34 TAC §41.36, §41.37
The Teacher Retirement System of Texas (TRS) proposes amendments
to §41.36 and §41.37 concerning the Texas School Employees Uniform
Group Health Coverage Program ("Program"). In accordance with Insurance Code
article 3.50-7, the proposed amendments set forth enrollment timelines and
the effective dates of coverage for participants in the Program.
The proposed amendments to §41.36 change the initial enrollment period
for employees whose employer is becoming a participating entity in TRS-ActiveCare
for the first time and clarify the enrollment period for employees who work
for a participating entity who become employed in an eligible position for
the first time. The proposed amendment to §41.37 makes a corresponding
change to the effective date of coverage for eligible full-time and part-time
employees whose employer becomes a participating entity in TRS-ActiveCare
for the first time.
Tony Galaviz, Chief Financial Officer, has determined that for each year
of the first five year period the proposals are in effect there will be no
foreseeable fiscal implication to state and local governments as a result
of enforcing or administering the sections. There is no foreseeable effect
on local employment or local economies as a result of the proposed sections.
There is no anticipated adverse economic effect on small businesses or micro-businesses
as a result of compliance with the proposed new sections.
Mr. Galaviz has also determined that for each year of the first five years
the proposals are in effect the public benefit anticipated is that participating
entities and their employees will have notice of enrollment deadlines and
dates that coverage will become effective. Mr. Galaviz has determined that
there are no anticipated economic costs to persons required to comply with
the proposed sections.
Comments on the proposal may be submitted to Charles L. Dunlap, Executive
Director, 1000 Red River Street, Austin, Texas 78701-2698. To be considered,
written comments must be received by TRS no later than 30 days after publication
of the amendments for proposal.
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 new sections 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 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
[
The
] 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
[
for an eligible
full-time or part-time employee shall begin on the date the full-time or part-time
employee first becomes eligible to enroll in the TRS-ActiveCare program and
shall end
] at 11:59 p.m. Central Time on the 31st day
thereafter.
[
after the date that full-time or part-time employee first became
eligible to enroll in the TRS-ActiveCare program. The date a full-time or
part-time employee is first eligible to enroll in the TRS-ActiveCare program
shall be the later of the following dates:
]
[(1)
The first day a full-time or part-time
employee's employer becomes a participating entity; or]
[(2)
The first day a full-time or part-time
employee becomes employed in an eligible capacity with a participating entity.
]
(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.
(c)
[
(b)
] 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)
[
(c)
] 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)
[
(d)
] 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)
[
(e)
] 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)
[
(f)
] 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)
[
(g)
] 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
[
31st day after
] the date their employer first becomes a participating entity. 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 February 14, 2003.
TRD-200301189
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