reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.4 - Employer Health Benefit Surcharge

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  When used in this section, the term "employer" has the meaning given in §
										821.001(7),
				  Government Code.
(b) For each
				  report month a retiree is enrolled in TRS-Care and working for an employer for
				  more than 92 hours in that calendar month, the employer that reports the
				  employment of the retiree on the Employment of Retired Members Report to TRS
				  shall pay monthly to the Retired School Employees Group Insurance Fund (the
				  Fund) a surcharge established by the Board of Trustees of TRS.
(c) The criteria used to determine if the
				  retiree is working more than 92 hours in that calendar month are the same as
				  the criteria for determining one-half time employment under §
										31.13 of this
				  title (relating to One-half Time Employment) even if the retiree's employment
				  also qualifies for an exception under §
										31.14 of
				  this title (relating to Full-time Employment after 12 Consecutive Month Break
				  in Service) or §
										31.15
				  of this title (relating to Tutors under Education Code §
				  33.913).
(d) The surcharge is also
				  owed by the employer on any retiree who is enrolled in TRS-Care, is working for
				  a third party entity but is working for more than 92 hours in that calendar
				  month and who is considered an employee of that employer under §
										824.601(d)
				  of the Government Code.
(e) The
				  surcharge under this section is not owed:
(1)
				  by an employer for any retiree who retired from TRS before September 1, 2005;
				  or
(2) by an employer for a retiree
				  reported as working under the exception for substitute service as provided in
				  §
											31.12
				  of this title (relating to Substitute Service) unless that retiree combines
				  substitute service under §
											31.12
				  of this title with other non-substitute employment with the same or another
				  employer or third party entity in the same calendar month;
(3) by an employer for any retiree that is
				  employed in multiple positions during a calendar month and does not exceed the
				  limits for such combined employment under § 31.19 of this title (relating
				  to Combining EAR Exceptions and Employer Surcharges); or
(4) by an employer for any service retiree
				  that is employed in a position that qualifies as a federally-funded COVID-19
				  position under § 31.16 of this title (relating to Federally-funded
				  COVID-19 Personnel) and Government Code § 824.6021.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.6 - Required Contributions from Public Schools

Current through Reg. 49, No. 28; July 12, 2024
(a) On a monthly basis, each public school
				  shall contribute the then-applicable required amount under §
										1575.204(a),
				  Insurance Code, of the salary of each active employee to TRS for deposit in the
				  Retired School Employees Group Insurance Fund. The public school shall make the
				  contribution at the same time and in the same manner in which the public school
				  delivers retirement contributions. Any waiver granted to a public school under
				  Government Code §
										825.408(a)
				  does not apply to the contribution under this section.
(b) For purposes of this section, "active
				  employee" means a contributing member of TRS who is employed by a public school
				  and is not entitled to coverage under a plan provided under Chapter 1551 or
				  Chapter 1601, Insurance Code.
(c)
				  For purposes of this section, "public school" means a school district; another
				  educational district whose employees are TRS members; a regional education
				  service center established under Chapter 8, Education Code; or an
				  open-enrollment charter school established under Subchapter D, Chapter 12,
				  Education Code.
(d) TRS may take
				  corrective action against a public school that fails to make the required
				  contribution in accordance with the requirements of this section, including but
				  not limited to placement of a warrant hold with the Comptroller of Public
				  Accounts.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.7 - Effective Date of Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  allowed by subsection (c) of this section, for TRS members who take a service
				  or disability retirement and enroll in coverage during their initial enrollment
				  period as described in §
										41.1
				  of this title (relating to Initial Enrollment Periods for the Health Benefits
				  Program Under the Texas Public School Retired Employees Group Benefits Act
				  (TRS-Care)), the effective date of coverage is:
(1) the first day of the month following the
				  effective date of retirement if the application for coverage is received by
				  TRS-Care on or before the effective retirement date; or
(2) the first day of the month following the
				  receipt of the application for coverage by TRS-Care if the application is
				  received after the effective retirement date but within the initial enrollment
				  period.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.8 - Eligible Bidders

