Section 9. Group Health and Related Benefits
9.01 HEALTH BENEFITS
The following policies apply to the Group Health and Related Benefits the County provides to employees, retirees, and eligible dependents. The County can amend or discontinue benefits at any time.
9.0111 Department Heads and Regular Position Employees are eligible for these benefits.
9.0112 Eligibility for elected and appointed officials begins on the first day of the pay period following 45 days in office, unless the elected or appointed official was insured by the County as an active employee on the day before the first day of the official’s term or first day in office.
9.0113 Employees hired from other entities that are covered under Harris County’s group health plans and were enrolled in the County’s group health plans while working for those entities are not subject to a waiting period.
9.0114 Enrollment in the County’s Benefits Plan is a condition of employment and is mandatory for all employees. Only newly hired employees who are eligible for Medicare or are currently enrolled in TRICARE as a retiree or active reservist in the United States military may waive their benefits upon initial enrollment. Please contact your Human Resources office to obtain a waiver of employee health and related benefits.
9.0115 If a newly hired employee is a covered dependent of a parent or spouse on the Plan, eligibility under that Plan as a dependent ends once their own benefits go into effect. Under no circumstances may an employee be covered on both Plans, as they must use their own. Benefits begin on the first day of the pay period following 45 days of continuous employment as a Regular Position Employee unless the insurance policy(ies) in effect at the time specify a different period.
Example: Lauren starts work on June 2nd. She reaches 45 days of continuous employment on July 16th. Therefore, she is eligible for Group Health and Related Benefits on the first day of the pay period following July 16th.
9.0121 Eligible dependents may include your spouse, children, grandchildren, or others who meet the eligibility requirements as listed in the Employee Benefits’ Guide. You may enroll eligible dependents for coverage under certain Group Health and Related Benefits plan(s). The effective date of dependent coverage is your effective eligibility date or the “Insurance Begin Date” set by the County Auditor.
9.0122 Covered retirees may be eligible to continue coverage for dependents who were covered at the time of Retirement. After that, retirees may not add dependents without a qualifying family status change. Upon a retiree’s death, coverage for all covered dependents will terminate.
Employees who retire in accordance with the provisions of the TCDRS (including disability Retirement) and who were covered as active employees under the Group Health and Related Benefits plan(s) in effect at the time of Retirement may be eligible to retain certain benefits coverage(s). Employees who receive Retirement benefits within 4 months of separation are eligible to retain certain Group Health and Related Benefits coverage(s) if they chose COBRA coverage for the period between their separation and retirement.
Continuation of certain Group Health and Related Benefits is available to covered employees and their dependents upon separation of employment and other qualifying events under the provisions of Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law 99-272 (COBRA), including applicable regulations, amendments, and conversion rights of the policy(ies) and plan(s) in force. Eligible employees, retirees, and dependents should refer to provider materials and relevant publications and notices by the County for further information.
We may require employees or retirees to pay a portion of premiums for coverage for themselves or their dependents. Employees on Unpaid Leave and all retirees must make premium payments to the County. Direct questions about billing to Human Resources & Risk Management.
Benefits are provided subject to the policy(ies) and plan(s) in force and applicable federal, state, and local laws regulating insurance and employee benefit plans. We have the right to offer alternative coverage(s) to retirees or their dependents. Obtain additional information about the current benefit plan(s) from Human Resources & Risk Management.
9.02 VERIFICATION OF ELIGIBILITY, ENROLLMENT PERIODS, AND CHANGES TO
9.021 Verification of Eligibility
Employees and Retirees must submit the documentation outlined below to add eligible dependents to their Group Health and Related Benefits coverage(s).
• Spouse – a filed copy of a Formal Marriage License or Certificate of Informal Marriage.
• Children – a Birth Certificate or court documents showing legal guardianship or legal custody. Verification of Birth Facts accepted only up to the age of five (5).
• Grandchildren – Certification of Financial Dependency form as required by the Group Health and Related Benefits provider and Birth Certificates of the child and grandchild to prove the required relationships. Grandchildren must be related to the employee by either birth or adoption (cannot be a step-grandchild).
9.022 Enrollment Periods
9.0221 The County provides an initial enrollment period for newly eligible employees to select from among certain coverage options for themselves and to elect or decline coverage for eligible dependents.
9.0222 We also provide open enrollment periods as required by law. If an annual open enrollment period is provided, you may add or drop dependents and make changes to plan selections then. Retirees may only change benefit plan selections during open enrollment periods.
9.023 Changes to Coverage Outside Open Enrollment Periods
Other than during an open enrollment period, employees may only add or drop dependents or make changes to their Flexible Spending Account contributions if a qualifying change in family status occurs as defined in the policy(ies) and under the law. Retirees may drop dependents at any time, but may only add dependents within the same calendar year of a qualifying change in family status, unless the Life Event occurs in December, at which time you have thirty (30) days to add dependents.
9.0231 Adding Dependents
To add dependents, you must complete a Life Event online in STARS, including uploading the appropriate documentation, within the same calendar year of a qualifying change in family status.
Due to security concerns, STARS can only be accessed from within the Harris County network. The coverage is effective the start of the following pay period in which the Life Event is approved.
9.0232 Adding Newborns
The effective date of dependent coverage for a newborn is the date of birth if you complete a Life Event in STARS, including uploading the appropriate documentation within 31 days of the birth. Otherwise, the coverage is effective the start of the following pay period in which the Life Event is approved.
