Insurance Eligibility

Employees are eligible for coverage. Retirees are eligible for GBP coverage if they have at least 10 years of eligible service credit, and are age 65 or older, or meet the Rule of 80. 

Your spouse and children must meet the eligibility requirements to be added to coverage for:

• health insurance,
• dental plans,
• Accidental Death  & Dismemberment Insurance, and 
• Dependent Term Life Insurance

You cannot cover: 

• ex-spouses,
• children who have reached or passed their 26th birthday, unless they are disabled, or 
• grandchildren who are not claimed on your federal income tax return.

The Texas Legislature decides who is eligible for the Texas Employees Group Benefits Program (GBP). ERS follows the eligibility laws established by the legislature.
 

Proof of good health, also known as evidence of insurability (EOI), is an application process in which you provide information on the condition of your health or your dependent's health to get certain insurance coverage.

EOI is required for any life and/or disability insurance elections made after your first 31 days of employment. 

• Short-term and long-term disability insurance is offered through the Texas Income Protection Plan (TIPP), administered by ReedGroup. 
• Optional and Dependent Term Life insurance is offered through Minnesota Life Insurance Company. 
• EOI for both life and disability insurance is managed by Minnesota Life, an affiliate of Securian Financial Group, Inc. (Securian).

An active employee needs EOI to add coverage or make coverage changes during eligible periods:

• when enrolling in Optional Term Life Insurance at Election 3 or 4,
• when enrolling in or increasing Optional Term Life coverage due to a qualifying life event (QLE) after the first 31 days of employment,
• when enrolling in TIPP due to a QLE after the first 31 days of employment, or
• during Annual Enrollment, when enrolling in Optional Term Life Insurance or TIPP, or increasing Optional Term Life Insurance.

Please note that EOI is not required within the first 31 days of hire/rehire/transfer to elect Optional Term Life at Election 1 or 2, or to enroll in TIPP. The 31-day period includes the first day of employment.  

A retiree who waived Optional Term Life Insurance as an active employee needs EOI when applying for Fixed Optional Life ($10,000) coverage at any of the three available times:

• within 31 days of retirement,
• within 31 days of a QLE, or
• during Annual Enrollment.

Please note that retirees can apply for Fixed Optional Life coverage only during these three times and must provide EOI in all cases. (Retirees are not eligible for Optional Term Life Insurance if they did not participate before retirement and, if they did participate, can continue only at Election 1 or 2.)  

A dependent needs EOI when applying for Dependent Term Life Insurance at the following times:

• when enrolling as a dependent who is not newly acquired/eligible within 31 days of a QLE,
• when enrolling for the first time upon a member's retirement (within 31 days of the retirement date), or
• during Annual Enrollment.

Please note that EOI is not required within the first 31 days of the employee's hire/rehire/ transfer or within the first 31 days of a dependent's becoming newly acquired or eligible. A retiree's dependent who has Dependent Term Life Insurance on the day of retirement from state employment may keep it in retirement as long as he or she remains an eligible dependent.  

Follow these steps:

Step One:

You can enroll in or make coverage changes to Optional or Dependent Term Life Insurance or enroll in TIPP online or by working with your benefits coordinator.

To enroll or make coverage changes online:

1. Log in to your ERS account from the sign in link at the top of the page.
2. At the Member Home Page, click on the appropriate action under My Insurance Information. (If you need to add a new dependent to your ERS account, you can do it here.)

To enroll or make coverage changes working with your benefits coordinator:

1. Get a Benefits Election Form from your benefits coordinator.
2. Fill it out completely, indicating what coverage you are applying for or changing, and sign it. Be sure to include your email address if you want to receive communications from Securian by email (which will include information and a link for submitting EOI online).
3. Return it to your benefits coordinator. Your benefits coordinator will enter the information and indicate if you prefer to receive your EOI application by mail or email.

Securian will send you a letter or email (if they have your email address) with instructions for submitting EOI. You should receive the email within five business days; the letter will take longer.

