34 Tex. Admin. Code § 85.3 - Eligibility and Participation
(a)
Dependent care reimbursement plan.
(1)
Eligibility. Any employee eligible to participate in the Texas Employees Group
Benefits Program may elect to participate in the dependent care reimbursement
account.
(2) Participation.
(A) An employee who is eligible under
paragraph (1) of this subsection may elect to participate by completing and
submitting an election form either in writing or electronically on, or within
30 days after, the date on which the employee begins active duty. An employee,
upon executing an election form for participation, either in writing or
electronically, shall be deemed to have consented to and be bound by all the
terms, conditions, and limitations of the plan, any and all amendments hereto,
any administrative rules adopted by the plan administrator, and any decision or
determinations made by the plan administrator with respect to the participant's
eligibility, obligations, rights and benefits available under the plan. An
election made on the date on which the employee begins active duty becomes
effective on that date. An election made after the date on which the employee
begins active duty becomes effective on the first day of the month following
the date on which the employee begins active duty.
(B) An employee who is otherwise eligible to
participate in the Texas Employees Group Benefits Program but who declined
participation in the dependent care reimbursement account prior to the
beginning of a plan year, and who, after the beginning of a plan year, has a
qualifying life event, as defined in §
85.7(c) of this
title (relating to Enrollment), may elect to participate in the dependent care
reimbursement account as provided in §
85.7(c) of this
title.
(C) A qualifying life event
as defined in §
85.7(c) of this
title will permit a change or revocation of participation during the plan year
as provided in §
85.7(c) of this
title.
(D) An eligible employee
shall have an opportunity to enroll or change benefit options during the annual
enrollment period. The annual enrollment period shall be prior to the beginning
of a new plan year. Elections and changes in elections made during the annual
enrollment period become effective on the first day of the plan year.
(E) The plan administrator shall maintain and
update the participant enrollment records. Any and all changes will be
communicated to the TPA via weekly file transfer protocol (FTP), tapes or other
selected media.
(3)
Duration of participation.
(A) An employee's
election to participate or to waive participation in the dependent care
reimbursement plan shall be irrevocable for the plan year unless there is a
qualifying life event as defined in §
85.7(c) of this
title.
(B) An employee returning to
active duty following termination of employment, or following a period of
approved leave without pay, during the same plan year shall reinstate the
election in effect on the employee's last previous active duty date.
Reinstatement becomes effective on the date on which the employee resumes
active duty, unless the employee requests a change in election as provided in
§
85.7(c) of this
title.
(b)
Health care reimbursement plan.
(1)
Eligibility.
(A) Any employee eligible to
participate in the Texas Employees Group Benefits Program may elect to
participate in a health care reimbursement account, except that an employee
participating in a consumer directed health plan with a health savings account,
as permitted under Subchapter J, Chapter 1551, Insurance Code, may only
participate in the limited purpose health care reimbursement account described
by §85.5(b)(3), of this title (relating to Benefits). Only participants in
a consumer directed health plan are eligible to elect to participate in the
limited purpose health care reimbursement account described by §
85.5(b)(3) of
this title.
(B) Prior to September
1, 2014, an employee whose employment has been terminated, voluntarily or
involuntarily, and who had a health care reimbursement account at the time of
termination, shall retain the health care reimbursement account for the
applicable period of election. The terminated employee must pre-pay, on a
monthly basis, the elected amount and any administrative fee for the plan year.
Payments are due on the first day of each month and must be received no later
than the 30th day of the month. Failure to pay will automatically cancel
enrollment.
(C) On and after
September 1, 2014, the employee's period of coverage ends on the date of
termination of employment.
(2) Participation.
(A) An employee who is eligible under
paragraph (1) of this subsection may elect to participate by completing and
submitting an election form either in writing or electronically on, or within
30 days after, the date on which the employee begins active duty. An employee,
upon executing an election form for participation, either in writing or
electronically, shall be deemed to have consented to and be bound by all the
terms, conditions, and limitations of the plan, any and all amendments hereto,
any administrative rules adopted by the plan administrator, and any decision or
determinations made by the plan administrator with respect to the participant's
eligibility, obligations, rights and benefits available under the plan. An
election made by an employee to participate in the health care reimbursement
plan shall be effective on the date that the employee's coverage in a GBP
health benefit plan begins. But if an employee opts out or waives GBP health
coverage as provided in §
81.8 of this title (relating to
Waiver of Health Coverage), the employee's election shall become effective on
the first day of the calendar month following 60 days of employment.
