34 Tex. Admin. Code § 85.7 - Enrollment
(a) Election of benefits.
(1) An eligible employee may elect to
participate in the health care and/or dependent care reimbursement accounts
within the flexible benefits plan by making an election and executing an
election form or enrolling electronically.
(2) An employee who becomes eligible after
the beginning of a plan year has 30 days from the date of eligibility to elect
or decline benefits by executing an election form.
(3) By enrolling in the plan, the employee
agrees to a reduction in compensation or agrees to after-tax payments equal to
the participant's share of the cost and any fees for each reimbursement account
selected.
(4) An election to
participate in a reimbursement plan must be for a specified dollar amount plus
any administrative fee.
(5) An
annual enrollment period will be designated by the Employees Retirement System
of Texas and shall be prior to the beginning of a new plan year. The annual
enrollment period shall provide an opportunity to change and to elect or
decline benefit options.
(6) An
active employee who is enrolled in reimbursement accounts immediately prior to
the annual enrollment period will be automatically re-enrolled with the same
elections and contribution amounts for the new plan year unless the active
employee takes action during the annual enrollment period to change
contribution amounts or to decline participation.
(b) Effects of failure to elect.
(1) If the Employees Retirement System of
Texas does not receive an election form from an eligible employee to
participate in the reimbursement accounts by the due date, it shall be deemed
an express election and informed consent by the eligible employee to:
(A) receive cash compensation as a benefit by
reason of failure to purchase optional benefits in lieu of cash compensation;
or
(B) in the case of automatic
re-enrollment during the annual enrollment period, to continue participation in
the reimbursement accounts with the same contributions for the new plan
year.
(2) To the extent
an eligible employee does not elect the maximum permissible participation
amounts hereunder, he shall be deemed to have elected cash
compensation.
(c) Benefit
election irrevocable except for qualifying life event.
(1) An election to participate shall be
irrevocable for the plan year unless a qualifying life event occurs, and the
change in election is consistent with the qualifying life event. The plan
administrator may require documentation in support of the qualifying life
event.
(2) A qualifying life event
occurs when an employee experiences one of the following changes:
(A) change in marital status;
(B) change in dependent status;
(C) change in employment status;
(D) change of address that results in loss of
benefits eligibility;
(E) change in
Medicare or Medicaid status, or Children's Health Insurance Program (CHIP)
status;
(F) significant cost of
benefit or coverage change imposed by a third party provider other than a
provider through the Texas Employees Group Benefits Program; or
(G) change in coverage ordered by a
court.
(3) An election
form requesting a change in election must be submitted on, or within 30 days
after, the date of the qualifying life event, provided, however, a change in
election due to CHIP status under paragraph (2) of this subsection must be
submitted on, or within 60 days after, the change in CHIP status.
(4) A change in election as provided in this
subsection becomes effective on the first day of the month following the date
of the qualifying life event.
(d) Payment of flexible benefit dollars.
(1) Flexible benefit dollars from an active
duty employee shall be recovered through payroll withholding at least monthly
during the plan year and remitted to the Employees Retirement System of Texas
for the purpose of purchasing benefits. For the health care reimbursement
account only, and except as otherwise provided in §
85.3(b)(3)(D) of
this title (relating to Eligibility and Participation), flexible benefit
dollars from employees on leave without pay status or who have insufficient
funds for any month shall be recovered through direct after-tax payment from
the employee or upon the return of the employee to active duty status from
payroll withholding, for the total amount due.
(2) An employee's flexible benefit dollars
with respect to any month during the plan year shall be equal to the
authorization on the employee's election form plus any administrative
fees.
(3) Flexible benefit dollars
received by the Employees Retirement System of Texas shall be credited to the
participant's dependent care reimbursement account and/or health care
reimbursement account, as appropriate.
(e) Forfeiture of account balances.
(1) The amount credited to a participant's
reimbursement account for each benefit election for any plan year will be used
to reimburse or pay qualified expenses incurred during the eligible employee's
period of coverage in such plan year, if the claim is electronically
adjudicated or if the participant files a correctly completed claim for
reimbursement on or before December 31 following the close of the plan
year.
(2) Except as provided by
§
85.6 of this title and by
subsection (g) of this section, any balances remaining after payment of all
timely and correctly filed claims postmarked no later than December 31
following the close of the plan year, shall be forfeited by the participant and
be available to pay administrative expenses of the flexible benefits
program.
(3) Except as provided by
§
85.6 of this title, an unexpended
balance in an amount of $25 or less is not eligible for carryover under
subsection (g) of this section if the participant does not reenroll in the plan
for the subsequent plan year. The unexpended balance shall be forfeited by the
participant and be available to pay administrative expenses of the flexible
benefits program.
(f)
Reimbursement report to participant. The plan administrator or its designee may
provide to the participant periodic reports on each reimbursement account,
showing the account transactions (disbursements and balances) during the plan
year. These reports may be provided periodically through electronic
means.
(g) Carryover of unexpended
balances. Under IRS regulations, a participant may be permitted to carry over a
specific amount of unspent flexible benefit plan dollars to the immediately
following plan year. The flexible benefit dollars carried over may be used to
pay or reimburse incurred expenses under the health care reimbursement plan
during the entire plan year to which the dollars are carried over. A
participant is entitled to carry over a designated amount set by the Employees
Retirement System of Texas and publicly posted. Except as provided by §
85.6 of this title, the carryover
amount shall not exceed the maximum of the indexed amount of the carryover
limit set by the Internal Revenue Service, and any balance in excess of this
designated amount is forfeited as provided by subsection (e) of this section.
Any amount of carryover that rolls over into the new plan year does not affect
the maximum amount of participant.
Notes
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