Question: I’ve had a recent surgery and necessary medical visits and find it outrageous how little HealthSelect pays the doctors for their efforts, and how much of the bills we are left to pay in addition to the copay. Surely there must be a better deal somewhere.

Answer: Although we addressed this at length in the “Ask the Director” column of the April HR Bulletin (see http://www.humanresources.swt.edu/bulletin/april2004/page13.html ), it appears in this question that there could be some misunderstanding on what portion of the bill is actually paid by the employee. Employees receive an Explanation of Benefits (EOB) from HealthSelect after they have been to the doctor or other medical provider. The EOB shows the employee what was billed by the doctor, what was paid by HealthSelect and what the employee may owe in copays or coinsurance. There is also an area showing what is not covered. The portion that is not covered is not paid by anyone. This amount is negotiated with providers prior to being accepted on the HealthSelect provider list. You are protected from liability for these amounts. Providers cannot charge you for these amounts. If they do, you should have your provider contact HealthSelect directly to solve the problem.

There are several caps on out-of-pocket expenses. For example there is a $100 per day copayment for hospitalizations up to $500 per hospital stay. The cap is set at $1,500 per year so you would have to be hospitalized at least 3 times in a year for 5 full days each time to reach that cap. There is also a cap of $1,000 per person for coinsurance (your 20% portion) when using providers within the network. There are no caps on other copays such as doctor visits.

The Employees Retirement System of Texas (ERS) negotiates all rates for all group insurance plans for all employees of state agencies and institutions of higher education. Comparing our plan to private sector companies or other state’s plans, it is very competitive. In September our rates will be going up. When coverage, copays, and coinsurance changed twice last year, our premiums actually went down while copays and coinsurance went up. This year, the premium increase will be 5.13%. We expected to see about a 10% increase because that is the amount all Employee Benefit publications were warning employers to expect. So we feel fortunate that the increase will be this low.

Question: I need to file some complaints with my health insurance provider and my prescription drug provider. I would like your advice and direction. My doctor had told me to stop taking a medication I had just ordered through Medco Health. Medco Health would not allow me to cancel the order.

Answer: When filing complaints against a group insurance company your first line of defense is to contact the appropriate company, in this case Medco Health. Be very specific with your complaint, provide dates, times, customer service representatives you talked to, etc. The more information you provide the better chance of getting the problem resolved. If you do not get resolution from that company, you should contact the Employees Retirement System of Texas (ERS) to file the complaint. If you get no resolution from ERS, your last line of defense is to file a complaint with the Texas Department of Insurance.

To contact any group insurance company you can find their website links and phone numbers at http://www.ers.state.tx.us/Insurance/CustSvcNumbers.htm.

To contact ERS you can type in a complaint on the Customer Service Direct page on their website at https://www1.ers.state.tx.us/CSDirect/default.htm or you can call them at 877-275-4377.

To contact the Texas Department of Insurance you can type in a complaint on the consumer area of their website at http://www.tdi.state.tx.us/consumer/index.html or you can call them at 800- 578-4677.

Question: Has there ever been an audit of people covered as dependents on insurance? I know of people carrying their grandchildren when the child is not even a dependent?

Answer: Yes. In December 2002, the Employees Retirement System of Texas (ERS) held an Amnesty Program. During this period, employees could drop dependents that were not included in one of the approved categories of dependents, without any questions asked. There were more than 4,200 ineligible dependents throughout the state that were dropped during this Amnesty Program, saving our health plan more than $3 million.

Any time after the Amnesty Program was over, employees can be selected by ERS for an audit. The employee would have to be able to provide documentation proving that their dependent was truly eligible. The type of documentation that is required may include such items as tax returns, birth certificates, proof of residence and marriage certificate. If an employee is not able to provide such documentation, the employee and their dependents can be barred permanently from participation in ERS insurance programs.

Question: I would like to know if an employee or their spouse and/or children get free or reduced tuition if they are employed full time with Texas State. If so, how long does the employee have to be working before they can get the benefits?

Answer: No. We do not provide free or reduced tuition and fees to children of employees. We do have programs for employee class release and certain fee reimbursement as follows:
Full-time regular staff may be released to take one course during regular working hours provided the staff member's department head has determined the work flow of the staff member's office will not be negatively impacted by the staff member's absence. Under this provision, full-time staff may be released up to three (3) hours per week during each long semester and six (6) hours per week during only one (1) summer session.

