Are both you and your spouse state agency or higher-education institution employees?

Are both you and your spouse state agency or higher-education institution employees?

July 3, 2019

​Things to consider during Summer Enrollment

Man and woman with their babyHere’s the scenario: both you and your spouse work for state agencies or institutions that offer benefits under the Texas Employees Group Benefits Program (GBP). It may seem like a no-brainer that you both opt for your own health insurance policies—you want to take advantage of the 100% state contribution toward your own premium, right?

Maybe… but be sure to weigh other considerations before you each enroll in your own GBP health insurance plan, including:

  • You both will have separate total out-of-pocket maximums for in-network services ($6,750 for Calendar Year or Plan Year 2020, depending on which health plan you’re enrolled in). The total out-of-pocket maximum is the most you are required to pay each year for deductibles, coinsurance and copays for covered in-network medical and prescription drug expenses. If you reach the total out-of-pocket maximum before the end of the year, the plan pays 100% of all eligible in-network health expenses for the rest of the year.
  • When deciding which of you should cover your dependents—and only one you can do so—think about who is more likely to meet the total out-of-pocket maximum for in-network services (keeping in mind that most families don’t meet the total out-of-pocket maximum most years). It might make sense for that person to add dependents to his or her coverage.
  • If you are the spouse covering dependent children, you will have a larger family total out-of-pocket maximum ($13,500 in CY20 or PY20). Remember: only your costs and your covered dependents’ costs count toward that maximum. If your spouse has their own individual medical plan coverage, they will still have to meet an individual total out-of-pocket maximum of $6,750 before the plan pays 100% of covered, in-network costs.
Note: If you opt out of your member coverage, you are not eligible for the opt-out credit when you are added to your spouse’s plan.

What about life insurance?

If both you and your spouse have individual health insurance coverage through ERS, you both have $5,000 of Basic Term Life Insurance, with $5,000 of Accidental Death & Dismemberment Insurance (AD&D) coverage, at no cost to you. If you’re interested in optional and/or dependent life or AD&D insurance, please keep the following in mind:

  • Both you and your spouse can apply for Optional Term Life Insurance, with evidence of insurability (EOI).
  • If your spouse has their own  Basic or Optional Term Life Insurance policy, you cannot apply for Dependent Term Life Insurance for them.
  • You can each apply for a separate Dependent Term Life Insurance policy for all your eligible dependent children. You might have to provide EOI before any of your dependents are enrolled in Dependent Term Life Insurance.
  • You may also enroll in Voluntary AD&D Insurance. You and your spouse each could have a Voluntary AD&D that covers just yourselves. Or you could have a policy that covers just yourself, and your spouse could have a policy that covers himself or herself and your dependent children. EOI is not needed for voluntary AD&D insurance.
  • Your spouse can still be a beneficiary on your life and/or AD&D policy.