§ 82-646. Requirements for retirement medical and dental coverage

(a) [Failure to give proper notice of retirement; deduction of insurance premiums.] An employee who fails to give two weeks' written notice of his/her retirement, unless beyond their control, whose insurance premiums or accrual amounts are paid on their behalf shall have the full insurance premium (county's plus employee's cost) deducted from his/her last pay check.

(b) Eligibility.

(1) Retirees are eligible for medical and dental coverage if they are enrolled in medical and dental coverage through the county and do not have a break in coverage, meaning that:

a. The retiree is enrolled in a county medical plan as an active, regular employee or has COBRA coverage through a county medical plan on the day prior to their retirement date; and

b. The retiree enrolls in county retiree medical coverage within 31 days of their retirement date; and

c. The retiree is continuously covered by a county group retiree medical plan and does not have a break in coverage for any reason, including nonpayment of premiums.

(2) If the retiree drops county group retiree medical or dental plan coverage for any reason other than returning to the county as a fulltime, regular employee with active benefits, the retiree will not be allowed to re-enter a medical plan or dental plan as a retiree in the future, including during annual enrollment. For example, if the retiree drops medical coverage but continues dental coverage, the retiree will not be allowed to elect medical coverage in the future. The employee will be allowed to return to a county group retiree-only health benefits plan when he/she leaves fulltime employment, provided the employee now retiree has no break in benefit coverage.

If an eligible surviving spouse and/or children currently enrolled in a county group retiree-only health benefit plans drops county group retiree medical or dental plan coverage for any reason other than becoming a fulltime county employee with active benefits, the surviving spouse and/or children will not be allowed to re-enter a medical plan or dental plan as a eligible surviving spouse and/or children in the future, including during annual enrollment. The employee/eligible spouse and/or children will be allowed to return to a county group retiree-only health benefits plan when he/she leaves fulltime employment, provided the employee/surviving spouse and/or children have no break in benefit coverage.

(3) A retiree who has not vested through service with Dallas County (currently ten years) is not eligible to receive a county subsidy for their medical benefits.

(4) If an employee is not vested through ten years of direct service with Dallas County and is eligible for group health benefits coverage through another employer, the employee is not eligible to participate in Dallas County's group health benefits plan.

(5) Retirees over 65 years of age are only eligible to enroll in county group retiree-only health benefit plans for retirees and surviving spouse/dependents over the age of 65. Eligible retires who are enrolled in a county group retiree-only health benefit plan, their eligible non-Medicare dependents can only enroll in the retiree-only eligible plan for non-Medicare dependents.

(c) Eligible dependents.

(1) If the retiree is eligible for retiree medical or dental coverage, their dependents may also be eligible for medical or dental coverage through the county plans, if they meet all of the following requirements:

a. The dependent meets the requirements of either a lawful spouse or eligible child as defined in the underlying plan's summary plan description; and

b. For medical coverage: The dependent is enrolled in medical coverage through the county and does not have a break in coverage, meaning that:

1. The dependent is enrolled in a county medical plan on the retiree's last day as an active, regular employee or has COBRA coverage through a county medical plan on the day prior to their retirement date; and

2. The retiree enrolls the dependent(s) when the retiree enrolls for county retiree medical coverage within 31 days of their retirement date; and

3. The dependent is continuously covered by a county group medical plan and does not have a break in coverage for any reason, including nonpayment of premiums. See the "premium payments" section [subsection (g)] herein] for more information.

c. For dental coverage: The dependent is enrolled in dental coverage through the county and does not have a break in coverage, meaning that:

1. The dependent is enrolled in a county dental plan on the retiree's last day as an active, regular employee or has COBRA coverage through a county dental plan on the day prior to the retirement date; and

2. The retiree enrolls the dependent(s) when the retiree enrolls for county retiree dental coverage within 31 days of the retirement date; and

3. The dependent is continuously covered by a county dental plan and does not have a break in coverage for any reason, including nonpayment of premiums. See the "premium payments" section below for more information.

(2) In addition to the eligible dependents described above. The retiree may be able to add new dependents to the medical or dental plans if they meet the requirements in the "change in status events" section [subsection (d)] below.

(d) Change in status events.

(1) Once the retiree enrolls for retiree medical or dental coverage, the retiree may not change benefit choices, including adding or dropping dependent coverage, until the next annual enrollment period unless the retiree or dependent experiences a qualified change in status event. Refer to the plan document or summary plan description for the underlying medical or dental plan for a list of the qualified change in status events and a description of the requirements.

