Eligibility

Health Plan Eligibility

EMPLOYEE ELIGIBILITY

Unless otherwise noted, you and your dependents are eligible for benefits as long as you are benefits-eligible and are a department head, regular-position employee¹ or an elected/appointed official at Harris County.

RETIREE ELIGIBILITY

If you retire in accordance with the provisions of the TCDRS (including disability Retirement) and were covered as an active employee under the Harris County Group Health & Related Benefits plan(s) at the time of retirement, you may be eligible to retain certain benefits.

DEPENDENT ELIGIBILITY

All covered dependents are enrolled in the same plan as the employee or retiree. Documentation is required to support the eligibility status of each of your dependents. Documents sent to the Benefits Office in a foreign language must be accompanied by a certified English translation. Harris County is required by law to provide health care coverage for children identified on National Medical Support Notices.²

Planning to retire this year?

Dependents must be covered for one full calendar year before your retirement in order to receive the County contribution for their premiums. You will be responsible for paying 100% of your dependent’s premium cost if covered for less than one calendar year at your retirement.

Health Plan Eligibility

Overview

Who is Eligible?	Required Supporting Documentation	Eligibility Details
Spouse	Copy of a filed marriage certificate or certificate of informal marriage Documents written in a foreign language must be accompanied by a certified English translation
Biological child	Birth Certificate or other court document listing the employee as the parent of the child A Verification of Birth Facts or birth record may be submitted up to age 5. A Birth Certificate is required for children 5 and older.	Coverage available up to age 26. Coverage ends on the last day of the pay period in which the dependent turns 26.
Adopted child	Certified copy of court order or paperwork placing child in employee’s home	Coverage available up to age 26. Coverage ends on the last day of the pay period in which the dependent turns 26.
Stepchild	Birth Certificate or other court document listing the employee’s spouse as the parent of the child Copy of a filed marriage certificate of the employee and parent of the child	Coverage available up to age 26. Coverage ends on the last day of the pay period in which the dependent turns 26.
Grandchildren	Certification of Financial Dependency form (obtain from benefitsathctx.com >> Resources) Birth Certificate of the grandchild Birth Certificate of the grandchild’s mother or father to prove relationship to employee	Grandchild must be related to the employee by birth or adoption. Cannot be employee’s step-grandchild. Grandchild must be claimed as a dependent on the employee’s federal tax return every year to remain on the plan. Grandchild audits occur every June. Coverage available up to age 26. Coverage ends on the last day of the pay period in which the dependent turns 26.
Foster child	Foster care placement agreement between the employee and Texas Department of Family & Protective Services or its subcontractor	Coverage available up to age 18. Coverage ends on the last day of the pay period in which the dependent turns 18.
Legal custody or guardianship	Court documents signed by a judge that grant permanent legal custody or permanent legal guardianship to the employee	Coverage available up to age 18. Coverage ends on the last day of the pay period in which the dependent turns 18.
Disabled children age 26 and over	Contact Benefits & Wellness to obtain the forms you and the doctor will complete and return to Aetna. A determination for your request to continue coverage will be communicated by Aetna to you and Harris County.	Dependent children who are determined to be totally disabled according to the Social Security Administration Office are eligible. Includes disabled children of employee or employee’s spouse who became disabled before age 26 and have been continuously covered.

Request for Continuation of Coverage for Disabled Child

Failure to drop dependents after a finalized divorce by court may be considered insurance fraud and may result in a referral to the District Attorney’s office for investigation. Any employee committing insurance fraud will be liable to reimburse Harris County for claims activity.

1 – A regular-position employee is defined as “an employee hired for an indefinite period and regularly scheduled to work at least 32 hours per week.” Please see Section 9 of the Harris County and Harris County Flood Control District Personnel Policies & Procedures for more information.

2 – Upon receipt of a Medical Support Notice from the Texas Attorney General or presiding court, or upon receipt of any similar such legal mandate by a court or agency having jurisdiction over the County, the County must comply with any such directive, subject to the terms of our plans. Such directives may not be overturned except through revised documentation received from the applicable agency overturning any prior directives. No refunds will be issued.

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Open Enrollment

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Open Enrollment

Eligibility

Health Plan Eligibility

Health Plan Eligibility