34 Tex. Admin. Code § 41.39 - Coverage for Individuals Changing Employers
(a) A full-time or part-time employee
enrolled in TRS-ActiveCare who, on or after September 1, 2011, changes
employment from one participating entity to another participating entity within
the same plan year may not change coverage plans or add dependents unless:
(1) changes to add dependents are authorized
due to a special enrollment event under provisions of the Health Insurance
Portability and Accountability Act of 1996 (Pub. L. No. 104-191 , 110 Stat.
1936 (1996));
(2) an
open-enrollment period exists on the first day of the new employment and the
full-time or part-time employee makes such changes in compliance with
open-enrollment conditions prescribed by the trustee; or
(3) the new employment is with a
participating entity that does not make available the option under which the
individual was covered on the last date of previous employment, provided that
options are offered under TRS-ActiveCare that are not applicable to all
participating entities.
(b) A full-time or part-time employee
enrolled in TRS-ActiveCare who, on or before August 31, 2011, changes
employment from one participating entity to another participating entity within
the same plan year may not change coverage plans or add dependents unless:
(1) changes to add dependents are authorized
due to a special enrollment event under special enrollment provisions of
TRS-ActiveCare;
(2) an
open-enrollment period exists on the first day of the new employment and the
full-time or part-time employee makes such changes in compliance with
open-enrollment conditions prescribed by the trustee; or
(3) the new employment is with a
participating entity that does not make available the option under which the
individual was covered on the last date of previous employment, provided that
options are offered under TRS-ActiveCare that are not applicable to all
participating entities.
(c) No break in coverage will occur for a
full-time or part-time employee enrolled in TRS-ActiveCare who changes
employment from one participating entity to another participating entity within
the same plan year if all the criteria set forth in paragraphs (1) - (3) of
this subsection are met. The former employer participating entity shall
determine the last date of employment for purposes of this subsection.
(1) The new employer makes available the same
coverage option under which the full-time or part-time employee was enrolled on
the last day of employment with the former employer;
(2) The individual is employed by the new
participating entity no later than the last day of the next calendar month
after the last date of employment with the former participating entity
employer; and
(3) The individual
promptly files an election to continue coverage with the new participating
entity employer with coverage to be effective in the calendar month in which
the individual is first employed with the new participating entity.
(d) Full-time or part-time
employees who initially waive coverage under TRS-ActiveCare may enroll during
any open-enrollment period as prescribed by the trustee; however, they may not
enroll due to a change in employment from one participating entity to another
during the same plan year unless the change occurs during a concurrent open
enrollment or the employee satisfies the requirements for an enrollment
opportunity provided under Rule 41.36(b) of this title.
Notes
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