34 TAC §41.30
The Teacher Retirement System of Texas (TRS) proposes amendments
to §41.30, concerning participation in the Texas School Employees Uniform
Group Health Coverage Program ("TRS-ActiveCare") by school districts, other
educational districts, charter schools, and regional education service centers.
In addition to proposed changes to improve administrative efficiency and
technical revision, the proposed amendments extend deadlines for certain entities
to elect to participate in TRS-ActiveCare under certain circumstances. The
proposed amendments would allow certain larger school districts to elect to
participate in TRS-ActiveCare under certain circumstances. In addition, the
proposed amendments provide certain entities that elected not to participate
in the program with the opportunity to change that election if certain criteria
are met.
Tony Galaviz, Chief Financial Officer, has determined that for each year
of the first five year period the proposal is in effect there will be no foreseeable
fiscal implication to state and local governments as a result of enforcing
or administering the section. There is no foreseeable effect on local employment
or local economies as a result of the proposed section. 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 proposal is in effect the public benefit anticipated as a result of the
section 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 persons required to comply with the proposed
section.
Comments on the proposal may be submitted to Charles L. Dunlap, Executive
Director, 1000 Red River, Austin, Texas 78701.
The amendments are proposed 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 amendments are also proposed 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 to administer the
Program. 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.
There are no other laws affected by this proposed amendment.
§41.30.Participation in the Texas School Employees Uniform Group Health Coverage Act (TRS-ActiveCare) by School Districts, Other Educational Districts, Charter Schools, and Regional Education Service Centers.
(a)
Manner, form and effect of election. All elections to opt
in or opt out of participation in the uniform group coverage under the Texas
School Employees Uniform Group Health Coverage Act (the "Act") (TRS-ActiveCare)
pursuant to the provisions of Insurance Code, Article 3.50-7, [
§§5
or 6,
] as added by the 77th Legislature, 2001 in House Bill 3343
and as permitted by the Teacher Retirement System of Texas (TRS), as trustee
of the program,
shall be in writing,
in a
[
on an election
] form prescribed
by TRS
[
by the Teacher Retirement System
of Texas ("TRS"),
] and received by TRS no later than 5:00 p.m. on or
before the applicable election deadline date specified in this section.
A notice of
[
An
] election [
form
] otherwise valid
received by facsimile before the applicable deadline is acceptable if TRS
receives the original, signed
notice of
election [
form
]
within seven calendar days after the applicable deadline. An incomplete or
unsigned
notice of election
[
form
] will not be deemed
received by TRS for purposes of determining whether a valid election has been
exercised. A valid election filed with TRS is irrevocable once the election
deadline passes, unless TRS is authorized to extend a deadline and does so
by resolution of the TRS Board of Trustees. Entities electing to participate
in
the TRS-ActiveCare program
[
the uniform group coverage
under the Act
] may not discontinue participation unless authorized by
Insurance Code, Article 3.50-7, and by appropriate rule or resolution adopted
by the TRS Board of Trustees. Entities opting out of participation in the
TRS-ActiveCare program
[
uniform group coverage under the Act
]
have no further opportunity to elect to participate except as authorized by
Insurance Code, Article 3.50-7, and by appropriate rule or resolution adopted
by the TRS Board of Trustees. If an entity has an option to opt in and thereby
participate in the
TRS-ActiveCare program,
[
coverage under
the Act,
] a failure to properly or timely file
a notice of
[
the
] election [
form
] shall have the effect of the entity
electing not to participate. Likewise, if an entity has an option to opt out
and thereby not participate in the
TRS-ActiveCare program,
[
coverage under the Act,
] a failure to properly or timely file
a notice of
[
the
] election [
form
] shall have the
effect of the entity electing to participate.
(b)
School districts with 500 or fewer employees. Pursuant
to Insurance Code, Article 3.50-7 §5(a), school districts with 500 or
fewer employees as of January 1, 2001 are required to participate effective
September 1, 2002 in the
TRS-ActiveCare program,
[
uniform group
coverage under the Act,
] except that certain of these school districts
may delay or opt out of participation by specified election deadlines as provided
in paragraphs (1) through (3) of this subsection. [
On or before September
1, 2001, all school districts must furnish information and verifications requested
by TRS on the form prescribed by TRS, regardless of whether an election to
delay or opt out of participation applies to such district or is being exercised
by such school district.
