PART 3. TEACHER RETIREMENT SYSTEM OF TEXAS
CHAPTER 41. HEALTH CARE AND INSURANCE PROGRAMS
SUBCHAPTER A. RETIREE HEALTH CARE BENEFITS (TRS-CARE)
The Board of Trustees (Board) of the Teacher Retirement System of Texas (TRS) proposes amendments to the following rules for TRS-Care, the health benefits program for TRS retirees administered by TRS, as trustee: §41.1 relating to initial enrollment periods for coverage under TRS-Care; and §41.7 relating to the effective date of coverage under TRS-Care. The amendments are proposed mainly to address a new, extended initial enrollment period for retirees.
Changes to §1575.161 of the Insurance Code, made pursuant to House Bill 1191, 81st Legislature, Regular Session (2009) ("H.B. 1191"), entitles retirees who are eligible for coverage under TRS-Care to select coverage beginning on any date that is on or after the date the person retires and on or before the 90th day after the retirement date. In light of the above, TRS proposes substantive amendments to §41.1 to reflect that 90-day enrollment period, and substantive amendments to §41.7 to address the ability of retirees to change coverage tiers within the initial enrollment period. The substantive proposed amendments to §41.1 are located in the newly-designated subsections (a) and (b). Newly-designated subsection (a) provides that the initial enrollment period in TRS-Care for TRS retirees who take service retirement and who are eligible to enroll in TRS-Care at the time of retirement expires at the end of the later of the last day of the month that is three (3) consecutive calendar months, but in no event less than 90 days, after their effective retirement date, or the last day of the month this is three (3) consecutive calendar months following the last day of the month in which their election to retire is received by TRS. Newly-designated subsection (b) provides that the initial enrollment period in TRS-Care for eligible TRS disability retirees expires at the end of the last day of the month that is three (3) consecutive calendar months, but in no event less than 90 days, after the date that the disability retirement is approved by the TRS Medical Board. A substantive proposed amendment to §41.7 is located in newly-designated subsection (b). Newly-designated subsection (b) provides that a TRS member who takes a service or disability retirement and enrolls in coverage during his or her initial enrollment period may, at any time during his or her initial enrollment period, make changes to his or her coverage elections. The effective date of coverage for the new elections is the first day of the month following receipt by TRS-Care of the application requesting the change in coverage.
Non-substantive amendments are proposed to §41.1 to delete obsolete language setting forth different initial enrollment periods for those retirees retiring before September 1, 2004, and those retirees retiring after September 1, 2004. A non-substantive amendment is proposed to §41.7. Newly-designated subsection (c) of §41.7 permits retirees to defer the effective date of coverage under TRS-Care up to the first day of the third month immediately following the month after the effective date of retirement. The proposed non-substantive amendment clarifies that this deferral period runs concurrent with, and does not extend, the enrollment periods set forth in §41.1. Subsections within both §41.1 and §41.7 have been re-designated as required by the proposed amendments in each section.
Ken Welch, TRS Chief Financial Officer, estimates that, for each year of the first five years that proposed amendments to §41.1 and §41.7 will be in effect, there will be no foreseeable implications relating to cost or revenues of the state or local governments as a result of enforcing or administering the amended rules.
For each year of the first five years that the proposals will be in effect, Mr. Welch and Ronnie Jung, TRS Executive Director, have determined that the public benefit will be to provide TRS retirees with longer enrollment periods for coverage under TRS-Care. Mr. Welch has also determined that there will be no direct economic costs to persons required to comply with the proposed rules. There will be no effect on a local economy because of the proposals, and therefore no local employment impact statement is required under §2001.022 of the Government Code. Moreover, there will be no adverse economic effect on small businesses or micro-businesses as a result of enforcing the proposed amended rules, and therefore no statement about the effect of the proposals on small businesses is required under §2006.002 of the Government Code.
Comments may be submitted in writing to Ronnie Jung, Executive Director, 1000 Red River Street, Austin, Texas 78701-2698. Written comments must be received by TRS no later than 30 days after publication of this notice.
Statutory Authority: The amendments to §41.1 and §41.7 are proposed under the authority of §1575.052, Insurance Code, which authorizes the Board to adopt rules it considers necessary to implement and administer the TRS-Care program.
