34 TAC §41.36, §41.37
The Teacher Retirement System of Texas (TRS) proposes amendments
to §41.36 concerning enrollment periods and §41.37 concerning effective
date of coverage, both of which relate to the Texas School Employees Uniform
Group Health Coverage Program ("TRS-ActiveCare").
The proposed amendments to §41.36 set forth the definition of a large
school district and permit large school districts to recommend an initial
enrollment period that differs from the initial enrollment period for other
entities participating in TRS-ActiveCare. The proposed amendments also permit
TRS to approve certain recommended initial enrollment periods and require
that the initial enrollment periods for large school districts be at least
as long as the enrollment period for other participating entities. Finally,
the proposed amendments to §41.37 establish the effective date of coverage
for those employees who enroll during an approved initial enrollment period
for a large school district.
Tony Galaviz, Chief Financial Officer, has determined that for each year
of the first five-year period the amendments are in effect, there will be
no fiscal implications to state or local governments as a result of enforcing
or administering the rule. There is no foreseeable effect on local employment
or local economies as a result of the proposed amendments and there is no
anticipated adverse economic effect on small businesses or micro-businesses
as a result of compliance with the proposed amendments.
Mr. Galaviz has also determined that for each year of the first five years
the amendments are in effect the public benefit anticipated as a result of
the sections will be the orderly election of participation in the school and
educational employees group coverage programs. Mr. Galaviz has determined
that there are no anticipated economic costs to person required to comply
with the proposed sections.
Comments on the proposal may be submitted to Charles L. Dunlap, Executive
Director, 1000 Red River, Austin, Texas 78701.
These amendments are proposed under the Insurance Code art. 3.50-7,
which gives TRS authority to adopt rules as necessary to implement and administer
the uniform group coverage program established by HB 3343. The amendments
are proposed under Government Code, Chapter 825, §825.102, which authorizes
the Board of Trustees of the Teacher Retirement System to adopt rules for
the administration of the funds of the retirement system and for the transaction
of business of the Board.
There are no other codes affected.
§41.36.Enrollment Periods for the TRS-ActiveCare Program.
(a)
A full-time or part-time employee who becomes employed
in an eligible capacity with a participating entity has an initial enrollment
period of 31 days, beginning on the first day that the full-time or part-time
employee becomes employed in an eligible capacity with a participating entity
and ending at 11:59 p.m. Central Time on the 31st day thereafter.
(b)
A full-time or part-time employee whose employer becomes
a participating entity has an initial enrollment period beginning no later
than 31 days prior to the date on which the employer becomes a participating
entity and ending on the last calendar day of the month immediately preceding
the date on which the employer becomes a participating entity
("end date").
Notwithstanding the preceding sentence, a large school district, as defined
hereafter, that becomes a participating entity after September 1, 2003, may
recommend an initial enrollment period of not less than 31 days that closes
before the end date. A recommended initial enrollment period that closes before
the end date is subject to approval by TRS. As used in this section, a large
school district shall mean a school district that had 1001 or more employees
at any time during the 2001 school year, as reflected on any report received
by TRS from that school district for a reporting period in that school year.
(c)
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.
(d)
The enrollment period for an individual who becomes eligible
for coverage due to a special enrollment event shall be as defined under provisions
of the Health Insurance Portability and Accountability Act of 1996 (Pub. L.
No. 104-191, 110 Stat. 1936 (1996)) (HIPAA). During a special enrollment period
as defined by HIPAA an individual who is already covered under a plan offered
under TRS-ActiveCare may not elect a different plan, for himself or any eligible
dependents, for the remainder of the existing plan year but may only add eligible
dependents for coverage under the employee's existing plan selection.
(e)
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 following elections by submitting
a completed enrollment form during the plan enrollment period, to become effective
on September 1 of the next plan year:
(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.
(f)
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 following elections by submitting
a completed enrollment form within 31 calendar days after receiving notice
of the contract termination, to become effective on a date determined by TRS:
(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.
(g)
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 shall make one of the following elections by
submitting a completed enrollment form within 31 calendar days after their
change in eligibility status, to become effective on the first day of the
month following the date their eligibility status changed:
(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.
(h)
The trustee by resolution 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.
§41.37.Effective Date of Coverage.
(a)
For eligible full-time employees, eligible part-time employees,
and their eligible dependents, coverage shall become effective September 1,
2002, provided that they enroll before August 31, 2002.
(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 whose employer first becomes a participating
entity after September 1, 2002, and who enroll no later than the last calendar
day of the month immediately preceding the date their employer first becomes
a participating entity
or no later than the last day of an approved initial
enrollment period for a large school district as provided by §41.36 of
this title (relating to Enrollment Periods for the TRS-ActiveCare Program)
. Coverage shall become effective for such individuals and their eligible
dependents on the date the employer first became a participating entity.
(c)
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 after August 31, 2002 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 either of the following dates as specified by the Individual on the application
for coverage:
(1)
The first day the eligible Individual, or the Individual
under whom a dependent qualifies for eligibility, 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 eligible Individual, or the Individual under whom a dependent
qualifies for eligibility, is employed in an eligible capacity with the participating
entity.
(d)
For eligible full-time employees, eligible part-time employees
and their eligible dependents who enroll during an open-enrollment period
established by resolution of the trustee, coverage shall become effective
on the date specified by resolution of the trustee.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of
the Secretary of State on June 5, 2003.
TRD-200303409
Charles Dunlap
Executive Director
Teacher Retirement System of Texas
Proposed date of adoption: July 25, 2003
For further information, please call: (512) 542-6115