Section 41.36 - Enrollment Periods for TRS-ActiveCare(a) An individual who becomes an eligible full-time or eligible part-time employee has an initial enrollment period, for both himself or herself as well as for his or her eligible dependents, beginning on the first day that the individual becomes an eligible employee and ending at 11:59:59 p.m. Austin Time on the 31st day thereafter.(b) If a current employee of a participating entity was an eligible part-time employee during an enrollment opportunity for the current plan year, and, later during the current plan year, this employee becomes an eligible full-time employee, then this employee has an enrollment period, for both himself or herself as well as for his or her eligible dependents, beginning on the first day that this individual becomes an eligible full-time employee and ending at 11:59:59 p.m. Austin Time on the 31st day thereafter. This enrollment opportunity exists even if this employee previously declined enrollment in TRS-ActiveCare during the current plan year.(c) An eligible full-time or part-time employee whose employer becomes a participating entity has an initial enrollment period, for both himself or herself as well as for his or her eligible dependents, beginning at least 31 days prior to the date that the annual enrollment period ends for the first plan year in which the employer becomes a participating entity.(d) 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.(e) The enrollment period for an individual who becomes eligible for coverage due to a special enrollment event, as described in § 41.34(8) of this chapter (relating to Eligibility for Coverage under the Texas School Employees Uniform Group Health Coverage Program), shall be the 31 calendar days immediately after the date of the special enrollment event. To make an effective election, a completed enrollment form must be received by a participating entity or the health plan administrator of TRS-ActiveCare within this 31-day period.(f) 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 elections provided under this subsection. To make an effective election, a completed enrollment form must be received by a participating entity or the health plan administrator of TRS-ActiveCare during the plan enrollment period. Coverage under the elected option becomes effective on September 1 of the next plan year. One of the following elections may be made under this subsection:(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.(g) 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 elections provided under this subsection. To make an effective election, a completed enrollment form must be received by a participating entity or the health plan administrator of TRS-ActiveCare within 31 calendar days after notice of the contract termination is sent to the eligible full-time or part-time employee by TRS or its designee. Coverage under the elected option becomes effective on a date determined by TRS. One of the following elections may be made under this subsection:(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.(h) 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 may make one of the elections provided under this subsection. To make an effective election, a completed enrollment form must be received by a participating entity or the health plan administrator of TRS-ActiveCare within 31 calendar days after the employee's change in eligibility status. Coverage under the elected option becomes effective on the first day of the month following the date the employee's eligibility status changed. One of the following elections may be made under this subsection: (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.(i) On behalf of the trustee, the executive director or a designee 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 period.34 Tex. Admin. Code § 41.36
The provisions of this §41.36 adopted to be effective August 26, 2002, 27 TexReg 7970; amended to be effective January 28, 2003, 28 TexReg 743; amended to be effective June 18, 2003, 28 TexReg 4560; amended to be effective August 18, 2003, 28 TexReg 6553; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective April 9, 2008, 33 TexReg 2825; amended to be effective April 1, 2011, 36 TexReg 2001; amended to be effective September 1, 2011, 36 TexReg 5380; amended by Texas Register, Volume 39, Number 51, December 19, 2014, TexReg 10029, eff. 12/22/2014; Amended by Texas Register, Volume 41, Number 42, October 14, 2016, TexReg 8204, eff. 10/20/2016; Amended by Texas Register, Volume 46, Number 41, October 8, 2021, TexReg 6944, eff. 10/17/2021