]
(1)
Pursuant to Insurance Code, Article 3.50-7 §5(g),
a school district with 500 or fewer employees as of January 1, 2001 that,
on January 1, 2001, was individually self-funded for the provision of health
care coverage to its employees may elect to opt out of the mandatory participation
in
the TRS-ActiveCare program
[
coverage
] effective September
1, 2002, by filing its
notice of
election [
form
] with
TRS on or before September 1, 2001.
Subsection (h) of this section provides
the method for a school district to change its election.
(2)
Pursuant to Insurance Code, Article 3.50-7 §5(e),
a school district with 500 or fewer employees as of January 1, 2001 that was
a member on January 1, 2001 of a risk pool established under the authority
of Local Government Code, Chapter 172, may opt out of the mandatory participation
in
the TRS-ActiveCare program
[
coverage
] effective September
1, 2002 by filing its
notice of
election [
form
] with
TRS on or before September 1, 2001 and electing thereby to continue in the
risk pool that the district participated in on January 1, 2001.
Subsection
(h) of this section provides the method for a school district to change its
election.
(3)
Pursuant to Insurance Code, Article 3.50-7 §5(h),
a school district with 500 or fewer employees as of January 1, 2001
,
other than a qualifying district as defined in subsection (b)(3)(B) of this
section,
that is a party to a contract for the provision of health insurance
coverage to the employees of the district that is in effect on September 1,
2002 may delay mandatory participation in
the TRS-ActiveCare program
[
coverage
] effective September 1, 2002, by filing its
notice of
election with TRS on or before September 1, 2001.
(A)
A qualifying school district,
as defined in subsection (b)(3)(B) of this section, may delay mandatory participation
in the TRS-ActiveCare program effective September 1, 2002, by filing its notice
of election with TRS on or before 5:00 p.m., Central Time, on August 15, 2002.
(B)
A qualifying school district
is one that meets the following criteria:
(i)
had 500 or fewer employees as of January 1,
2001;
(ii)
made available to its employees in the 2001-2002
school year one or more plans of comparable coverage as determined by the
TRS comparability report for the 2001-2002 school year; and
(iii)
reflected in its comparability compliance
report to TRS that at least 50% of the district's aggregate employees covered
by plans offered by the district in the 2001-2002 school year were participating
in the comparable plan(s) made available by the district.
(C)
At the time of
an election under subsection
(b)(3) of this section,
[
such election,
] such a school district
must provide the expiration date of the contract to TRS and shall begin mandatory
participation in the
TRS-ActiveCare program
[
uniform group
coverage under the Act
] on the first day of the month immediately following
the month in which termination or expiration of the contract occurs.
(c)
School districts with 501 or more
employees but not
more than 1000
employees.
School
[
Pursuant to Insurance
Code, Article 3.50-7 §5(b), school
] districts with 501 or more
employees
but not more than 1000 employees at any time during the 2001
school year, as reflected on any report received by TRS for a reporting period
during that school year
[
on January 1, 2001
] may elect to
participate in the
TRS-ActiveCare program in the manner prescribed in
subsection (h) of this section.
[
uniform group coverage under the
Act, with coverage effective September 1, 2005. January 1, 2005 is the deadline
for such a school district to file its election with TRS to participate in
the uniform group coverage under the Act. Notwithstanding the preceding two
sentences, school districts with 501 or more employees may elect to participate
prior to September 1, 2005 as set forth in paragraphs (1) and (2) of this
subsection. All school districts must furnish information and verifications
to TRS on or before September 30, 2001 on a form prescribed by TRS, regardless
of whether an election to participate prior to September 1, 2005 applies to
such district or is being exercised by such district.
]
[
(1)
Pursuant to Insurance Code,
Article 3.50-7 §5(b-1), school districts may elect to participate prior
to September 1, 2005 if TRS determines that participation prior to September
1, 2005 by school districts with more than 500 employees on January 1, 2001
would be administratively feasible and cost-effective. TRS will set the election
deadline from time to time by rule or resolution of the TRS Board of Trustees,
as applicable.]