(B) An employee who is eligible but who
declined participation in the health care reimbursement account prior to the
beginning of a plan year, and who, after the beginning of a plan year, has a
qualifying life event, as defined in §
85.7(c) of this
title, may elect to participate in a health care reimbursement account as
provided in §
85.7(c) of this
title.
(C) A qualifying life event
as defined in §
85.7(c) of this
title will permit the following changes in election during the plan year, as
provided in §
85.7(c) of this
title:
(i) an increase in the election amount,
if the increase is consistent with the qualifying life event; or
(ii) a decrease in the election or election
amount, if the decrease is consistent with the qualifying life event.
(D) An eligible employee shall
have an opportunity to enroll or to change benefit options during the annual
enrollment period. The annual enrollment period shall be prior to the beginning
of a new plan year. Elections and changes in elections made during the annual
enrollment period become effective on the first day of the plan year.
(E) The plan administrator shall maintain and
update the participant enrollment records. Any and all changes will be
communicated to the TPA via weekly file transfer protocol (FTP), tapes or other
selected media.
(F) If an eligible
employee elects to enroll in a consumer directed health plan with a health
savings account, any unspent flexible benefit plan dollars in the employee's
health care reimbursement account at the end of the previous plan year shall
automatically be transferred to and carryover into a limited purpose account as
described by §
85.5(b)(3) of
this title, up to the maximum carryover permitted by the IRS. Such carryover
shall comply with §
85.7(g) of this
title. Any flexible benefit plan dollars remaining that exceed the maximum
carryover permitted by the IRS will be forfeited by the employee.
(3) Duration of participation.
(A) Except as otherwise provided in paragraph
(2)(C)(ii) or (D) of this subsection, an employee's election to or not to
participate in a health care reimbursement account shall be irrevocable for the
plan year.
(B) An employee
returning to active duty following termination of employment, or following a
period of leave without pay, during the same plan year shall reinstate the
election in effect on the employee's last previous active duty date.
Reinstatement becomes effective on the date on which the employee resumes
active duty, unless the employee requests a change in election as provided in
§
85.7(c) of this
title or a different requirement is imposed by the Family and Medical Leave Act
of 1993 (FMLA).
(C) For plan years
beginning before September 1, 2014, an employee who is enrolled in a health
care reimbursement account who terminates employment during the plan year must
retain the health care account for the remainder of the plan year and prepay
premiums or make monthly premium payments due for the remainder of the plan
year, as described in paragraph (1)(B) of this subsection.
(D) For plan years beginning on and after
September 1, 2014, an employee who is enrolled in a health care reimbursement
account who terminates employment during the plan year does not retain the
health care account for the remainder of the plan year. The employee's period
of coverage ends on the date of termination. An employee may only file a claim
for reimbursement for expenses incurred before the date of
termination.
(E) Notwithstanding
any provision to the contrary in this Plan, if an employee goes on a qualifying
unpaid leave under the Family Medical Leave Act (FMLA), to the extent required
by the FMLA, the plan administrator will continue to maintain the employee's
health care reimbursement account on the same terms and conditions as though he
were still an active employee (i.e., the plan administrator or its designee
will continue to provide benefits to the extent the employee opts to continue
his coverage). If the employee opts to continue his coverage, the employee
shall pay his or her contribution in the same manner as a participant on the
non-FMLA leave, including payment with after-tax dollars while on leave. The
employee may also be given the option to pre-fund all or a portion of the
contribution for the expected duration of the leave on a pre-tax salary
reduction basis out of his pre-leave compensation by making a special election
to that effect prior to the date such compensation would normally be made
available to him (provided, however, that pre-tax dollars may not be utilized
to fund coverage during the next plan year).
Notes
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