Current through Reg. 49, No. 28; July 12, 2024
(a) TRS-Care may
				  include separate contracts for:
(1) health
				  benefit plans ;
(2) prescription
				  drug plans;
(3) utilization review
				  services;
(4) administrative
				  services; and
(5) ancillary
				  services .
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.9 - Bid Procedure

Current through Reg. 49, No. 28; July 12, 2024
(a) All bids for
				  contracts under TRS-Care must be submitted in compliance with the bid
				  requirements provided by TRS .
(b)
				  The bid opening shall take place at a date and time set by TRS
(c) In determining the quality of the bids,
				  TRS may consider such factors and criteria as it deems relevant and appropriate
				  under the circumstances.
(d) TRS
				  shall not provide compensation to bidders for any expenses incurred by the
				  bidder for bids preparation or for any demonstrations that may be made. Bidders
				  submit bids at their own risk and expense.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.10 - Eligibility to Enroll in the Health Benefits Program Under the Texas Public School Retired Employees Group Benefits Act (TRS-Care)

Current through Reg. 49, No. 28; July 12, 2024
(a) If they meet the applicable requirements
				  set out in this section, the following persons are eligible to enroll in the
				  health benefits program under the Texas Public School Retired Employees Group
				  Benefits Act (TRS-Care):
(1) service retirees
				  of the Teacher Retirement System of Texas (TRS) who are not eligible to enroll
				  as an employee or retiree in a plan provided under the Texas Employees Group
				  Benefits Act (Insurance Code, Chapter 1551), or under the State University
				  Employees Uniform Insurance Benefits Act (Insurance Code, Chapter
				  1601);
(2) disability retirees of
				  TRS;
(3) surviving spouses of
				  deceased service or disability retirees of TRS or of certain deceased active
				  TRS members; and
(4) surviving
				  dependent children of deceased service or disability retirees of TRS or of
				  certain deceased active TRS members.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.11 - Years of Service Credit Used to Determine Premiums

Current through Reg. 49, No. 28; July 12, 2024
(a) In addition to other criteria that TRS
				  may use to determine premiums, pursuant to section
				  1575.212,
				  Insurance Code, TRS may use years of service credit to determine applicable
				  premium rates.
(b) If TRS uses
				  years of service credit to determine applicable premium rates, then to
				  determine the applicable premium for a retiree, regardless of the retiree's
				  effective date of retirement, TRS will use the retiree's years of service
				  credit to which the retiree is entitled under the Chapter 823, Government Code,
				  at the time of the TRS retirement.
(c) If TRS uses years of service credit to
				  determine applicable premium rates, then to determine the applicable premium
				  for surviving spouses and divorced spouses who elect COBRA coverage, TRS will
				  use the retiree's years of service credit as determined by subsection (b) of
				  this section.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.12 - Eligibility for the Alternative Plan for Medicare-Eligible Participants

Current through Reg. 49, No. 28; July 12, 2024
An individual is eligible to enroll in the Alternative Plan
					 offered under TRS-Care if:
(1) the
				  individual is eligible to enroll in TRS-Care; and
(2) the individual is eligible for Medicare
				  and either:
(A) does not have reasonable
				  access to a particular provider, as determined by TRS; or
(B) as of January 1, 2018, does not have
				  Medicare Part B coverage and the individual's ability to obtain Medicare Part B
				  coverage is cost prohibitive, as determined by TRS.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.13 - One-Time Reenerollment Opportunity

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  retiree who was enrolled in TRS-Care and voluntarily terminated the retiree's
				  enrollment between January 1, 2017, and December 31, 2019, will have a one-time
				  opportunity to reenroll in TRS-Care if the retiree is otherwise eligible and
				  meets the following requirements:
(1) The
				  retiree is eligible to enroll in Medicare at the time the retiree applies for
				  reenrollment in TRS-Care; and
(2)
				  The retiree applies for reenrollment into TRS-Care no later than December 31,
				  2023.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.14 - Expulsion from TRS-Care for Fraud

