| (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.
(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; amended to be effective October 20, 2016, 41 TexReg 8204; amendedto be effective October 17, 2021, 46 TexReg 6944 |