[
(2)
Pursuant to Insurance Code,
Article 3.50-7 §5(a-1), September 30, 2001 is the deadline for a school
district with at least 501 but not more than 1,000 employees on January 1,
2001 to file its election to commence participation effective September 1,
2002. A school district that does not elect to opt in early and participate
effective September 1, 2002, may elect in the future to opt in if otherwise
permitted under this subsection.]
(d)
School districts with 1001
or more employees. A school district with 1001 or more employees at any time
during the 2001 school year, as reflected on any report received by TRS for
a reporting period during that school year, may elect to participate in the
TRS-ActiveCare program, provided that notice of its election shall be in a
form prescribed by TRS and shall be received by TRS at its offices on or after
November 22, 2002, in which event the school district will become a participating
entity on the later of the first day of the month following (6) months after
the date on which TRS receives the notice or a preferred date specified by
the school district in its notice. Alternatively, the district will become
a participating entity effective on the date approved by the Executive Director,
if applicable, as described in subsection (i) of this section.
(e)
[
(d)
] Educational districts. Pursuant
to Insurance Code, Article 3.50-7 §5(i), educational districts whose
employees are members of TRS are required to participate effective September
1, 2002 in the
TRS-ActiveCare program,
[
uniform group coverage
under the Act,
] except that educational districts with 500 or fewer
employees on January 1, 2001 may opt out of participation. September 1, 2001
is the deadline for such an educational district to file its
notice of
election with TRS to opt out of participation in the
TRS-ActiveCare
program.
[
uniform group coverage under the Act. Regardless of whether
an educational district elects to opt out of participation and file an election
form, information and verifications requested by TRS must be furnished by
all educational districts on the form prescribed by TRS and returned to TRS
on or before September 1, 2001.
]
Subsection (h) of this section
provides a method for an educational district to change its election.
(f)
[
(e)
] Charter schools. Pursuant to
Insurance Code, Article 3.50-7 §6, an open-enrollment charter school
established under Education Code, Chapter 12, Subchapter D, ("charter school")
may elect to participate in the
TRS-ActiveCare program.
[
uniform group coverage under the Act.
] Only an eligible charter school
under the Act
may elect to participate. [
A charter school that
received funding in accordance with Education Code, Chapter 12, prior to June
1, 2001, must furnish information and verifications requested by TRS, on the
form prescribed by TRS, on or before September 1, 2001, whether or not the
charter school elects to participate in the uniform group coverage.
]
(1)
Pursuant to Insurance Code, Article 3.50-7 §6(a),
to be eligible, a charter school must agree to inspection of all records of
the school relating to its participation in the
TRS-ActiveCare program
[
uniform group coverage under the Act
] by TRS, by the administering
firm as defined in Insurance Code, Article 3.50-7 §2(1), by the commissioner
of education, or by a designee of any of those entities, and further must
agree to have its accounts relating to participation in the
TRS-ActiveCare
program
[
uniform group coverage under the Act
]annually audited
by a certified public accountant at the school's expense. The agreement of
the charter school shall be evidenced in writing and shall constitute a part
of
a notice of
[
the
] election [
form
] prescribed
by TRS pursuant to subsection (a) of this section.
[
(2)
Pursuant to Insurance Code,
Article 3.50-7 §6(b), an eligible charter school shall elect to participate
in the uniform group coverage under the Act effective September 1, 2002, by
filing its election form with TRS on or before September 1, 2001 if the charter
school received any state funding in accordance with Education Code, Chapter
12, prior to June 1, 2001. ]
[
(3)
Pursuant to Insurance Code,
Article 3.50-7 §6(b), an eligible charter school that did not receive
any state funding in accordance with Education Code, Chapter 12, prior to
June 1, 2001, shall elect, if at all, to participate in the uniform group
coverage under the Act by filing its election form with TRS on or before the
later of September 1, 2001 or the ninetieth calendar day following the date
the Texas Education Agency authorized the Comptroller to issue the first payment
of state funds to such charter school. Participation in coverage for such
eligible charter school shall be effective on the later of September 1, 2002
or the first day of the month following the month in which a valid election
to participate is filed with TRS. ]
(2)
This paragraph applies only
to charter schools eligible to participate in the TRS-ActiveCare program that
either received state funding in accordance with Education Code, Chapter 12,
prior to June 1, 2001, and did not file a notice of election to participate
on or before September 1, 2001, or received or will receive state funding
in accordance with Education Code, Chapter 12, on or after June 1, 2001, and
did not or do not file a notice of election to participate on or before the
later of September 1, 2001 or the ninetieth calendar day following the date
the Texas Education Agency authorized the Comptroller to issue the first payment
of funds to such charter school, so long as the ninetieth calendar day is
no later than June 30, 2003. Those eligible charter schools may elect to opt
into and participate in the TRS-ActiveCare program by filing a notice of election
in a form prescribed by TRS and received by TRS in its offices no later than
5:00 p.m., Central Time, on July 1, 2003, in which event the charter school
will become a participating entity no later than the first day of the month
following sixty (60) days after the date on which TRS receives the notice.