Cross-reference to Statute: The proposed amendments to §41.1 and §41.7 affect Chapter 1575 of the Insurance Code, which provides for the establishment and administration of the TRS-Care program.
§41.1.Initial Enrollment Periods for the Health Benefits Program Under the Texas Public School Retired Employees Group Benefits Act (TRS-Care).
[(a) The initial enrollment
period in the health benefits program under the Texas Public School
Retired Employees Group Benefits Act (TRS-Care) for eligible Teacher
Retirement System of Texas (TRS) retirees who take a service retirement
before September 1, 2004, expires at the end of the later of:]
[(1) the 31st day after their effective retirement date; or]
[(2) the 31st day following the last day of the month in which their election to retire is received by TRS.]
(a) [(b)] The initial enrollment
period in TRS-Care for TRS retirees who take a service retirement
[after September 1, 2004, ]and who are eligible to enroll
in TRS-Care at the time of retirement expires at the end of the later of:
(1) the last day of the month that is three (3)
consecutive calendar months, but in no event less than 90 days, [
31st day] after their effective retirement date; or
(2) the last day of the month that is three (3)
consecutive calendar months [31st day] following
the last day of the month in which their election to retire is received
by TRS.
(b) [(c)] The initial enrollment
period in TRS-Care for eligible TRS disability retirees expires at
the end of the last day of the month that is three (3) consecutive
calendar months, but in no event less than 90 days, [31st
day] after the date that the disability retirement is approved
by the TRS Medical Board.
(c) [(d)] The initial enrollment
period in TRS-Care for a surviving spouse and a surviving dependent
child of an eligible retiree expires at the end of the later of:
(1) the 31st day after the end of the month in which the eligible retiree died; or
(2) the 31st day after the date of the notice of eligibility that is sent to the surviving spouse or the surviving dependent child at the individual's last known address, as shown in the TRS-Care records.
(d) [(e)] The initial enrollment
period for a surviving spouse of a deceased active member and for
a surviving dependent child, as both are defined by §1575.003,
Insurance Code, expires at the end of the later of:
(1) the 31st day after the end of the month in which the active member died; or
(2) the 31st day following the date of the notice of opportunity to enroll that is sent to the surviving spouse or the surviving dependent child at the individual's last known address, as shown in the TRS-Care records.
(e) [(f)] Notwithstanding the
other provisions of this section:
(1) A retiree may enroll a new spouse within 31 days of the date on which the retiree marries;
(2) A retiree or surviving spouse may enroll a child who becomes a dependent as defined by §1575.003, Insurance Code, within 31 days after the date on which the child becomes a dependent eligible for coverage under TRS-Care; and
(3) A participant shall be entitled to all applicable COBRA rights under the Federal Public Health Service Act.
(f) [(g)] If a retiree or surviving
spouse fails to enroll a newly eligible spouse or dependent child
within the time periods set out in subsection (e) [
(f)] of this section, the retiree or surviving spouse will not be able
to enroll the spouse or dependent child in TRS-Care until a subsequent
enrollment period.
§41.7.Effective Date of Coverage.
(a) Except as allowed by subsection (c) [(b)
] of this section, for TRS members who take a service or disability
retirement and enroll in coverage during their initial enrollment
period as described in §41.1 of this title (relating to Initial
Enrollment Periods for the Health Benefits Program Under the Texas
Public School Retired Employees Group Benefits Act (TRS-Care)), the
effective date of coverage is:
(1) the first day of the month following the effective date of retirement if the application for coverage is received by TRS-Care on or before the effective retirement date; or
(2) the first day of the month following the receipt of the application for coverage by TRS-Care if the application is received after the effective retirement date but within the initial enrollment period.
(b) A TRS member who takes a service or disability retirement and enrolls in coverage during his or her initial enrollment period may, at any time during his or her initial enrollment period, make changes to his or her coverage elections. The effective date of coverage for the new elections is the first day of the month following receipt by TRS-Care of the application requesting the change in coverage.
(c) [(b)] Regardless of the date
a TRS member submits his application for retirement, if a TRS member
enrolls in coverage during his initial enrollment period as described
in §41.1 of this title, the TRS member may defer the effective
date of coverage described in subsection (a) of this section for himself
and his eligible dependents to the first day of any of the three (3)
months immediately following the month after the effective date of
retirement. This deferment period runs concurrent with, and does
not extend, the enrollment period as described in §41.1 of this
title. In [Notwithstanding the preceding sentence, in]
no event may a TRS member defer the effective date of TRS-Care coverage
to a date prior to the date upon which TRS-Care receives the application
for coverage from the TRS member.
