34 Tex. Admin. Code § 41.53 - Special Transitional Plan

(a) Special Transitional Plan. In order to transition an entity into the TRS-ActiveCare plan year, TRS may establish a short duration Special Transitional Plan for an otherwise eligible entity that has an existing group health plan year that does not terminate the day preceding the beginning of the regular TRS-ActiveCare plan year. The purpose of the Special Transitional Plan is to assist an entity to transition into the TRS-ActiveCare plan year by covering the gap period between the end of the entity's existing coverage and the beginning of the regular TRS-ActiveCare plan year coverage.

(b) Notice of election and required information. An entity applying to a Special Transitional Plan ("applicant entity") must:

(1) Submit to TRS the information required under § 41.45 of this title (relating to Required Information from School Districts, Other Educational Districts, Charter Schools, and Regional Education Service Centers Electing to Participate in TRS-ActiveCare) at least 180 days in advance of the first day of the month in which the Special Transitional Plan is to be effective; and

(2) Submit an application to the Special Transitional Plan and a notice of election to participate in the regular TRS-ActiveCare plan under § 41.30 of this title (relating to Participation in the Health Benefits Program under the Texas School Employees Uniform Group Health Coverage Act by School Districts, Other Educational Districts, Charter Schools, and Regional Education Service Centers) at the same time. Such application and election to participate must be submitted no later than 90 days in advance of the first day of the month in which the Special Transitional Plan is to be effective and never later than December 31 of the year before the plan year in which the election to participate in TRS-ActiveCare is to be made effective.

(c) Manner, form, and effect of election.

(1) Application for the Special Transitional Plan. All applications for a Special Transitional Plan under this section shall be in writing, in a form prescribed by TRS.

(2) Incomplete or untimely applications. An incomplete or untimely filed application to a Special Transitional Plan will be denied.

(3) Duration. A Special Transitional Plan issued by TRS under this section shall have a duration of less than a year, shall begin on the TRS approved date, and shall end on the day before the regular TRS-ActiveCare plan year begins.

(d) Coverage. The Special Transitional Plan shall have the same benefits and coverage as one or more of the TRS-ActiveCare plan options being offered to similar participating entities in the applicant entity's region on the day that the applicant entity begins the Special Transitional Plan, except for any fully insured HMO plan options. Such terms shall include those of § 41.33 of this title (relating to Definitions Applicable to the Texas School Employees Uniform Group Health Coverage Program) through § 41.40 of this title (relating to Coverage Continuation While on Leave Without Pay), except as modified by TRS to adjust them to the limited-time nature and effective dates of the Special Transitional Plan.

(e) Eligibility. Individuals shall be eligible for the Special Transitional Plan under the same eligibility requirements as the TRS-ActiveCare Plan, as described in § 41.34 of this title (relating to Eligibility for Coverage under the Texas School Employees Uniform Group Health Coverage Program).

(f) Rates and Premiums. The Special Transitional Plan may have rates that differ from the rates that apply to other similar entities participating in the TRS-ActiveCare Plan in the applicant entity's region. The applicant entity shall pay its premiums for the Special Transitional Plan in the same way that participating entities pay the premiums for the TRS-ActiveCare Plan under § 41.41 of this title (relating to Premium Payments) and be subject to the same corrective actions.

(g) Enrollment periods. The applicant entity must participate in two different open enrollments after the date of their application: one enrollment period for the Special Transitional Plan, which will begin at least 31 days prior to the beginning of the Special Transitional Plan; and another enrollment period for the regular TRS-ActiveCare Plan, in accordance with § 41.36 of this title (relating to Enrollment Periods for TRS-ActiveCare).

(h) Appeals. The appeals processes for claims, benefits, and eligibility under the Special Transitional Plan shall be the same as those that apply to the regular TRS-ActiveCare Plan.

(i) Expulsion. The Special Transitional Plan shall follow the same expulsion process as the regular TRS-ActiveCare Plan, as described in § 41.52 of this title (relating to Expulsion from TRS-ActiveCare).

(j) Responsibility for notices, disclosures, and administrative adjustments. It is the applicant entity's responsibility to give to its employees, eligible dependents, agents, contractors, and administrators all necessary notices and disclosures about any short-term and long-term implications of joining TRS-ActiveCare on a different date than the applicant entity's plan year through the Special Transitional Plan, and to conduct any necessary administrative adjustments.

Notes

34 Tex. Admin. Code § 41.53

Adopted by Texas Register, Volume 48, Number 39, September 29, 2023, TexReg 5740, eff. 10/5/2023