annuity or mutual fund investment defined contribution plan.

 

Who is eligible to choose the Optional Retirement Program (ORP) in lieu of the Teacher Retirement System (TRS)?

Full-time faculty, librarians, and certain administrators who have never been eligible for ORP before in Texas are eligible for ORP.

 

When am I “vested”?

Teacher Retirement System (TRS) members: Five years.  Vesting in TRS means entitlement to a lifetime retirement annuity income as a TRS retiree at a minimum age of 55 (or younger if years of service plus age equals 80 or more). 

Optional Retirement Program (ORP) members: One year plus one day (13 months of contributions).  Vesting in ORP means entitlement to the employer ORP contribution of 6.0% (including contributions made on your behalf prior to vesting).

 

Can I get into Teacher Retirement System (TRS) if I am in or have been in the Optional Retirement Program (ORP)?

No, unless prior to vesting in ORP, you change to a position that is ONLY eligible for TRS.

 

Can I get into the Optional Retirement Program (ORP) if I am in or have been in Teacher Retirement System (TRS)?

No, unless you become eligible for ORP for the first time in your career in Texas.

 

Who is listed as my beneficiary for the death/survivor benefit options through my Teacher Retirement System (TRS) or Optional Retirement Program (ORP) account?

TRS mails an annual statement of account to your home mailing address on file with them every October. Your beneficiary information is shown on this annual statement. ORP participants must contact their ORP company for instructions on how to confirm beneficiary information. To change your beneficiary designation with TRS complete  TRS-11 form and mail it to TRS.  To change your beneficiary designation with ORP, contact your ORP company.

 

How do I qualify for retiree health insurance?

Current Texas state statute allows for enrollment in lifetime state-paid health and prescription drug coverage for employees who meet all the criteria for the ERS Retiree Insurance Program as defined in State law and ERS rules. Because State law is always subject to change, an employee is advised to check with ERS and the TWU Office of Human Resources for the latest updates.

 

LEAVE

 

Where can I get more information on the Family and Medical Leave Act (FMLA)?

See the TWU policy at http://www.twu.edu/humanresources.   

 

When can I use my accrued vacation time?

Staff members who accrue vacation time may use earned vacation leave after completing six months of State employment.

 

Where can I get more information about different types of leave?

See the TWU policies at http://www.twu.edu/humanresources/OPGuidelinesIndex.htm and also employee handbook at http://www.twu.edu/staffhandbook/. 

 

What are my leave balances?

Check your payslip through the TWU Pioneer Portal.  Contact HR Payroll if you need assistance.

 

OTHER QUESTIONS?