34 Tex. Admin. Code § 41.36 - Enrollment Periods for TRS-ActiveCare
(a) An individual who becomes an eligible
full-time or eligible part-time employee has an initial enrollment period, for
both himself or herself as well as for his or her eligible dependents,
beginning on the first day that the individual becomes an eligible employee and
ending at 11:59:59 p.m. Austin Time on the 31st day thereafter.
(b) If a current employee of a participating
entity was an eligible part-time employee during an enrollment opportunity for
the current plan year, and, later during the current plan year, this employee
becomes an eligible full-time employee, then this employee has an enrollment
period, for both himself or herself as well as for his or her eligible
dependents, beginning on the first day that this individual becomes an eligible
full-time employee and ending at 11:59:59 p.m. Austin Time on the 31st day
thereafter. This enrollment opportunity exists even if this employee previously
declined enrollment in TRS-ActiveCare during the current plan year.
(c) An eligible full-time or part-time
employee whose employer becomes a participating entity has an initial
enrollment period, for both himself or herself as well as for his or her
eligible dependents, beginning at least 31 days prior to the date that the
annual enrollment period ends for the first plan year in which the employer
becomes a participating entity.
(d)
A full-time or part-time employee's eligible dependents, if covered, must be
enrolled in the same coverage plan as the full-time or part-time employee under
whom they qualify as a dependent. Except as otherwise provided under applicable
state or federal law, an eligible full-time or part-time employee may not
change coverage plans or add dependents during a plan year.
(e) The enrollment period for an individual
who becomes eligible for coverage due to a special enrollment event, as
described in §
41.34(8) of this
chapter (relating to Eligibility for Coverage under the Texas School Employees
Uniform Group Health Coverage Program), shall be the 31 calendar days
immediately after the date of the special enrollment event. To make an
effective election, a completed enrollment form must be received by a
participating entity or the health plan administrator of TRS-ActiveCare within
this 31-day period.
(f) Eligible
full-time and part-time employees and their eligible dependents who are
enrolled in an HMO with a TRS contract that is not renewed for the next plan
year may make one of the elections provided under this subsection. To make an
effective election, a completed enrollment form must be received by a
participating entity or the health plan administrator of TRS-ActiveCare during
the plan enrollment period. Coverage under the elected option becomes effective
on September 1 of the next plan year. One of the following elections may be
made under this subsection:
(1) change to
another approved HMO for which the full-time or part-time employee is eligible;
or
(2) enroll in the TRS-ActiveCare
preferred provider organization coverage plan, without preexisting condition
exclusions.
(g) Eligible
full-time or part-time employees and their eligible dependents who are enrolled
in an HMO with a TRS contract that is terminated during the plan year may make
one of the elections provided under this subsection. To make an effective
election, a completed enrollment form must be received by a participating
entity or the health plan administrator of TRS-ActiveCare within 31 calendar
days after notice of the contract termination is sent to the eligible full-time
or part-time employee by TRS or its designee. Coverage under the elected option
becomes effective on a date determined by TRS. One of the following elections
may be made under this subsection:
(1) change
to another approved HMO for which the full-time or part-time employees and
their eligible dependents are eligible; or
(2) enroll in the TRS-ActiveCare preferred
provider organization coverage plan, without preexisting condition
exclusions.
(h) Eligible
full-time or part-time employees and their eligible dependents enrolled in an
approved HMO whose eligibility status changes because the eligible full-time or
part-time employee no longer resides, lives, or works in the HMO service area
may make one of the elections provided under this subsection. To make an
effective election, a completed enrollment form must be received by a
participating entity or the health plan administrator of TRS-ActiveCare within
31 calendar days after the employee's change in eligibility status. Coverage
under the elected option becomes effective on the first day of the month
following the date the employee's eligibility status changed. One of the
following elections may be made under this subsection:
(1) enroll in another approved HMO for which
the full-time or part-time employee is eligible; or
(2) enroll in the TRS-ActiveCare preferred
provider organization coverage plan, subject to applicable preexisting
condition limitations.
(i) On behalf of the trustee, the executive
director or a designee may prescribe open-enrollment periods and the conditions
under which an eligible full-time or part-time employee and his eligible
dependents may enroll during an open-enrollment period.
Notes
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