(3)
Eligible charter schools that
do not elect to participate in the TRS-ActiveCare program pursuant to subsection
(f)(2) of this section may opt into and participate in the TRS-ActiveCare
program by filing a notice of election in a form prescribed by TRS and received
by TRS in its offices at any time or date after 5:00 p.m., Central Time, on
July 1, 2003, in which event the charter school will become a participating
entity on the later of the first day of the month following six (6) months
from the date on which TRS receives the notice or a preferred date specified
by the charter school. Alternatively, the eligible charter school will become
a participating entity effective on the date approved by the Executive Director,
if applicable, as described in subsection (i) of this section.
(g)
[
(f)
] Regional education service
centers. Pursuant to Insurance Code, Article 3.50-7 §5(a), each regional
education service center established under Education Code, Chapter 8, is required
to participate effective September 1, 2002 in the
TRS-ActiveCare program.
[
uniform group coverage under the Act. Information and verifications
requested by TRS must be furnished by each regional education service center
on the form prescribed by TRS and returned to TRS on or before September 1,
2001.
]
(h)
School districts described
in subsection (b)(1), (b)(2), or (c) of this section, and educational districts
described in subsection (e) of this section may opt into and participate in
the TRS-ActiveCare program as follows:
(1)
By filing a notice of election in a form prescribed
by TRS and received by TRS in its offices no later than 5:00 p.m., Central
Time, on July 1, 2003, in which event the district will become a participating
entity no later than the first day of the month following sixty (60) days
from the date that TRS receives the notice; or
(2)
By filing a notice of election in a form prescribed
by TRS and received by TRS in its offices at any time or date after 5:00 p.m.,
Central Time, on July 1, 2003, in which event the district will become a participating
entity on the later of the first day of the month following six (6) months
from the date on which TRS receives the notice or a preferred date specified
by the school district; or
(3)
By complying with subsection (i) of this section.
(i)
An entity that will become
a participating entity in the TRS-ActiveCare program on the first day of the
month following six (6) months after the date on which TRS receives the entity's
notice of election but desires to become a participating entity on an earlier
date may include in its notice a request that the Executive Director consider
an exception to the notice requirement. The notice must include the earlier
date on which the entity desires its coverage to begin. The Executive Director
will grant the exception if, in his or her sole discretion, upon considering
the following criteria, he or she finds that an exception is in the best interest
of the TRS-ActiveCare program:
(1)
the impact on the requesting entity's employees
and dependents;
(2)
the impact on the TRS-ActiveCare program's third-party
administrator;
(3)
the impact on the TRS-ActiveCare program's provider
network;
(4)
the number of potential enrollees that would
be coming into the TRS-ActiveCare program for the first time on the same date;
and
(5)
the impact on the TRS-ActiveCare program as
a whole, taking into account any recommendations and observations of TRS's
health care consultant.
[
(g)
This section becomes effective
at the earliest date permitted by law, but not later than September 1, 2001.]
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 April 7, 2003.
TRD-200302283
Charles L. Dunlap
Executive Director
Teacher Retirement System of Texas
Proposed date of adoption: May 23, 2003
For further information, please call: (512) 542-6115
34 TAC §41.45
The Teacher Retirement System of Texas (TRS) proposes new §41.45,
concerning required information from school districts with more than 1,000
employees that elect to participate in the Texas School Employees Uniform
Group Health Coverage Program (TRS-ActiveCare").