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  trustee, acting through the executive director, may expel from participation in
				  TRS-Care a person who has engaged in, caused, or attempted to engage in
				  fraudulent activity relating to the program or any benefits offered under the
				  program.
(b) Upon receipt of a
				  complaint or upon its own motion, the TRS staff may file a petition for
				  expulsion with the executive director. The executive director, may docket the
				  petition and refer the matter for an adjudicative hearing before the State
				  Office of Administrative Hearings or otherwise as authorized by law. If a
				  petition is docketed, the provisions of Chapter 43 of this title (relating to
				  Contested Cases) shall apply to the proceeding.
(c) Following a hearing, the executive
				  director may expel a person from participation in TRS-Care for a period of time
				  not to exceed five years. Pursuant to the delegation of authority through this
				  section, the order of the executive director is the final decision of
				  TRS.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.15 - Optional Dental Benefits Plan

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Establishment.
(1) In accordance with Section
				  1575.1601, Insurance
				  Code, TRS makes available to individuals under the TRS-Care program an optional
				  plan that provides coverage for dental care (hereinafter referred to as an
				  "optional dental benefits plan").
(2) TRS may offer an optional dental benefits
				  plan through an insurance carrier or the optional dental benefits plan may be
				  self-funded.
(3) An optional dental
				  benefits plan may have one or more benefit designs for participants to choose
				  from, as determined by TRS.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS › Subchapter A - RETIREE HEALTH CARE BENEFITS (TRS-CARE) › Section 41.16 - Optional Vision Benefits Plan

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Establishment.
(1) In accordance with Section
				  1575.1601, Insurance
				  Code, TRS makes available to individuals under the TRS-Care program an optional
				  plan that provides coverage for vision care (hereinafter referred to as an
				  "optional vision benefits plan").
(2) TRS may offer an optional vision benefits
				  plan through an insurance carrier or the optional vision benefits plan may be
				  self-funded.
(3) An optional vision
				  benefits plan may have one or more benefit designs for participants to choose
				  from, as determined by TRS.
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 41.31 - Eligible Bidders

Current through Reg. 49, No. 28; July 12, 2024
(a) TRS-ActiveCare
				  may include separate contracts for:
(1)
				  health benefit plans ;
(2)
				  prescription drug plans ;
(3)
				  utilization review services ;
(4)
				  administrative services ; and
(5)
				  ancillary services.
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 41.32 - Bid Procedure

Current through Reg. 49, No. 28; July 12, 2024
(a) All bids for
				  contracts under TRS-ActiveCare must be submitted in compliance with the bid
				  requirements provided by TRS .
(b)
				  The bid opening shall take place at a date and time set by TRS.
(c) In determining the quality of the bids,
				  TRS may consider such factors and criteria as it deems relevant and appropriate
				  under the circumstances.
(d) TRS
				  shall not provide compensation to bidders for any expenses incurred by the
				  bidder for bids preparation or for any demonstrations that may be made. Bidders
				  submit bids at their own risk and expense.
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 41.35 - Coverage Plans

