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 41.34 - Eligibility for Coverage under the Texas School Employees Uniform Group Health Coverage Program

Current through Reg. 49, No. 28; July 12, 2024
The following persons are eligible to be enrolled in
					 TRS-ActiveCare under terms, conditions and limitations established by the
					 trustees unless expelled from the program under provisions of Chapter 1579,
					 Insurance Code:
(1) A full-time
				  employee as defined in §
										41.33
				  of this title (relating to Definitions Applicable to the Texas School Employees
				  Uniform Group Health Coverage Program).
(2) A part-time employee as defined in §
										41.33
				  of this title.
(3) Dependents, as
				  defined in §
										41.33
				  of this title pursuant to §
										1579.004,
				  Insurance Code. A child defined in §
										1579.004(3),
				  Insurance Code, who is 26 years of age or older, is eligible for coverage only
				  if, and only for so long as, such child's mental disability or physical
				  incapacity is a medically determinable condition that prevents the child from
				  engaging in self-sustaining employment as determined by TRS.
(4) Individuals employed or formerly employed
				  by a participating entity, and their dependents, who are eligible for, or
				  participating in, continuation coverage under the Consolidated Omnibus Budget
				  Reconciliation Act of 1985 (Pub. L. 99-272), through a group health benefit
				  plan sponsored by the individual's employer on the first day that employer
				  first becomes a participating entity if such individuals or their dependents
				  would have met the requirements for eligibility in paragraphs (1), (2), or (3)
				  of this section on the individual's last day of employment with the
				  participating entity. Notwithstanding the foregoing, the individual is eligible
				  to participate in TRS-ActiveCare only for the rest of the duration of the
				  individual's eligibility for COBRA continuation coverage. This subsection will
				  not apply to individuals that receive COBRA continuation coverage offered
				  through an alternative group health plan coverage offered by a participating
				  entity at the same time that the entity is offering coverage through
				  TRS-ActiveCare, and the participating entity terminates the alternative group
				  health plan coverage, or the participating entity is terminated from the
				  program by TRS for violating Section 1579.1045, Insurance Code, and §
										41.30(e)
				  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).
(5) An individual
				  who qualifies for coverage pursuant to §
										41.38(b)
				  of this title (relating to Termination Date of Coverage), and their
				  dependents.
(6) Full-time or
				  part-time employees as defined in §
										41.33
				  of this title and their eligible dependents may participate in an approved HMO
				  if they reside, live, or work in the approved service area of the HMO and are
				  otherwise eligible to participate in the HMO under the terms of the TRS
				  contract with the HMO.
(7)
				  Individuals who become eligible as determined by TRS for continuation coverage
				  under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No.
				  99-272), through their participation in TRS-ActiveCare.
(8) Individuals who become eligible for
				  coverage under the special enrollment provisions of the Health Insurance
				  Portability and Accountability Act of 1996 (Pub.
				  L. No. 104-191, 110 Stat. 1936 (1996)).
(9) Any other individuals who are required to
				  be covered under applicable law.