9.0233 Terminating or Dropping Dependent Coverage
Following a qualifying change in family status, an employee must complete a Life Event in STARS, including uploading the appropriate documentation during the same calendar year in which the event took place, unless the event occurs in December, at which time you have thirty (30) days to drop dependents. The coverage is terminated at the end of the pay period in which the Life Event is approved.
9.024 Termination Of Coverage
9.0241 4 – Week Rule
Except as required by law, employees compensated for less than 32 hours per week for 4 consecutive weeks lose eligibility for Group Health and Related Benefits but are eligible to elect COBRA benefits. (See § 9.014 regarding COBRA). Employees who lose coverage under this section and do not choose COBRA coverage are subject to a new waiting period if they later become eligible for Group Health and Related Benefits.
9.0242 Separation of Employment
Employees who separate employment with the County lose coverage on the last date of the pay period following their separation date.
9.0243 Failure to Pay
Employees and retirees who fail to pay premium contributions lose their Group Health and Related Benefits. Unless the employee is Changes in dependent coverage are not allowed if the qualifying change in family status occurred prior to January 1 of the current calendar year except in cases of a newborn reported within 31 days of birth, dependent ineligibility, or death. Unless the employee is returning from FMLA leave, benefits are not reinstated until past due premiums are paid in full.
9.0244 Fraud or Misrepresentation
Anyone who commits fraud or makes misrepresentations about the use of Group Health and Related Benefits loses coverage as outlined in the respective benefit plan documents. Further, the County will report all suspected cases of fraud to the District Attorney.
Obtain additional information about Group Health and Related Benefits from Human Resources & Risk Management.
9.03 EMPLOYEE ASSISTANCE PROGRAM
9.031 We have an employee assistance program (EAP) available to you or any member of your household. The EAP offers confidential consultation and counseling services to employees and members of your household who are experiencing problems at work or at home. Some of these problems may include, but are not limited to: family, marital, alcohol/drug abuse, emotional distress, job-related, legal, or financial difficulties.
There are three types of referrals:
• Self-referral: You can contact the EAP on your own by calling the number listed in your Employee Benefits’ Guide.
• Informal referral: Your supervisor, a co-worker, family member, or community professional may recommend or suggest that you call the EAP.
• Formal referral: If the issue is affecting your work, your department may require you to call the EAP and comply with any recommendations the EAP makes.
Refer to your Employee Benefits’ Guide for more information.
The County is a member of the Texas County and District Retirement System (TCDRS). Obtain additional information regarding TCDRS from Human Resources & Risk Management.
9.041 Commissioners Court determines the amount of employee and employer contributions to TCDRS. TCDRS calculates and pays Retirement benefits.
9.042 All employees except those in Temporary Positions must make contributions to TCDRS.
9.043 Employees who want to retire must submit a completed retirement application packet to Human Resources & Risk Management, or online at http://www.TCDRS.org, in advance of the proposed effective date of retirement. The effective date of retirement is the last day of the month.
9.05 DEFERRED COMPENSATION/457 SAVINGS PLAN
The County offers a 457(b) plan, which is a savings plan for eligible employees. The plan is similar to a 401(k) plan. You may choose to defer a specific amount of your paycheck on a pre-tax or after-tax basis through payroll deduction. The taxes on eligible pre-tax contributions are deferred until withdrawal, as well as the taxes on any investment earnings from these contributions. The 457(b) plan is a great way to supplement your retirement. Refer to your Employee Benefits’ Guide for more information.
9.06 WORKERS’ COMPENSATION
The County provides Workers’ Compensation benefits for accidents, illnesses, or injuries employees sustain in the course and scope of employment in accordance with the existing Texas Workers’ Compensation laws.
9.061 You must report any on-the-job accident, illness, or injury to your immediate supervisor or designated department officer within 24 hours of the occurrence. The supervisor or designated officer must then forward the notice to Human Resources & Risk Management immediately. Failure to report an on-the-job accident, illness, or injury in a timely manner may result in the loss of or denial of Workers’ Compensation benefits.
9.062 Workers’ Compensation benefits are subject to any deductions required by law or by court order (e.g., child support payments). Employees are responsible for making arrangements for payment of any voluntary payroll deductions.
9.063 Employees, except for certain law enforcement officers, must use available Sick Leave, Vacation Leave, and Compensatory Time during the first 7 calendar days of lost time for a compensable injury. After 7 calendar Department Heads are prohibited from creating re-employment agreements with employees. You must not have any expectation, understanding, or agreement that you will be rehired by any Harris County department after retiring.
• The IRS requires the employment separation be bona fide; and
• Even when no prohibited agreement existed, TCDRS requires at least one full calendar month to pass before a retiree or former employee who has withdrawn their TCDRS account may be re-hired.
After 7 calendar days, the department must code the employee’s absences as Workers’ Compensation.
9.064 If an employee is eligible for FMLA leave and the Workers’ Compensation injury is a Serious Health Condition under the FMLA, the department simultaneously designates the Workers’ Compensation absences as FMLA leave.
9.065 Employees who return to work for their regularly scheduled hours must use available Paid Leave for time off for doctor’s appointments or any other followup treatment related to the compensable injury.
Obtain additional information regarding Workers’ Compensation benefits from
Human Resources & Risk Management.