Current through Reg. 49, No. 28; July 12, 2024
(a) TRS-ActiveCare
				  shall include at least two coverage plans, including a catastrophic care
				  coverage plan and a primary care coverage plan, in accordance with Chapter
				  1579, Insurance Code. The coverages provided for eligible persons under the
				  plans offered will include, but are not limited to, basic medical expense
				  coverage and prescription drug coverage, in accordance with terms, conditions,
				  and limitations adopted by resolution of the trustee.
(b) TRS-ActiveCare may also include
				  additional plans for health-care coverage under terms, conditions and
				  limitations adopted by resolution of the trustee.
(c) The coverage plans offered under
				  TRS-ActiveCare will each include at least two of the following rating tiers:
(1) Employee only;
(2) Employee and spouse;
(3) Employee and children;
(4) Employee and family.
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 41.37 - Effective Date of Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  otherwise provided by §
										41.39
				  of this title (relating to Coverage for Individuals Changing Employers)
				  coverage shall become effective as described in this subsection for eligible
				  full-time employees and eligible part-time employees whose employer first
				  becomes a participating entity and who enroll during the annual enrollment
				  period. immediately preceding the date their employer first becomes a
				  participating entity. Coverage shall become effective for such individuals and
				  their eligible dependents on the first day of the plan year the employer first
				  became a participating entity.
(b)
				  Except as otherwise provided by §
										41.39
				  of this title (relating to Coverage for Individuals Changing Employers)
				  coverage shall become effective as described in this subsection for eligible
				  full-time employees and eligible part-time employees who begin working for a
				  participating entity in an eligible capacity and who enroll no later than the
				  31st day after the first date they become eligible to enroll, ("Individuals").
				  Coverage shall become effective for such Individuals and their eligible
				  dependents on one of the following dates as specified by the Individual on the
				  application for coverage:
(1) The first day
				  the Individual is employed in an eligible capacity with the participating
				  entity; or
(2) The first day of the
				  calendar month following the month in which the Individual is employed in an
				  eligible capacity with the participating entity.
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 41.38 - Termination Date of Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Unless
				  otherwise required by law or this section, coverage shall terminate at the
				  earliest of:
(1) 11:59 p.m. Austin Time on
				  the last calendar day of the month in which the covered individual's employer,
				  or the employer of the individual under whom a dependent qualified for
				  coverage, ceases to be a participating entity;
(2) 11:59 p.m. Austin Time on the last
				  calendar day of the month in which a covered individual, or the individual
				  under whom a dependent qualified for coverage, terminates employment as
				  determined by the participating entity, except as otherwise provided under
				  §
											41.39
				  of this title (relating to Coverage for Individuals Changing
				  Employers);
(3) 11:59 p.m. Austin
				  Time on the last calendar day of the month in which a covered individual, or
				  the individual under whom a dependent qualified for coverage, is no longer
				  eligible for coverage under TRS-ActiveCare under §
											41.34
				  of this title (relating to Eligibility for Coverage under the Texas School
				  Employees Uniform Group Health Coverage Program);
(4) 11:59 p.m. Austin Time on the date
				  specified by the trustee if the covered individual, or the individual under
				  whom a dependent qualified for coverage, is expelled from the
				  program;
(5) 11:59 p.m. Austin Time
				  on the last calendar day of the month immediately preceding the month in which
				  TRS receives a notification from a participating entity, in the form prescribed
				  by TRS, that a covered individual failed to make a required monthly premium
				  payment to the participating entity;
(6) 11:59 p.m. Austin Time on the last
				  calendar day of the month in which a covered individual enters into active,
				  full-time military, naval, or air service, except as provided under the
				  Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) or
				  other applicable law;
(7) 11:59
				  p.m. Austin Time on the last calendar day of the month in which the
				  administering firm or TRS receives notice, in a form acceptable to TRS, that a
				  covered individual, or the individual under whom a dependent qualified for
				  coverage, has chosen to voluntarily drop coverage under
				  TRS-ActiveCare;
(8) 11:59 p.m.
				  Austin Time on the last day of the month for which TRS-ActiveCare received
				  payment if the participating entity employing the covered individual, or the
				  individual under whom a dependent qualified for coverage, has failed to make
				  all premium payments due for a period of 90 days or longer; or
(9) the termination date and time that a
				  health maintenance organization participating in TRS-ActiveCare provides for in
				  its Evidence of Coverage for the reasons listed in that Evidence of
				  Coverage.
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 41.39 - Coverage for Individuals Changing Employers

Current through Reg. 49, No. 28; July 12, 2024
(a) A full-time or part-time employee
				  enrolled in TRS-ActiveCare who, on or after September 1, 2011, changes
				  employment from one participating entity to another participating entity within
				  the same plan year may not change coverage plans or add dependents unless:
(1) changes to add dependents are authorized
				  due to a special enrollment event under provisions of the Health Insurance
				  Portability and Accountability Act of 1996 (
				  Pub. L. No.
				  104-191, 110 Stat. 1936 (1996));
(2) an open-enrollment period exists on the
				  first day of the new employment and the full-time or part-time employee makes
				  such changes in compliance with open-enrollment conditions prescribed by the
				  trustee; or
(3) the new employment
				  is with a participating entity that does not make available the option under
				  which the individual was covered on the last date of previous employment,
				  provided that options are offered under TRS-ActiveCare that are not applicable
				  to all participating entities.
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 41.41 - Premium Payments