Proposed new §41.45 would require school districts that had more than
1,000 employees as reflected on any report submitted to TRS during the 2001
school year to submit certain information to TRS when the district submits
its notice of election to participate in TRS-ActiveCare or within fifteen
calendar days after receiving notification from TRS. The proposal would require
that such a school district submit aggregate information for each medical
and prescription drug plan that the school district had for the plan year
to date for the year in which the school district submits its notice of election,
as well as for the prior two complete plan years. Alternatively, if a school
district cannot obtain this information from its insurer or third-party administrator,
the proposal would require that it submit a letter from the insurer or third-party
administrator in which the insurer or third-party administrator represents
that it cannot legally provide the information to the district. The proposal
indicates that TRS will not deny a school district's request to participate
in TRS-ActiveCare based on any information provided. However, it will permit
TRS to delay the effective date of a district's participation in TRS-ActiveCare
if the district fails to submit the required information. Finally, the proposed
rule would allow TRS to specify the format in which the school district must
submit the required information.
Tony Galaviz, Chief Financial Officer, has determined that for each year
of the first five year period the proposed rule is in effect there will be
no foreseeable fiscal implications to state and 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 rule. There
is no anticipated adverse economic effect on small businesses or micro-businesses
as a result of compliance with the proposed new rule.
Mr. Galaviz has also determined that for each year of the first five years
the proposed rule is in effect the public benefit anticipated as a result
of the rule will be that affected school districts will have notice of these
requirements and that TRS will be able to set appropriate premium rates for
TRS-ActiveCare. Mr. Galaviz has determined that there are no anticipated economic
costs to persons required to comply with the proposed rule.
Comments on the proposal may be submitted to Charles L. Dunlap, Executive
Director, 1000 Red River, Austin, Texas 78701.
The new section is proposed 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 section is also proposed 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 to administer the
Program. 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.
There are no other laws affected by the new rule.
§41.45.Required Information from School Districts with More than 1,000 Employees
(a)
When a large school district, as defined in subsection
(b) of this section, submits its notice of election or within 15 calendar
days after receiving notice from TRS staff, the large school district must
submit to TRS the information listed in the following paragraphs for each
medical and prescription drug plan that the large school district offered
to its employees during the designated time period. Large school districts
must include this information for the year to date for the plan year in which
the large school district submits its notice of election (current year) and
for the two complete plan years immediately preceding the current year. The
required information is:
(1)
Plan type (PPO, POS, HMO, etc.), including the effective
date of each plan;
(2)
Average number of employees participating in each plan;
(3)
Average number of covered lives in each plan;
(4)
Description of all medical and prescription drug benefits,
including effective dates of any changes in each plan;
(5)
Total premium rates by family tier for each insured plan,
including effective dates of any changes;
(6)
Total COBRA rates by family tier for each self-funded plan,
including effective dates of any changes;
(7)
Required employee contribution rates by family tier for
each plan, including effective dates of any changes;
(8)
Funding arrangement (fully insured, self-funded, etc.)
for each plan;
(9)
Total premiums paid by year for each plan, if insured;
and
(10)
Total claims paid by year for each plan.
(b)
For purposes of this section, a large school district means
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)
If a large school district cannot obtain the information
required under subsection (a) of this section, the large school district must
obtain a letter from the insurer or third-party administrator stating that
the insurer or third-party administrator cannot legally provide that information
to the large school district. The large school district must submit that letter
to TRS in lieu of the requested information in subsection (a) of this section.
(d)
TRS will not deny a large school district's request to
participate in TRS-ActiveCare based on any information provided to TRS in
accordance with the requirements of this section.
(e)
TRS may delay a large school district's effective date
of participation in TRS-ActiveCare if the school district does not provide
the information required by this section within the time frames prescribed
in subsection (a) of this section.
(f)
TRS may prescribe the form in which large school districts
must submit the information required by this section.
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 April 7, 2003.
TRD-200302282
Charles L. Dunlap
Executive Director
Teacher Retirement System of Texas
Proposed date of adoption: May 23, 2003
For further information, please call: (512) 542-6115