If the full-time staff member has completed twelve (12) months of full-time non-student Texas State employment service prior to the beginning of the semester for which the staff member is enrolling, and the course is determined to be beneficially related to the staff member's job functions, the time off for the course will be considered training time and will not be charged to the staff member's leave or need to be made up by working extra hours.

Faculty members may attend academic classes at Texas State or elsewhere provided that such enrollment does not interfere with the completion of assigned duties. If a fee payment is requested for Texas State courses, requests are initiated by the faculty member at the departmental level on the Enrollment in Academic Courses/Fee Payment form (UPPS No. 04.04.01-PE-0997-1). The department head forwards the form to the Human Resources Office for eligibility verification.

If enrollment is related to current or prospective assignments, absence from campus is not considered a leave of absence, but rather a part of the faculty member's regular University activities. Faculty members may also enroll in courses here or elsewhere for personal development provided that attendance does not interfere with the completion of assigned duties. In either case, the faculty member should notify department chair in writing before enrolling in classes so that the chair can determine that no conflict exists.

As an additional benefit, the University will pay certain fees for staff and faculty employees who enroll in Texas State academic courses provided they

1. receive the required approval to take the course;
2. are a full-time regular employee with the University; and
3. have three or more years of full-time staff employment with the University (includes any and all previous service that was full-time) prior to the beginning of the semester for which the staff member is requesting a fee waiver.

Fees that are eligible to be paid by the University include only:

The payment does not apply to any other fees or tuition.

If an employee who has had fees paid terminates employment with the University prior to the end of the semester for which the fees were paid, the employee must reimburse the University for any and all fees paid by the University.

Enrollment in academic courses and fee waiver policy can be found in UPPS 04.04.01 at http://www.txstate.edu/effective/upps/upps-04-04-01.html. Employees must complete an Enrollment in Academic Courses/Fee Payment form (UPPS No. 04.04.01-PE-0997-1) and submit it to their department head for approval. The department head forwards the form to Human Resources for eligibility verification. To learn more information about this program, see UPPS 04.04.01 (Personnel Policies and Procedures).

In addition there are three other programs designed for employees that promote educational opportunities as follows:

1. The Staff Educational Development Program
2. The Leadership Development Program Internship
3. The Program for Executive Management Training

These programs are explained in detail in UPPS 04.04.35 (Professional Development and Educational Opportunities)

Question: How do we find out how many years of service we have credited?

Answer: This is a complicated question, believe it or not. The way service is counted varies depending on what the reason is for the calculation as follows:

1. If you are trying to determine when you get longevity increases, vacation accrual increases or when tracking prior state service, full and part-time employment and student employment counts toward the total.
2. If you are trying to determine your years of service for retirement purposes, regular part-time or regular full-time service where the employee works at least ½ time, is included. No student work employment counts toward this.
3. If you are trying to determine when you would receive a service award from Texas State, only regular full-time employment applies.

In any of these cases, you can contact the Benefit Office at 5-2557 to determine what your total would be in each specific case.

Some employees may have the ability to retire from ERS instead of TRS. If this is true, ERS may have different rules and should be contacted directly to determine eligibility of specific types of service.

Question: Is there any written employment policy at Texas State that prohibits discrimination based on an applicant’s political affiliation ?

Answer: Texas State has an anti-discrimination policy statement as follows: “Texas State University-San Marcos is an affirmative action, equal opportunity educational institution. It is the University's policy to not discriminate on the basis of ethnicity, color, religion, age, gender, national origin, disability, or status as a disabled or Vietnam era veteran in the recruitment and employment of faculty and staff, and the operation of any of its programs and activities. This policy applies to all applicants and employees, regardless of position. Employment decisions will be based on an individual's qualifications for the position and the requirements of University policy.”

Question: “Why is a certain employee allowed to use a title (Manager) that they do not hold, on official correspondence, both internal to the university and external ? This person also does not supervise any other employees, so how can they be considered a “manager?”

Answer: Departmental directors may allow their employees to use any internal title that they feel is appropriate. This includes letterhead, e-mail and other internal and external documentation and modes of communication. Use of titles that deviate from those in the University Pay Plan is purely at the director’s discretion, however, for Texas State purposes the employee’s official university title will always be used for official business. Thus it may become confusing if an employee uses an “in-house” title on business cards and other external communication documents, and someone in possession of these documents contacts Human Resources for information about a title..and we say the University has no such title. “In-house” titles should be used sparingly.

While a position must perform certain duties to be considered a manager in the University Pay Plan, these same requirements are not made of an internal title that is used by departmental staff. It is possible that in some instances a department director may consider a position a “manager” if it manages a program, not staff. This can be found in certain grant funded and research areas.