(d) [(c)] The effective date
of coverage for a surviving spouse or for a surviving dependent child
is the first day of his or her eligibility if TRS-Care receives an
application within the initial enrollment period as described in §41.1
of this title and the deceased participant had the surviving spouse
or the surviving dependent child enrolled in TRS-Care before the participant died.
(e) [(d)] If the surviving spouse
or the surviving dependent child was not enrolled in TRS-Care immediately
preceding his or her becoming eligible for coverage, the effective
date of coverage will be, at the election of the surviving spouse
or the surviving dependent child, either the first day of the month
following:
(1) TRS-Care's receipt of an application during the initial enrollment period as described in §41.1 of this title; or
(2) the month of the death of the deceased TRS service or disability retiree or deceased active TRS member, provided TRS-Care receives an application during the initial enrollment period as described in §41.1 of this title.
(f) [(e)] The effective date
of coverage for an eligible dependent who is enrolled under a retiree's
or surviving spouse's TRS-Care coverage during the initial enrollment
period is the same date as the retiree or surviving spouse's effective
date of coverage unless the dependent is enrolled after the retiree's
effective retirement date and after the retiree has enrolled but within
the initial enrollment period, in which case the dependent's effective
date of coverage will be the first day of the month following TRS-Care's
receipt of the application to enroll the dependent.
(g) [(f)] The effective date
of coverage for an eligible dependent who is enrolled under a retiree's
or surviving spouse's TRS-Care coverage as a result of a special enrollment
event, as described in and limited by §41.2(b) of this title
(relating to Additional Enrollment Opportunities), is the date specified
under the provisions of the Health Insurance Portability and Accountability
Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)).
(h) [(g)] The effective date
of coverage for a retiree, a surviving spouse, and an eligible dependent
described in [paragraph (2) or (3) of] §41.2(a)
(2) or (3) of this title [
(relating to Additional Enrollment
Opportunities)] who submit an application within the time period
described by §41.2(a)(8) of this title [
(relating to Additional Enrollment Opportunities)] is:
(1) the first day of the month following the retiree's or surviving spouse's 65th birthday if the application for coverage is received by TRS-Care on or before the retiree's or surviving spouse's 65th birthday; or
(2) the first day of the month following the receipt of the application by TRS-Care if the application is received after the retiree's or surviving spouse's 65th birthday but within the enrollment period.
(i) [(h)] Except as provided
in subsections (l), (m), and (n) [
(k), (l), and (m)]of this section, the effective date of changes in coverage due to
the acquisition of Medicare is the first of the month following the
date of TRS-Care's receipt of a copy of the participant's or dependent's
Medicare card.
(j) [(i)] Except as provided
in subsections (l), (m), and (n) [
(k), (l), and (m)]of this section, the effective date of reduction in coverage shall
be the first day of the month following TRS-Care's receipt of a signed
request for reduced coverage.
(k) [(j)] A retiree, surviving
spouse, or surviving dependent child may cancel any coverage by submitting
the appropriate cancellation notice to TRS-Care. Cancellations will
be effective on:
(1) the first day of the month following the date printed on the notice of cancellation form ("notice date") sent to the retiree at the retiree's last known address, as shown in the TRS-Care records, if TRS-Care receives the completed notice of cancellation within fourteen days of the notice date; or
(2) the first day of the month following TRS-Care's receipt of the retiree's completed notice of cancellation form if the form is received more than fourteen calendar days after the notice date; or
(3) the first day of the month following TRS-Care's receipt of a written request to cancel coverage from a surviving spouse or from or on behalf of a surviving dependent child.
(l) [(k)] Where a participant
who has Medicare Part A coverage incorrectly enrolls in an insurance
coverage option that provides for coverage without corresponding Medicare
Part A coverage and payment is made by Medicare and TRS-Care in a
manner that violates the provisions of Chapter 1575, Insurance Code,
which requires TRS-Care to be secondary to Medicare, TRS may seek
the recovery of funds paid in violation of Chapter 1575 and may make
the effective date of the correct coverage retroactive to the first
day of the earliest month for which recovery of such overpaid funds
is possible under Medicare rules.