(2) If the retiree does experience a qualified change in status event, the retiree may make a new election for coverage as long as the election is consistent with the qualified change in status event. To be considered consistent, the qualified change in status event must result in either becoming eligible for or losing eligibility for coverage under the plan. The change must correspond with the specific eligibility gain or loss.

(3) In order for a new dependent to be covered, the retiree must enroll the new dependent within 31 days after the date of the qualified change in status event. Benefits will begin on the first day of the month following notification of status change. The retiree must satisfy all other eligibility and enrollment requirements of the county retiree medical or county dental plans in which the retiree is enrolled. Refer to the underlying plan document for specific enrollment deadlines and instructions. If the retiree misses the plan's enrollment deadlines, the retiree cannot make any changes, regardless of the type of change in status event that occurred.

(4) Note that the act of retiring does not constitute a qualified change in status event for the retiree. Thus, the retiree may not add new dependents to the plan at the time of the retirement. However, if the spouse retires, the act of retiring could be a qualified change in status event, allowing the spouse to enroll in the county plans, if the spouse loses his or her coverage as a direct result of retirement.

(5) The opportunity to add new dependents to the plan due to qualified change in status events applies only to the retiree and their eligible dependents. Once the retiree is deceased, no new dependents may be added to the plan due to a change in status event, even if that event appears to otherwise satisfy the plan's requirements. See the section on "dependents of deceased retirees" below [subsection (e)] for more information.

(e) Dependents of deceased retirees.

(1) The surviving spouse and eligible child(ren) of a deceased retiree are eligible to continue coverage, if they meet all of the following requirements:

a. The surviving spouse and/or eligible child(ren) is/are enrolled in coverage through the county at the time of the retiree's death;

b. The surviving spouse and/or eligible child(ren) meet(s) all other eligibility requirements of the plan; and

c. The surviving spouse and/or eligible child(ren) do(es) not have a break in coverage, including nonpayment of premium.

(2) If a surviving spouse or dependent drops county group retiree medical plan or county dental plan coverage for any reason other than fulltime, regular employment with the county, that dependent will not be allowed to re-enter the applicable plan in the future.

(3) After the retiree's death, no new dependents are eligible for coverage at any time. For example, if a surviving spouse remarries, the new spouse is not eligible for retiree medical or dental coverage.

(4) A surviving spouse or dependent over 65 years of age are only eligible to enroll in county group retiree-only health benefit plans for retirees and surviving spouse/dependents over the age of 65.

(f) Annual enrollment.

(1) The county will hold an annual enrollment period each plan year. During the annual enrollment period, the retiree may change choices in retiree medical and dental coverage, cancel coverage for dependents, or make no changes. Enrollment changes made during the annual enrollment period will be effective on January 1 following the annual enrollment period.

(2) The retiree may not add dependents to retiree medical or dental plan coverage during annual enrollment. Dependents are eligible only if they were covered by the plan at the time of their retirement, or if they experience a qualified change in status event as described in the "change in status events" section [subsection (d)] above.

(g) Premium payments.

(1) Once the retiree elects retiree medical or dental plan coverage, the retiree must continue to pay the monthly premiums for themselves and any dependents in a timely manner, following the retiree billing rules communicated by the plan administrator, in order to continue eligibility. If the retiree discontinues premium payments for any reason other than returning to fulltime, regular employment with the county, eligibility will end for the retiree and any covered dependents, and the retiree cannot elect coverage again at a later date.

(2) As health care costs increase, required premium payments for retiree medical and dental coverage may also increase. The county reserves the right to change required premium payments or modify plan benefits offered at any time.

(3) Retirees with less than ten years of service with Dallas County are not eligible for county benefits subsidies.

(h) If the retiree medical plans end or are modified. The county reserves the right to change, suspend, or end the retiree medical and dental plans at any time, in whole or in part. In the event that the retiree medical and dental plans are discontinued or terminated, benefits would be paid only for services received up to the date of plan termination. The retiree will be notified if the retiree medical and dental plans are amended or terminated.

(Admin. Policy Manual, § B(6.05); Ord. No. 2005-248, 2-1-2005; Ord. No. 2005-2149, 11-1-2005; Ord. No. 2006-160, 1-24-2006; Ord. No. 2008-0041, 1-8-2008; Ord. No. 2008-1754, 9-16-2008)

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Preexisting conditions, V.A.T.S. Insurance Code, art. 26.90.