Current through Reg. 49, No. 28; July 12, 2024
(a) Each
				  participating entity shall remit to TRS the amount on each bill directed to the
				  participating entity by TRS or the administering firm. The participating entity
				  shall remit payment on or before the fifteenth day of each month in which TRS
				  or the administering firm issued a bill. Payment shall be delivered in the same
				  manner (e.g., currently, TEXNET) in which the participating entity delivers
				  retirement contributions. Any waiver granted to a participating entity under
				  §
										825.408(a),
				  Government Code, does not apply to amounts billed under this section or to
				  amounts otherwise owed to TRS for TRS-ActiveCare.
(b) A participating entity will be billed for
				  all full-time and part-time employees enrolled in TRS-ActiveCare who were
				  employed by the participating entity on the date that TRS or its designee
				  generates the bill for that billing month as reported by the participating
				  entity. In addition, a participating entity will be billed retroactively for
				  all full-time and part-time employees who enroll after the date on which the
				  bill is generated for that month and choose coverage for that month. A
				  participating entity will also be billed for any individual covered in
				  accordance with §
										41.40
				  of this title (relating to Coverage Continuation While on Leave Without Pay).
				  Participating entities are responsible for collecting all applicable premiums
				  and other costs that are required to be paid by its full-time employees,
				  part-time employees, and any individuals covered in accordance with §
										41.40
				  of this title. A participating entity shall remit the full amount billed each
				  month.
(c) Participating entities
				  shall not modify the amount of any bill or remit any amount different from the
				  amount billed. A participating entity shall report adopted adjustments,
				  including those seeking credit for terminated employees, to the administering
				  firm no later than the 45th day after the billing date. TRS may reject any
				  adopted adjustments that are inappropriate or untimely, including those
				  adjustments seeking credit for terminated employees reported later than 45 days
				  after the billing date on which the employee was first incorrectly reported as
				  eligible for coverage. Approved adjustments will be reflected on a subsequent
				  bill.
(d) TRS may take corrective
				  action against a participating entity that fails to remit payment in accordance
				  with the timelines and other requirements of this section, including but not
				  limited to placement of a warrant hold with the Comptroller of Public
				  Accounts.
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 41.45 - Required Information from School Districts, Other Educational Districts, Charter Schools, and Regional Education Service Centers Electing to Participate in TRS-ActiveCare

Current through Reg. 49, No. 28; July 12, 2024
(a) An eligible
				  entity that submits a written election to participate in TRS-ActiveCare under
				  §41.30 must include with the notice of election the information listed
				  below for each medical and prescription drug plan that the entity offered to
				  its employees during the designated time period. The entity must include this
				  information for the year to date for the plan year in which the entity submits
				  its notice of election (current year) and for the two complete plan years
				  immediately preceding the current year. The required information is:
(1) Plan type (PPO, POS, HMO, etc.),
				  including the effective date of each plan;
(2) Average number of employees participating
				  in each plan;
(3) Average number of
				  covered lives in each plan;
(4)
				  Description of all medical and prescription drug benefits, including effective
				  dates of any changes in each plan;
(5) Total premium rates by family tier for
				  each insured plan, including effective dates of any changes;
(6) Total COBRA rates by family tier for each
				  self-funded plan, including effective dates of any changes;
(7) Required employee contribution rates by
				  family tier for each plan, including effective dates of any changes;
(8) Funding arrangement (fully insured,
				  self-funded, etc.) for each plan;
(9) Total premiums paid by year for each
				  plan, if insured;
(10) Total claims
				  paid by year for each plan;
(11)
				  Employee counts by age, gender, and participation status;
(12) A high cost claimant report;
				  and
(13) Any other summary health
				  information that TRS may require.
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 41.50 - Appeals Relating to Claims or Other Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a) For appeals that relate to claims or
				  other benefits , the following procedures apply:
(1) A person enrolled in TRS-ActiveCare,
				  other than a person enrolled in a health maintenance organization (HMO)
				  participating in TRS-ActiveCare, who is denied payment of a claim or other
				  benefit ("Claimant") may appeal the denial through a written request filed with
				  the administering firm in accordance with procedures established by the
				  administering firm.
(2) The final
				  decision by the administering firm or by any external review organization,
				  whichever occurs later, shall be the final decision on the appeal.
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 41.52 - Expulsion from TRS-ActiveCare

