| (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.
(c) Manner, form, and effect of election.
(1) Application for the Special Transitional Plan.
All applications for a Special Transitional Plan under this section
shall be in writing, in a form prescribed by TRS.
(2) Incomplete or untimely applications. An incomplete
or untimely filed application to a Special Transitional Plan will
be denied.
(3) Duration. A Special Transitional Plan issued by
TRS under this section shall have a duration of less than a year,
shall begin on the TRS approved date, and shall end on the day before
the regular TRS-ActiveCare plan year begins.
(d) Coverage. The Special Transitional Plan shall have
the same benefits and coverage as one or more of the TRS-ActiveCare
plan options being offered to similar participating entities in the
applicant entity's region on the day that the applicant entity begins
the Special Transitional Plan, except for any fully insured HMO plan
options. Such terms shall include those of §41.33 of this title
(relating to Definitions Applicable to the Texas School Employees
Uniform Group Health Coverage Program) through §41.40 of this
title (relating to Coverage Continuation While on Leave Without Pay),
except as modified by TRS to adjust them to the limited-time nature
and effective dates of the Special Transitional Plan.
(e) Eligibility. Individuals shall be eligible for
the Special Transitional Plan under the same eligibility requirements
as the TRS-ActiveCare Plan, as described in §41.34 of this title
(relating to Eligibility for Coverage under the Texas School Employees
Uniform Group Health Coverage Program).
(f) Rates and Premiums. The Special Transitional Plan
may have rates that differ from the rates that apply to other similar
entities participating in the TRS-ActiveCare Plan in the applicant
entity's region. The applicant entity shall pay its premiums for the
Special Transitional Plan in the same way that participating entities
pay the premiums for the TRS-ActiveCare Plan under §41.41 of
this title (relating to Premium Payments) and be subject to the same
corrective actions.
(g) Enrollment periods. The applicant entity must participate
in two different open enrollments after the date of their application:
one enrollment period for the Special Transitional Plan, which will
begin at least 31 days prior to the beginning of the Special Transitional
Plan; and another enrollment period for the regular TRS-ActiveCare
Plan, in accordance with §41.36 of this title (relating to Enrollment
Periods for TRS-ActiveCare).
(h) Appeals. The appeals processes for claims, benefits,
and eligibility under the Special Transitional Plan shall be the same
as those that apply to the regular TRS-ActiveCare Plan.
(i) Expulsion. The Special Transitional Plan shall
follow the same expulsion process as the regular TRS-ActiveCare Plan,
as described in §41.52 of this title (relating to Expulsion from
TRS-ActiveCare).
(j) Responsibility for notices, disclosures, and administrative
adjustments. It is the applicant entity's responsibility to give to
its employees, eligible dependents, agents, contractors, and administrators
all necessary notices and disclosures about any short-term and long-term
implications of joining TRS-ActiveCare on a different date than the
applicant entity's plan year through the Special Transitional Plan,
and to conduct any necessary administrative adjustments.
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