| (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.
(b) Eligibility.
(1) Only retirees, dependents, surviving spouses, and
surviving dependent children, as defined under Chapter 1575, Insurance
Code, are eligible to enroll in an optional dental benefits plan (hereinafter
referred to as "eligible members").
(2) Individuals shall be eligible for an optional dental
benefits plan under the same requirements as described in §41.10
of this title (relating to Eligibility to Enroll in the Health Benefit
Program under the Texas Public School Retired Employees Group Benefits
Act (TRS-Care)).
(3) Eligible members may enroll in an optional dental
benefits plan even if they are not enrolled or applying for enrollment
in any other TRS-Care plan at the time of enrollment in an optional
dental benefits plan.
(4) If an eligible member is eligible for an optional
dental benefits plan as a retiree and also as a dependent of another
retiree, the retiree may elect to participate in an optional dental
benefits plan as a retiree or as a dependent but cannot participate
as both. An eligible member must choose to participate as a retiree
or as a dependent.
(c) Plan Year. The plan year for an optional dental
benefits plan is from January 1 to December 31 (hereinafter referred
to as "plan year").
(d) Enrollment and Disenrollment.
(1) Enrollment. Eligible members desiring to enroll
in an optional dental benefits plan must do so within the open enrollment
period or during an additional enrollment opportunity.
(A) Open Enrollment.
(i) An eligible member may enroll in an optional dental
benefits plan during an open enrollment period established by TRS.
(ii) On behalf of the trustee, the executive director
or a designee may prescribe open enrollment periods and the conditions
under which eligible members may enroll during an open enrollment
period.
(B) Additional Enrollment Opportunities. Individuals
shall have the same additional enrollment opportunities for an optional
dental benefits plan as those provided under §41.2(a) - (c) of
this title (relating to Additional Enrollment Opportunities).
(2) Disenrollment. Eligible members may only disenroll
from an optional dental benefits plan during the open enrollment period,
with the exception that an eligible member may disenroll during a
special enrollment opportunity as described by §41.2(b) of this
title.
(3) Enrollment and Disenrollment Process. Eligible
members must follow the enrollment and disenrollment processes established
by TRS.
(e) Payment of Contributions.
(1) Retirees, surviving spouses, and surviving dependent
children, or their representatives (collectively "participants") shall
pay monthly contributions, as set by TRS, for their and their dependents'
participation in an optional dental benefits plan and may, at TRS'
sole discretion, be required to do so through deductions from the
participant's TRS annuity payment or through direct payments to TRS
or its designee.
(A) In accordance with Section 1575.153, Insurance
Code, the participant must, in writing, authorize the trustee to deduct
the entirety of the participant's contributions for the participant's
coverage under the TRS-Care plan(s) from the participant's TRS annuity
payment.
(B) If the amount of the participant's TRS annuity
payment is not enough to cover all of the participant's contributions
for coverage under the participants TRS-Care plan(s), the participant
shall be directly billed by TRS or its designee.
(2) If a participant is required to pay their contributions
for an optional dental benefits plan directly to TRS or its designee,
failure to timely pay the full amount of a required contribution for
coverage will result in termination of the optional dental benefits
plan. Participants or eligible members that have lost their coverage
due to lack of payment of contribution for coverage may be subject
to recoupment by TRS of outstanding contribution amounts, penalties,
and be subject to reenrollment conditions prior to reenrollment.
(f) Effective Date of Coverage.
(1) An optional dental benefits plan shall follow the
same effective dates of coverage that apply under §41.7(a) -
(h) and (j) of this title (relating to Effective Date of Coverage).
(2) In addition, if an eligible member enrolls during
a TRS open enrollment period as described in subsection (d)(1)(A)
of this section, the effective date of coverage shall be the first
day of the plan year following the end of the open enrollment period.
(g) Expulsion for fraud. Expulsion for fraud from an
optional dental benefits plan shall follow the same process as described
in §41.14 of this title (relating to Expulsion from TRS-Care
for Fraud).
(h) Competitive Bidding.
(1) Bid procedures for an optional dental benefits
plan shall follow the same process as described in §41.9 of this
title (relating to Bid Procedure).
(2) TRS may award separate contracts for different
aspects in the administration of an optional dental benefits plan,
such as insurance coverage, claims administration, utilization review
services, administrative services, and ancillary services.
(3) Each bidder must comply with the minimum qualifications
contained in the applicable solicitation from TRS.
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