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  trustee, acting through the executive director, may expel from participation in
				  TRS-ActiveCare a participant who submits or causes to be submitted a false or
				  fraudulent claim or enrollment application, or who has defrauded or attempted
				  to defraud, any health benefits plan or pharmacy benefits plan offered under
				  TRS-ActiveCare.
(b) Upon receipt of
				  a complaint or upon its own motion, the TRS staff may file a petition for
				  expulsion with the executive director. The executive director may docket the
				  petition and refer the matter for an adjudicative hearing before the State
				  Office of Administrative Hearings or otherwise as authorized by law. If a
				  petition is docketed, the provisions of Chapter 43 of this title (relating to
				  Contested Cases) shall apply to the proceeding.
(c) Following a hearing, the executive
				  director may expel a person from participation in TRS-ActiveCare for a period
				  of time not to exceed five years if the executive director finds that the
				  person submitted or caused to be submitted a false or fraudulent claim or
				  enrollment application or has defrauded or attempted to defraud any health
				  benefits plan or pharmacy benefits plan offered under TRS-ActiveCare. Pursuant
				  to the delegation of authority through this section, the order of the executive
				  director is the final decision of TRS.
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 41.53 - Special Transitional Plan

Current through Reg. 49, No. 28; July 12, 2024
(a) Special
				  Transitional Plan. In order to transition an entity into the TRS-ActiveCare
				  plan year, TRS may establish a short duration Special Transitional Plan for an
				  otherwise eligible entity that has an existing group health plan year that does
				  not terminate the day preceding the beginning of the regular TRS-ActiveCare
				  plan year. The purpose of the Special Transitional Plan is to assist an entity
				  to transition into the TRS-ActiveCare plan year by covering the gap period
				  between the end of the entity's existing coverage and the beginning of the
				  regular TRS-ActiveCare plan year coverage.
(b) Notice of election and required
				  information. An entity applying to a Special Transitional Plan ("applicant
				  entity") must:
(1) Submit to TRS the
				  information required under §
											41.45 of this title (relating to
				  Required Information from School Districts, Other Educational Districts,
				  Charter Schools, and Regional Education Service Centers Electing to Participate
				  in TRS-ActiveCare) at least 180 days in advance of the first day of the month
				  in which the Special Transitional Plan is to be effective; and
(2) Submit an application to the Special
				  Transitional Plan and a notice of election to participate in the regular
				  TRS-ActiveCare plan under §
											41.30 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) at the same
				  time. Such application and election to participate must be submitted no later
				  than 90 days in advance of the first day of the month in which the Special
				  Transitional Plan is to be effective and never later than December 31 of the
				  year before the plan year in which the election to participate in
				  TRS-ActiveCare is to be made effective.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.1 - Administrative Review of Individual Requests

Current through Reg. 49, No. 28; July 12, 2024
(a)
				Organization. TRS is divided into administrative divisions, which are further
				divided into departments, for the efficient implementation of its duties. Any
				person who desires any action from TRS must consult with the proper department
				within TRS and comply with all proper requirements for completing forms and
				providing information to that department.
(b) Final administrative decision by chief
				benefit officer. In the event that a person is adversely affected by a
				determination, decision, or action of department personnel, the person may
				appeal the determination, decision, or action to the appropriate manager within
				the department, and then to the chief benefit officer of TRS. The chief benefit
				officer shall mail a final written administrative decision, which shall
				include:
(1) the chief benefit officer's
				determination regarding the person's appeal and reasons for denying the appeal,
				if applicable; and
(2) a statement
				that if the person is adversely affected by the decision, the person may
				request an adjudicative hearing to appeal the decision and the deadline for
				doing so.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.2 - Effect of Invalidity of Rule

