34 Tex. Admin. Code § 41.16 - Optional Vision Benefits Plan
(a)
Establishment.
(1) In accordance with Section
1575.1601, Insurance
Code, TRS makes available to individuals under the TRS-Care program an optional
plan that provides coverage for vision care (hereinafter referred to as an
"optional vision benefits plan").
(2) TRS may offer an optional vision benefits
plan through an insurance carrier or the optional vision benefits plan may be
self-funded.
(3) An optional vision
benefits plan may have one or more benefit designs for participants to choose
from, as determined by TRS.
(b) Eligibility.
(1) Only retirees, dependents, surviving
spouses, and surviving dependent children, as defined under Chapter 1575,
Insurance Code, are eligible to enroll in an optional vision benefits plan
(hereinafter referred to as "eligible members").
(2) Individuals shall be eligible for an
optional vision benefits plan under the same requirements as described in
§
41.10 of this title (relating to
Eligibility to Enroll in the Health Benefits Program Under the Texas Public
School Retired Employees Group Benefits Act (TRS-Care)).
(3) Eligible members may enroll in an
optional vision benefits plan even if they are not enrolled or applying for
enrollment in any other TRS-Care plan at the time of enrollment in an optional
vision benefits plan.
(4) If an
eligible member is eligible for an optional vision benefits plan as a retiree
and also as a dependent of another retiree, the retiree may elect to
participate in an optional vision benefits plan as a retiree or as a dependent
but cannot participate as both. An eligible member must choose to participate
as a retiree or as a dependent.
(c) Plan Year. The plan year for an optional
vision benefits plan is from January 1 to December 31 (hereinafter referred to
as "plan year").
(d) Enrollment and
Disenrollment.
(1) Enrollment. Eligible
members desiring to enroll in an optional vision benefits plan must do so
within the open enrollment period or during an additional enrollment
opportunity.
(A) Open Enrollment.
(i) An eligible member may enroll in an
optional vision benefits plan during an open enrollment period established by
TRS.
(ii) On behalf of the trustee,
the executive director or a designee may prescribe open enrollment periods and
the conditions under which eligible members may enroll during an open
enrollment period.
(B)
Additional Enrollment Opportunities. Individuals shall have the same additional
enrollment opportunities for an optional vision benefits plan as those provided
under §
41.2(a) - (c) of
this title (relating to Additional Enrollment Opportunities).
(2) Disenrollment. Eligible
members may only disenroll from an optional vision benefits plan during the
open enrollment period, with the exception that an eligible member may
disenroll during a special enrollment opportunity as described by §
41.2(b) of this
title.
(3) Enrollment and
Disenrollment Process. Eligible members must follow the enrollment and
disenrollment processes established by TRS.
(e) Payment of Contributions.
(1) Retirees, surviving spouses, and
surviving dependent children, or their representatives (collectively,
"participants") shall pay monthly contributions, as set by TRS, for their and
their dependents' participation in an optional vision benefits plan and may, at
TRS' sole discretion, be required to do so through deductions from the
participant's TRS annuity payment or through direct payments to TRS or its
designee.
(A) In accordance with Section
1575.153, Insurance
Code, the participant must, in writing, authorize the trustee to deduct the
entirety of the participant's contributions for the participant's coverage
under the TRS-Care plan(s) from the participant's TRS annuity
payment.
(B) If the amount of the
participant's TRS annuity payment is not enough to cover all of the
participant's contributions for coverage under the participants TRS-Care
plan(s), the participant shall be directly billed by TRS or its
designee.
(2) If a
participant is required to pay their contributions for an optional vision
benefits plan directly to TRS or its designee, failure to timely pay the full
amount of a required contribution for coverage will result in termination of
the optional vision benefits plan. Participants or eligible members that have
lost their coverage due to lack of payment of contribution for coverage may be
subject to recoupment by TRS of outstanding contribution amounts, penalties,
and be subject to reenrollment conditions prior to reenrollment.
(f) Effective Date of Coverage.
(1) An optional vision benefits plan shall
follow the same effective dates of coverage that apply under §
41.7(a) - (h) and
(j) of this title (relating to Effective Date
of Coverage).
(2) In addition, if
an eligible member enrolls during a TRS open enrollment period as described in
subsection (d)(1)(A) of this section, the effective date of coverage shall be
the first day of the plan year following the end of the open enrollment
period.
(g) Expulsion
for fraud. Expulsion for fraud from an optional vision benefits plan shall
follow the same process as described in §
41.14 of this title (relating to
Expulsion from TRS-Care for Fraud).
(h) Competitive Bidding.
(1) Bid procedures for an optional vision
benefits plan shall follow the same process as described in §
41.9 of this title (relating to
Bid Procedure).
(2) TRS may award
separate contracts for different aspects in the administration of an optional
vision benefits plan, such as insurance coverage, claims administration,
utilization review services, administrative services, and ancillary
services.
(3) Each bidder must
comply with the minimum qualifications contained in the applicable solicitation
from TRS.
Notes
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