Section 41.15 - Optional Dental Benefits Plan(a) Establishment.(1) In accordance with Section 1575.1601, Insurance Code, TRS makes available to individuals under the TRS-Care program an optional plan that provides coverage for dental care (hereinafter referred to as an "optional dental benefits plan").(2) TRS may offer an optional dental benefits plan through an insurance carrier or the optional dental benefits plan may be self-funded.(3) An optional dental benefits plan may have one or more benefit designs for participants to choose from, as determined by TRS.(b) Eligibility. (1) Only retirees, dependents, surviving spouses, and surviving dependent children, as defined under Chapter 1575, Insurance Code, are eligible to enroll in an optional dental benefits plan (hereinafter referred to as "eligible members").(2) Individuals shall be eligible for an optional dental benefits plan under the same requirements as described in § 41.10 of this title (relating to Eligibility to Enroll in the Health Benefits Program Under the Texas Public School Retired Employees Group Benefits Act (TRS-Care)).(3) Eligible members may enroll in an optional dental benefits plan even if they are not enrolled or applying for enrollment in any other TRS-Care plan at the time of enrollment in an optional dental benefits plan.(4) If an eligible member is eligible for an optional dental benefits plan as a retiree and also as a dependent of another retiree, the retiree may elect to participate in an optional dental benefits plan as a retiree or as a dependent but cannot participate as both. An eligible member must choose to participate as a retiree or as a dependent.(c) Plan Year. The plan year for an optional dental benefits plan is from January 1 to December 31 (hereinafter referred to as "plan year").(d) Enrollment and Disenrollment.(1) Enrollment. Eligible members desiring to enroll in an optional dental benefits plan must do so within the open enrollment period or during an additional enrollment opportunity. (A) Open Enrollment. (i) An eligible member may enroll in an optional dental benefits plan during an open enrollment period established by TRS.(ii) On behalf of the trustee, the executive director or a designee may prescribe open enrollment periods and the conditions under which eligible members may enroll during an open enrollment period.(B) Additional Enrollment Opportunities. Individuals shall have the same additional enrollment opportunities for an optional dental benefits plan as those provided under §41.2(a) - (c) of this title (relating to Additional Enrollment Opportunities).(2) Disenrollment. Eligible members may only disenroll from an optional dental benefits plan during the open enrollment period, with the exception that an eligible member may disenroll during a special enrollment opportunity as described by § 41.2(b) of this title.(3) Enrollment and Disenrollment Process. Eligible members must follow the enrollment and disenrollment processes established by TRS.(e) Payment of Contributions. (1) Retirees, surviving spouses, and surviving dependent children, or their representatives (collectively "participants") shall pay monthly contributions, as set by TRS, for their and their dependents' participation in an optional dental benefits plan and may, at TRS' sole discretion, be required to do so through deductions from the participant's TRS annuity payment or through direct payments to TRS or its designee. (A) In accordance with Section 1575.153, Insurance Code, the participant must, in writing, authorize the trustee to deduct the entirety of the participant's contributions for the participant's coverage under the TRS-Care plan(s) from the participant's TRS annuity payment.(B) If the amount of the participant's TRS annuity payment is not enough to cover all of the participant's contributions for coverage under the participants TRS-Care plan(s), the participant shall be directly billed by TRS or its designee.(2) If a participant is required to pay their contributions for an optional dental benefits plan directly to TRS or its designee, failure to timely pay the full amount of a required contribution for coverage will result in termination of the optional dental benefits plan. Participants or eligible members that have lost their coverage due to lack of payment of contribution for coverage may be subject to recoupment by TRS of outstanding contribution amounts, penalties, and be subject to reenrollment conditions prior to reenrollment.(f) Effective Date of Coverage. (1) An optional dental benefits plan shall follow the same effective dates of coverage that apply under §41.7(a) - (h) and (j) of this title (relating to Effective Date of Coverage).(2) In addition, if an eligible member enrolls during a TRS open enrollment period as described in subsection (d)(1)(A) of this section, the effective date of coverage shall be the first day of the plan year following the end of the open enrollment period.(g) Expulsion for fraud. Expulsion for fraud from an optional dental benefits plan shall follow the same process as described in § 41.14 of this title (relating to Expulsion from TRS-Care for Fraud).(h) Competitive Bidding. (1) Bid procedures for an optional dental benefits plan shall follow the same process as described in § 41.9 of this title (relating to Bid Procedure).(2) TRS may award separate contracts for different aspects in the administration of an optional dental benefits plan, such as insurance coverage, claims administration, utilization review services, administrative services, and ancillary services.(3) Each bidder must comply with the minimum qualifications contained in the applicable solicitation from TRS.34 Tex. Admin. Code § 41.15
The provisions of this §41.15 adopted to be effective May 10, 2000, 25 TexReg 4189; amended to be effective March 12, 2003, 28 TexReg 2113; amended to be effective February 24, 2004, 29 TexReg 1670; amended to be effective March 8, 2007, 32 TexReg 1092; Amended by Texas Register, Volume 44, Number 32, August 9, 2019, TexReg 4190, eff. 8/15/2019; Repealed by Texas Register, Volume 48, Number 39, September 29, 2023, TexReg 5740, eff. 10/5/2023; Amended by Texas Register, Volume 49, Number 20, May 17, 2024, TexReg 3581, eff. 5/26/2024