Current through Reg. 49, No. 28; July 12, 2024
If any provision of this chapter or its application to any
				  person or circumstance is held invalid, the invalidity does not affect other
				  provisions or applications of this chapter that can be given effect without the
				  invalid provision or application, and to this end the provisions of this
				  chapter are severable.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.4 - Decisions Subject to Review by an Adjudicative Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as provided in subsection (b) of
				this section, a person adversely affected by a final administrative decision of
				the Teacher Retirement System of Texas (TRS) relating to the pension plan on a
				matter over which TRS has jurisdiction and authority to grant relief and the
				relief sought does not conflict with the terms of the pension plan may appeal
				the decision and request an adjudicative hearing with regard to the following:
(1) any matter related to a member's service
				or disability retirement, death or survivor benefits, or request for refund of
				accumulated contributions;
(2) the
				eligibility of a person for membership in TRS;
(3) the amount of annual compensation
				credited by TRS;
(4) the amount of
				deposits or fees required of a member;
(5) any matter involving the granting,
				purchase, transfer, or establishment of service credit;
(6) any application for correction of error
				in the file of a member, beneficiary, or alternate payee, other than a
				determination of whether an order is a qualified domestic relations
				order;
(7) the cancellation or
				suspension of retirement, survivor, or death benefits; or
(8) any other matter affecting eligibility
				for retirement and related disability and death benefits or the amount of such
				benefits payable under the laws governing TRS.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.5 - Request for Adjudicative Hearing

Current through Reg. 49, No. 28; July 12, 2024
(a) On
				a matter over which TRS has jurisdiction and authority to grant relief that
				does not conflict with the terms of the pension plan, a person may appeal a
				final administrative decision by filing a petition for adjudicative hearing
				with the deputy director. The petition shall conform to the requirements of
				§
									43.12 of this chapter (relating to
				Form of Petitions and Other Pleadings).
(b) A petition for adjudicative hearing must
				be filed by the later of:
(1) 45 days after
				the date the final administrative decision is mailed; or
(2) a number of days after the final
				administrative decision is mailed equal to the number of days it took TRS to
				issue the final administrative decision.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.6 - Filing of Documents

Current through Reg. 49, No. 28; July 12, 2024
All documents relating to any appeal of a final
				  administrative decision shall be filed with the deputy director at TRS, 1000
				  Red River Street, Austin, Texas 78701-2698. A document may be filed with TRS by
				  hand-delivery, courier-receipted delivery, facsimile transmission, or regular,
				  certified, or registered mail. A document is deemed filed when mailed if it is
				  received by TRS within a timely manner under Texas Rule of Civil Procedure 5
				  and the sender provides adequate proof of the mailing date. If the deputy
				  director has docketed an appeal and referred it for an adjudicative hearing,
				  documents shall be filed with the administrative law judge and a copy provided
				  to the TRS docket clerk during the time the matter is pending before the
				  administrative law judge.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.7 - Computation of Time

Current through Reg. 49, No. 28; July 12, 2024
In computing any period of time prescribed or allowed by this
				  chapter, by order of the executive director or board, or by any applicable
				  statute, the period shall begin on the day after the act, event, or default in
				  question, and it shall conclude on the last day of that designated period,
				  unless the last day is a Saturday, Sunday, or legal holiday, in which event the
				  period runs until the end of the next day that is not a Saturday, Sunday, or a
				  legal holiday.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.8 - Extensions

