34 TAC §§41.33 - 41.35
The Teacher Retirement System of Texas (TRS) adopts on an
emergency basis new §§41.33, 41.34 and 41.35 concerning the Texas
School Employees Uniform Group Health Coverage Program ("Program"). The new
sections relate to definitions, eligibility requirements and coverage plans.
The new sections are adopted on an emergency basis pursuant to §2001.034
of the Government Code, which allows a state agency to adopt an emergency
rule if a requirement of state or federal law requires adoption of the rule
on less than 30 days notice.
In accordance with Insurance Code article 3.50-7, the new sections set
forth definitions, coverage plans and eligibility criteria. Among other things,
the sections provide notice to participating entities and their employees
of the requirements for eligibility in the Program.
This emergency adoption is necessary because TRS is required to comply
with timelines under House Bill 3343, 77th Legislature, including Insurance
Code article 3.50-7 and sections 5.01 through 5.07 of Acts 2001, 77th Leg.,
ch. 1187 including requirements in section 5.01 that TRS develop coverage
plans "with coverage beginning September 1, 2002." Printed materials reflecting
criteria in the new sections must be completed in March 2002 so that enrollment
can proceed and coverage can begin September 1. Accordingly, TRS finds that
the requirements of state law require the adoption of the new sections on
fewer than 30 days notice.
The new sections are adopted on an emergency basis under the
Government Code, Chapter 825, §825.102, which authorizes the Board of
Trustees of the Teacher Retirement System to adopt rules for, among other
things, the transaction of business of the board. The new sections are also
adopted under House Bill 3343, which was passed by the 77th Legislature, 2001,
including Insurance Code article 3.50-7, which authorizes TRS to adopt rules
relating to various matters including coverage plans and applicable definitions.
Insurance Code article 3.50-7, §3(c) further authorizes TRS, as trustee,
to "adopt rules relating to the program as considered necessary by the trustee."
As described above, the sections are also adopted under Government Code §2001.034.
There are no other codes affected.
§41.33. Definitions Applicable to the Texas School Employees Uniform Group Health Coverage Program.
The following words and terms when used in subchapter C or in connection
with the administration of Insurance Code §3.50-7 shall have the following
meanings unless the context clearly indicates otherwise.
(1)
Full-time employee -- A participating member who:
(A)
is currently employed by a participating entity;
(B)
is eligible for TRS membership based on current full-time
service as described by §25.1 of this title (relating to Full-Time Service),
or based on current employment as a bus driver as described by §25.2
of this title (relating to Bus Drivers); and
(C)
is not receiving coverage as an employee or retiree of
an institution that participates in a uniform group insurance program under
the Texas Employees Uniform Group Insurance Benefits Act (Insurance Code article
3.50-2) or the Texas State College and University Employees Uniform Group
Insurance Benefits Act (Insurance Code article 3.50-3) or the Texas Public
School Employees Group Insurance Program established under Insurance Code
article 3.50-4 (TRS-Care).
(2)
Participating entity -- An entity participating in the
TRS-ActiveCare program including a school district; another educational district
whose employees are members of the retirement system; a regional education
service center; and a charter school that meets the requirements of Insurance
Code article 3.50-7. An entity is considered to be participating in the TRS-ActiveCare
program on and after the first date coverage becomes effective for its employees.
(3)
Participating member -- A person defined by Government
Code §§822.001 and 822.002 whose membership in the retirement system
has not been terminated as described by Government Code §§822.003
- 822.006 and who is currently contributing to the Teacher Retirement System
of Texas pension trust fund in accordance with Government Code §825.403.
(4)
Part-time employee -- An individual who:
(A)
is neither a participating member nor a full-time employee;
(B)
is currently employed by a participating entity for 10
hours or more each week; and
(C)
is not receiving coverage as an employee or retiree of
an institution that participates in a uniform group insurance program under
the Texas Employees Uniform Group Insurance Benefits Act (Insurance Code article
3.50-2) or the Texas State College and University Employees Uniform Group
Insurance Benefits Act (Insurance Code article 3.50-3) or the Texas Public
School Employees Group Insurance Program established under Insurance Code
article 3.50-4 (TRS-Care).
