Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter C - TEXAS SCHOOL EMPLOYEES GROUP HEALTH (TRS-ACTIVECARE) › Section 41.36 - Enrollment Periods for TRS-ActiveCare

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  An individual who becomes an eligible full-time or eligible part-time employee
				  has an initial enrollment period, for both himself or herself as well as for
				  his or her eligible dependents, beginning on the first day that the individual
				  becomes an eligible employee and ending at 11:59:59 p.m. Austin Time on the
				  31st day thereafter.
(b) If a
				  current employee of a participating entity was an eligible part-time employee
				  during an enrollment opportunity for the current plan year, and, later during
				  the current plan year, this employee becomes an eligible full-time employee,
				  then this employee has an enrollment period, for both himself or herself as
				  well as for his or her eligible dependents, beginning on the first day that
				  this individual becomes an eligible full-time employee and ending at 11:59:59
				  p.m. Austin Time on the 31st day thereafter. This enrollment opportunity exists
				  even if this employee previously declined enrollment in TRS-ActiveCare during
				  the current plan year.
(c) An
				  eligible full-time or part-time employee whose employer becomes a participating
				  entity has an initial enrollment period, for both himself or herself as well as
				  for his or her eligible dependents, beginning at least 31 days prior to the
				  date that the annual enrollment period ends for the first plan year in which
				  the employer becomes a participating entity.
(d) 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.
(e) 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.
(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.