| (a) Dependent care reimbursement plan.
(1) Eligibility. Any employee eligible to participate
in the Texas Employees Group Benefits Program may elect to participate
in the dependent care reimbursement account.
(2) Participation.
(A) An employee who is eligible under paragraph (1)
of this subsection may elect to participate by completing and submitting
an election form either in writing or electronically on, or within
30 days after, the date on which the employee begins active duty.
An employee, upon executing an election form for participation, either
in writing or electronically, shall be deemed to have consented to
and be bound by all the terms, conditions, and limitations of the
plan, any and all amendments hereto, any administrative rules adopted
by the plan administrator, and any decision or determinations made
by the plan administrator with respect to the participant's eligibility,
obligations, rights and benefits available under the plan. An election
made on the date on which the employee begins active duty becomes
effective on that date. An election made after the date on which the
employee begins active duty becomes effective on the first day of
the month following the date on which the employee begins active duty.
(B) An employee who is otherwise eligible to participate
in the Texas Employees Group Benefits Program but who declined participation
in the dependent care reimbursement account prior to the beginning
of a plan year, and who, after the beginning of a plan year, has a
qualifying life event, as defined in §85.7(c) of this title (relating
to Enrollment), may elect to participate in the dependent care reimbursement
account as provided in §85.7(c) of this title.
(C) A qualifying life event as defined in §85.7(c)
of this title will permit a change or revocation of participation
during the plan year as provided in §85.7(c) of this title.
(D) An eligible employee shall have an opportunity
to enroll or change benefit options during the annual enrollment period.
The annual enrollment period shall be prior to the beginning of a
new plan year. Elections and changes in elections made during the
annual enrollment period become effective on the first day of the
plan year.
(E) The plan administrator shall maintain and update
the participant enrollment records. Any and all changes will be communicated
to the TPA via weekly file transfer protocol (FTP), tapes or other
selected media.
(3) Duration of participation.
(A) An employee's election to participate or to waive
participation in the dependent care reimbursement plan shall be irrevocable
for the plan year unless there is a qualifying life event as defined
in §85.7(c) of this title.
(B) An employee returning to active duty following
termination of employment, or following a period of approved leave
without pay, during the same plan year shall reinstate the election
in effect on the employee's last previous active duty date. Reinstatement
becomes effective on the date on which the employee resumes active
duty, unless the employee requests a change in election as provided
in §85.7(c) of this title.
(b) Health care reimbursement plan.
(1) Eligibility.
(A) Any employee eligible to participate in the Texas
Employees Group Benefits Program may elect to participate in a health
care reimbursement account, except that an employee participating
in a consumer directed health plan with a health savings account,
as permitted under Subchapter J, Chapter 1551, Insurance Code, may
only participate in the limited purpose health care reimbursement
account described by §85.5(b)(3), of this title (relating to
Benefits). Only participants in a consumer directed health plan are
eligible to elect to participate in the limited purpose health care
reimbursement account described by §85.5(b)(3) of this title.
(B) Prior to September 1, 2014, an employee whose employment
has been terminated, voluntarily or involuntarily, and who had a health
care reimbursement account at the time of termination, shall retain
the health care reimbursement account for the applicable period of
election. The terminated employee must pre-pay, on a monthly basis,
the elected amount and any administrative fee for the plan year. Payments
are due on the first day of each month and must be received no later
than the 30th day of the month. Failure to pay will automatically
cancel enrollment.
(C) On and after September 1, 2014, the employee's
period of coverage ends on the date of termination of employment.
(2) Participation.
(A) An employee who is eligible under paragraph (1)
of this subsection may elect to participate by completing and submitting
an election form either in writing or electronically on, or within
30 days after, the date on which the employee begins active duty.
An employee, upon executing an election form for participation, either
in writing or electronically, shall be deemed to have consented to
and be bound by all the terms, conditions, and limitations of the
plan, any and all amendments hereto, any administrative rules adopted
by the plan administrator, and any decision or determinations made
by the plan administrator with respect to the participant's eligibility,
obligations, rights and benefits available under the plan. An election
made by an employee to participate in the health care reimbursement
plan shall be effective on the date that the employee's coverage in
a GBP health benefit plan begins. But if an employee opts out or waives
GBP health coverage as provided in §81.8 of this title (relating
to Waiver of Health Coverage), the employee's election shall become
effective on the first day of the calendar month following 60 days
of employment.
(B) An employee who is eligible but who declined participation
in the health care reimbursement account prior to the beginning of
a plan year, and who, after the beginning of a plan year, has a qualifying
life event, as defined in §85.7(c) of this title, may elect to
participate in a health care reimbursement account as provided in §85.7(c)
of this title.
