RULE §41.36 Enrollment Periods for TRS-ActiveCare


Published: 2015

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(a) A full-time or part-time employee who becomes employed
in an eligible capacity with a participating entity has an initial
enrollment period of 31 days, beginning on the first day that the
full-time or part-time employee becomes employed in an eligible capacity
with a participating entity and ending at 11:59 p.m. Austin Time on
the 31st day thereafter.
(b) A full-time or part-time employee whose employer
becomes a participating entity has an initial enrollment period beginning
no later than 31 days prior to the date on which the employer becomes
a participating entity and ending on the last calendar day of the
month immediately preceding the date on which the employer becomes
a participating entity ("end date"). Notwithstanding the preceding
sentence, a large school district, as defined hereafter, that becomes
a participating entity after September 1, 2003, may recommend an initial
enrollment period of not less than 31 days that closes before the
end date. A recommended initial enrollment period that closes before
the end date is subject to approval by TRS. As used in this section,
a large school district shall mean a school district that had 1001
or more employees at any time during the 2001 school year, as reflected
on any report received by TRS from that school district for a reporting
period in that school year.
(c) 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.
(d) On or after September 1, 2011, 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.
(e) On or before August 31, 2011, the enrollment period
for an individual who becomes eligible for coverage due to a special
enrollment provision of TRS-ActiveCare, as described in §41.34(9)
of this chapter, 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.


Source Note: The provisions of this §41.36 adopted to be effective August 26, 2002, 27 TexReg 7970; amended to be effective January 28, 2003, 28 TexReg 743; amended to be effective June 18, 2003, 28 TexReg 4560; amended to be effective August 18, 2003, 28 TexReg 6553; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective April 9, 2008, 33 TexReg 2825; amended to be effective April 1, 2011, 36 TexReg 2001; amended to be effective September 1, 2011, 36 TexReg 5380; amended to be effective December 22, 2014, 39 TexReg 10029