Whether you receive a letter or email, you will be encouraged to submit your EOI application online. This process is faster and easier than mailing or faxing your completed EOI application. If you choose to mail or fax your EOI application, however, the letter also will include a paper application, and the email will include a number to call Securian to request a paper application.

Step Two:

Whether you choose to apply for EOI online or via mail/fax, the application you access online or receive in the mail should be pre-populated with your information. Answer EOI questions truthfully and thoroughly. The Employees Retirement System of Texas (ERS) vigorously enforces laws against participants who try to defraud the Texas Employees Group Benefits Program (GBP). Providing false answers on an EOI application for any GBP coverage is a violation of state insurance laws. You could have your coverage cancelled and be expelled from the GBP.

Step Three:

Review the EOI application to make sure you've left nothing blank. Missing information will slow down the processing of your application.

Step Four:

Submit your online EOI application as instructed on the form or website. Or, if you choose to submit a hard copy, mail it to the postal address or fax it to the number provided by Securian when they sent the paper application. If Minnesota Life does not receive the EOI application within 30 days, your coverage will remain at your current level and will not change. You can reapply for coverage during the next enrollment opportunity.

Step Five:

If you submit your EOI online, Securian's real-time underwriting response will let you know immediately if you have been approved or if further underwriting is required and what to expect next. If you send your application via mail or fax, you will hear from Securian within two weeks. Securian will notify you and ERS of the approval or denial of your Optional/Dependent Term Life Insurance and/or short- or long-term disability insurance. (Securian will not share your medical history information, which is confidential, with ERS.) ERS will enter your information into the system. If you've been approved, your coverage will start the first of the month after notification.

If you have any questions about the EOI process, please contact Securian toll-free at (877) 494-1716. Representatives are available 8 a.m. - 5 p.m. Central time, Monday - Friday.  

You do not need to file a claim if you:

• use network providers and facilities, and
• receive services in the coverage area.

Claims for services received by a out-of-network provider may need to be filed by you depending on the provider's billing practices. 

Note: An EOB is a not a bill.

You can appeal a decision with a Texas Employees Group Benefits Program (GBP) insurance carrier. Additional guidelines are provided in writing to members during the appeals process. Steps to the appeals process:

1. Ask the plan administrator to reconsider the original claim or application.
2. Ask ERS to review the plan administrator's denial.
3. ERS will notify you of the decision.

In the event of your death, your beneficiary, other person designated by you, or a person lawfully authorized to represent your estate, must contact ERS to obtain the instructions and forms required to file a claim for benefits. The forms are sent to the designated beneficiary.

• Employee beneficiary receives a $5,000 benefit
• Retiree beneficiary receives a $2,500 benefit 

It's important to select the in­dividuals who will receive your retirement account and life insurance benefits in the event of your death. This person is called your beneficiary. You can have more than one beneficiary. 

View information about how to update your beneficiary. 

If you get care from a provider who is not in the HealthSelect network, that provider may bill you for the portion of the charges that HealthSelect doesn’t cover, after you’ve paid any required copay, coinsurance and deductible. This is known as “balance billing.” It’s one way you may pay more if you see a provider who is not in the HealthSelect network.

You may be eligible to challenge a balance bill by requesting mandatory mediation between the provider and HealthSelect from the Texas Department of Insurance (TDI). To be eligible for mandatory mediation from TDI, the balance bill must be either:

• from an out-of-network hospital-based physician at an in-network hospital in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for medical services or supplies provided after September 1, 2015, 
• from an out-of-network hospital-based health care professional (in addition to physicians) at an in-network hospital in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for health care services, medical services or supplies provided after December 31, 2017, or
• from an out-of-network emergency care provider or facility in the amount of $500 or more after applicable out-of-pocket costs (copays, coinsurance and deductibles) for health care services, medical services or supplies provided after December 31, 2017.

To learn more or request mediation from the Texas Department of Insurance, call the TDI Consumer Help Line toll-free at (800) 252-3439 or visit http://www.tdi.texas.gov/consumer/cpmmediation.html.

Learn about how you can avoid balance billing from out-of-network providers at in-network facilities.