(5)
TRS-ActiveCare program -- The Texas School Employees Uniform
Group Health Coverage Program established by Insurance Code article 3.50-7.
(6)
Trustee or TRS -- The Teacher Retirement System of Texas
acting in its capacity as trustee under Insurance Code article 3.50-7.
§41.34. Eligibility for Coverage under the Texas School Employees Uniform Group Health Coverage Program.
The following persons are eligible to be enrolled in the TRS-ActiveCare
program under terms, conditions and limitations established by the trustee
unless expelled from the program under provisions of Insurance Code article
3.50-7.
(1)
A full-time employee as defined in §41.33 of this
title (relating to Definitions Applicable to the Texas School Employees Uniform
Group Health Coverage Program).
(2)
A part-time employee as defined in §41.33 of this
title (relating to Definitions Applicable to the Texas School Employees Uniform
Group Health Coverage Program).
(3)
Dependents, as defined under Insurance Code article 3.50-7,
section 2(3)(A), (B) or (C), of either a full-time employee or a part-time
employee. A child defined in Insurance Code article 3.50-7, section 2(3)(C)
is eligible for coverage only if, and only for so long as, such child's mental
retardation or physical incapacity is a medically determinable condition that
prevents the child from engaging in self-sustaining employment as determined
by TRS.
(4)
Individuals employed or formerly employed by a participating
entity, and their dependents, who are eligible for, or participating in, continuation
coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985
(Pub. L. 99-272), through a group health benefit plan sponsored by the individual's
employer on the first day that employer becomes a participating entity if
such individuals or their dependents would have met the requirements for eligibility
in paragraphs (1), (2), or (3) of this section on the individual's last day
of employment with the participating entity.
(5)
Individuals who become eligible as determined by TRS for
continuation coverage under the Consolidated Omnibus Budget Reconciliation
Act of 1985 (Pub. L. No. 99-272), through their participation in the TRS-ActiveCare
program.
(6)
Individuals who become eligible for coverage under provisions
of the Health Insurance Portability and Accountability Act of 1996 (Pub. L.
No. 104-191, 110 Stat. 1936 (1996)) (HIPAA), except for any provisions of
HIPAA from which TRS has elected to be exempt in accordance with its status
as a self-insured non-Federal governmental plan.
(7)
Any other individuals who are required to be covered under
applicable law.
§41.35.Coverage Plans.
(a)
The TRS-ActiveCare program shall include at least three
coverage plans including a catastrophic care coverage plan and a primary care
coverage plan, in accordance with Insurance Code article 3.50-7. The coverages
provided for eligible persons under the three plans will include, but are
not limited to, basic medical expense coverage and prescription drug coverage,
in accordance with terms, conditions, and limitations adopted by resolution
of the trustee.
(b)
The TRS-ActiveCare program may also include additional
plans for health-care coverage under terms, conditions and limitations adopted
by resolution of the trustee.
(c)
The coverage plans offered under the TRS-ActiveCare program
will each include at least two of the following rating tiers:
(1)
Employee only;
(2)
Employee and spouse;
(3)
Employee and children;
(4)
Employee and family.
(d)
TRS may offer optional coverages that may include but are
not limited to life, dental care, eye care, long-term care, disability, or
other coverages considered advisable to eligible persons in accordance with
terms, conditions and limitations adopted by resolution of the trustee.
This agency hereby certifies that the emergency adoption
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 February 26, 2002.
TRD-200201187
Charles Dunlap
Executive Director
Teacher Retirement System of Texas
Effective Date: February 26, 2002
Expiration Date: July 24, 2002
For further information, please call: (512) 542-6115