(C) A qualifying life event as defined in §85.7(c)
of this title will permit the following changes in election during
the plan year, as provided in §85.7(c) of this title:
(i) an increase in the election amount, if the increase
is consistent with the qualifying life event; or
(ii) a decrease in the election or election amount,
if the decrease is consistent with the qualifying life event.
(D) An eligible employee shall have an opportunity
to enroll or to change benefit options during the annual enrollment
period. The annual enrollment period shall be prior to the beginning
of a new plan year. Elections and changes in elections made during
the annual enrollment period become effective on the first day of
the plan year.
(E) The plan administrator shall maintain and update
the participant enrollment records. Any and all changes will be communicated
to the TPA via weekly file transfer protocol (FTP), tapes or other
selected media.
(F) If an eligible employee elects to enroll in a consumer
directed health plan with a health savings account, any unspent flexible
benefit plan dollars in the employee's health care reimbursement account
at the end of the previous plan year shall automatically be transferred
to and carryover into a limited purpose account as described by §85.5(b)(3)
of this title, up to the maximum carryover permitted by the IRS. Such
carryover shall comply with §85.7(g) of this title. Any flexible
benefit plan dollars remaining that exceed the maximum carryover permitted
by the IRS will be forfeited by the employee.
(3) Duration of participation.
(A) Except as otherwise provided in paragraph (2)(C)(ii)
or (D) of this subsection, an employee's election to or not to participate
in a health care reimbursement account shall be irrevocable for the
plan year.
(B) An employee returning to active duty following
termination of employment, or following a period of leave without
pay, during the same plan year shall reinstate the election in effect
on the employee's last previous active duty date. Reinstatement becomes
effective on the date on which the employee resumes active duty, unless
the employee requests a change in election as provided in §85.7(c)
of this title or a different requirement is imposed by the Family
and Medical Leave Act of 1993 (FMLA).
(C) For plan years beginning before September 1, 2014,
an employee who is enrolled in a health care reimbursement account
who terminates employment during the plan year must retain the health
care account for the remainder of the plan year and prepay premiums
or make monthly premium payments due for the remainder of the plan
year, as described in paragraph (1)(B) of this subsection.
(D) For plan years beginning on and after September
1, 2014, an employee who is enrolled in a health care reimbursement
account who terminates employment during the plan year does not retain
the health care account for the remainder of the plan year. The employee's
period of coverage ends on the date of termination. An employee may
only file a claim for reimbursement for expenses incurred before the
date of termination.
(E) Notwithstanding any provision to the contrary in
this Plan, if an employee goes on a qualifying unpaid leave under
the Family Medical Leave Act (FMLA), to the extent required by the
FMLA, the plan administrator will continue to maintain the employee's
health care reimbursement account on the same terms and conditions
as though he were still an active employee (i.e., the plan administrator
or its designee will continue to provide benefits to the extent the
employee opts to continue his coverage). If the employee opts to continue
his coverage, the employee shall pay his or her contribution in the
same manner as a participant on the non-FMLA leave, including payment
with after-tax dollars while on leave. The employee may also be given
the option to pre-fund all or a portion of the contribution for the
expected duration of the leave on a pre-tax salary reduction basis
out of his pre-leave compensation by making a special election to
that effect prior to the date such compensation would normally be
made available to him (provided, however, that pre-tax dollars may
not be utilized to fund coverage during the next plan year).
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| Source Note: The provisions of this §85.3 adopted to be effective August 12, 1988, 13 TexReg 3754; amended to be effective September 28, 1989, 14 TexReg 4787; amended to be effective September 1, 1990, 15 TexReg 4646; amended to be effective September 1, 1991, 16 TexReg 3779; amended to be effective September 1, 1992, 17 TexReg 2874; amended to be effective September 2, 1993, 18 TexReg 5595; amended to be effective November 11, 1996, 21 TexReg 10766; amended to be effective February 12, 1998, 23 TexReg 1313; amended to be effective September 1, 1998, 23 TexReg 4571; amended to be effective September 16, 1999, 24 TexReg 7276; amended to be effective July 10, 2000, 25 TexReg 6557; amendedto be effective July 17, 2003, 28 TexReg 5539; amended to be effective December 31, 2003, 28 TexReg 11625; amended to be effective May 29, 2005, 30 TexReg 3022; amended to be effective December 26, 2013, 38 TexReg 9374; amended to be effective June 10, 2014, 39 TexReg 4486; amended to be effective June 6, 2016, 41 TexReg 4045; amended to be effective September 8, 2020, 45 TexReg 6240 |