Current through Reg. 49, No. 28; July 12, 2024
Unless otherwise provided by statute, the time for filing
				  pleadings or other documents may be extended, upon the filing of a motion,
				  prior to the expiration of the applicable period of time, showing that there is
				  good cause for such extension of time and that the need for the extension is
				  not caused by the neglect, indifference, or lack of diligence of the party
				  making the motion. A copy of any such motion shall be served upon all other
				  parties of record to the proceeding contemporaneously with its filing. In the
				  case of filings that initiate a proceeding or that are made before an appeal
				  has been referred for an adjudicative hearing, the deputy director will
				  determine whether good cause exists and whether an extension should be granted.
				  In the case of filings made in a proceeding after TRS has referred the appeal
				  for an adjudicative hearing, rules governing hearings before SOAH will control
				  so long as the matter is before SOAH. If a matter is referred for an
				  adjudicative hearing to a hearing official not affiliated with SOAH, then the
				  rules of this chapter shall apply to the conduct of the hearing while pending
				  before the hearing official. For matters returned by an administrative law
				  judge or hearing examiner to TRS, either through dismissal from the
				  adjudicative hearing docket or through issuance of a proposal for decision, the
				  executive director may determine whether good cause exists and whether an
				  extension should be granted. The executive director is authorized to rule on
				  motions for extensions on matters directed to the Board if no Board meeting is
				  scheduled before the expiration of the applicable period of
				  time.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.9 - Docketing of Appeal for Adjudicative Hearing and Dismissal for Failure to Obtain Setting

Current through Reg. 49, No. 28; July 12, 2024
(a) On an appeal
				over which TRS has jurisdiction, authority to grant relief, in which the relief
				requested is consistent with the terms of the plan, and that otherwise complies
				with this chapter, the deputy director shall assign the petition a TRS docket
				number, provide all parties notice of the docket number, and refer the matter
				for an adjudicative hearing before the State Office of Administrative Hearings
				or otherwise as authorized by law.
(b) The deputy director may decline to docket
				an appeal over which TRS has no jurisdiction or no authority to grant relief,
				that seeks relief that is inconsistent with the terms of the pension plan, that
				is not timely filed, or that otherwise fails to comply with this chapter. The
				deputy director's decision declining to docket an appeal is the final decision
				of TRS when the circumstances described in §
									2001.144, Government
				Code, are met. A person may not appeal such decision to the executive director
				or the board.
(c) Prior to
				docketing an appeal, the deputy director may review the request filed with TRS
				to determine the sufficiency. If the petition does not materially comply with
				this chapter, the deputy director shall return the petition to the person who
				filed it, along with reasons for the return. The person shall be given a
				reasonable time (not to exceed 90 days) to file a corrected petition. If the
				petition is not corrected to substantially comply with this chapter within the
				time given, the deputy director may decline to docket the appeal.
(d) If a contested case is referred to the
				SOAH for adjudicative hearing, then during the period of time the case is
				before SOAH, the adjudicative hearing rules for SOAH (1 TAC Chapter 155) shall
				apply unless inconsistent with applicable statutes or constitutional
				provisions. If a matter is referred for an adjudicative hearing to a hearing
				official not affiliated with SOAH, then the rules of this chapter shall apply
				to the conduct of the hearing while pending before the hearing
				official.
(e) A party that files an
				appeal and causes a matter to be docketed and referred to for adjudicative
				hearing shall have the responsibility of prosecuting the appeal within a
				reasonable time period. TRS may seek dismissal with prejudice of an appeal if a
				responsible party fails to obtain a setting for a hearing on the merits within
				two years of referral of the matter for an adjudicative hearing.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.10 - Authority to Grant Relief

Current through Reg. 49, No. 28; July 12, 2024
At any time before an appeal is referred for adjudicative
				  hearing, the deputy director or, in the matter of certification for disability
				  retirement, the Medical Board may grant the relief sought by the petitioner and
				  dismiss the appeal, provided that the interest of other individual parties are
				  not adversely affected and the relief does not conflict with the terms of the
				  pension plan. If a matter has been referred to SOAH, the SOAH administrative
				  law judge may dismiss the case from the SOAH docket in accordance with SOAH
				  rules. If a matter is referred for an adjudicative hearing to a hearing
				  official not affiliated with SOAH, then the rules of this chapter shall apply
				  to the dismissal of the case.
Texas Administrative Code › Title 34 - PUBLIC FINANCE › Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS › Chapter 43 - CONTESTED CASES › Section 43.11 - Classification of Pleadings

Current through Reg. 49, No. 28; July 12, 2024
Regardless of any error in the designation of a pleading, it
				  shall be accorded its true status in the proceeding in which it is
				  filed.