(m) [(l)] Where a participant
who has Medicare Part A coverage incorrectly enrolls in a TRS-Care
coverage option that provides for coverage without corresponding Medicare
Part A and there is no claim made upon TRS-Care or the legitimate
claim is less than the amount of overpaid contributions, TRS-Care
may refund or credit the amount due to the participant and may make
the effective date of the correct coverage retroactive to when the
participant was first enrolled in both Medicare and TRS-Care to a
maximum retroactive period of twelve months, including the month in
which proof of Medicare Part A is received by TRS-Care.
(n) [(m)] Upon TRS-Care's discovery
that a participant does not have Medicare Part A coverage and is incorrectly
enrolled in a TRS-Care coverage option that requires Medicare Part
A coverage, TRS-Care will contact the participant and advise the participant
that the cost of coverage and the coverage will be adjusted prospectively
effective the first day of the next month unless a copy of a Medicare
card showing Part A coverage is received prior to that date. Claims
will be paid based upon the coverage in effect at the time the services
were provided. Any claims already paid as if Part A were in effect
will not be adjusted.
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 July 1, 2009.
TRD-200902731
Ronnie G. Jung
Executive Director
Teacher Retirement System of Texas
Earliest possible date of adoption: August 16, 2009
For further information, please call: (512) 542-6438
CHAPTER 302. GENERAL PROVISIONS RELATING TO THE TEXAS EMERGENCY SERVICES RETIREMENT SYSTEM
The State Board of Trustees of the Texas Emergency Services Retirement System (System) proposes new rule, 34 TAC §302.6, providing for an interest charge on certain past-due contributions from departments participating in the System.
The new rule would impose an interest charge, based on the retirement system's current assumed rate of investment return, on contributions that are owed the System because of the correction of an error in enrollment of a member or crediting service to a member if the error was the fault of a department participating in and reporting to the System and not of the System itself.
Lisa Ivie Miller has determined as a result of adoption of the proposed new rule, for the first five years there would be no cost to state or local governments that perform their responsibilities to the System as required by current law. A cost would be incurred by those local governments that participate in the System and fail to enroll members or certify retirement credit as required by current law, but there would be no loss of revenue to local governments. Recovery of the cost would partially reimburse the System for the benefits payable by the System and potentially reduce statutory liability for state contributions.
Ms. Miller has also determined that the public benefit for the first five years that the new rule would be in effect would be to ensure that the System recovers, for the benefit of members and annuitants, a portion of the costs incurred from not being able to invest contributions at the time that they are otherwise due under the law.
Small businesses or individuals would not be affected by the adoption of the proposed new rule.
Comments on the proposed rule may be submitted in writing to Lisa Ivie Miller, Commissioner, Office of the Fire Fighters' Pension Commissioner, P.O. Box 12577, Austin, Texas 78711-2577, not later than August 21, 2009. Comments may also be submitted electronically to rules@ffpc.state.tx.us or faxed to (512) 936-3480.
The new rule is proposed under the statutory authority of §863.005, Government Code, which takes effect September 1, 2009. No other statutes, articles, or codes are affected by the proposed new rule.
§302.6.Charge for Certain Contributions Past Due.
(a) A participating department is liable for the payment of an interest charge if the correction of an error results in the enrollment of, or the crediting of qualified service to, a member who previously was entitled to be enrolled or granted credit for qualified service and the error was the omission of the participating department and not the pension system.
(b) An interest charge assessed under this section is calculated on the amount of local contributions due because of the correction of the error and based on the pension system's assumed rate of return as recommended by the actuary, adopted by the State Board of Trustees, and in effect on the date the correction is made, and is compounded annually. The charge is assessed from the date the local contributions would have been made except for the error to the date the correction is made.
(c) An interest charge assessed under this section becomes payable with the first quarterly payment that becomes due after the date of assessment. This section does not apply to an error corrected before October 1, 2009.
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 July 1, 2009.
TRD-200902729
Kevin Heyburn
Assistant Attorney General
Office of the Fire Fighters' Pension Commissioner
Earliest possible date of adoption: August 16, 2009
For further information, please call: (512) 463-9935