1. (a) Age 65 Additional Enrollment Opportunity. "Eligible participants," as defined in paragraph (1) of this subsection, have an additional enrollment opportunity in TRS-Care as described in this subsection when they become 65 years old (the "Age 65 Additional Enrollment Opportunity").

   1. (1) For purposes of this subsection, the term "eligible participants" means:

      1. (A) all TRS service retirees who are enrolled in TRS-Care;
      2. (B) dependents, as defined in Insurance Code, §1575.003, who are enrolled in TRS-Care and who are eligible to enroll in TRS-Care in their own right as a TRS service or disability retiree; and
      3. (C) surviving spouses, as defined in Insurance Code, §1575.003 who are enrolled in TRS-Care.
   2. (2) Those eligible participants who are enrolled in TRS-Care on August 31, 2004, and who become 65 years old after that date have the Age 65 Additional Enrollment Opportunity on the date that they become 65 years old.
   3. (3) Those eligible participants who enroll in TRS-Care after August 31, 2004, and who become 65 years old after the date of their enrollment have the Age 65 Additional Enrollment Opportunity on the date that they become 65 years old.
   4. (4) The Age 65 Additional Enrollment Opportunity for those eligible participants who enroll in TRS-Care after August 31, 2004, and who are 65 years old or older when they enroll in TRS-Care runs concurrently with the initial enrollment period as set out in §41.1 of this title (relating to Initial Enrollment Periods for the Health Benefits Program Under the Texas Public School Retired Employees Group Benefits Act (TRS-Care)).
   5. (5) An eligible participant who is not enrolled in Medicare Part A at the time of his or her Age 65 Additional Enrollment Opportunity can enroll in the next-higher TRS-Care coverage tier, as determined by TRS-Care, and add dependent coverage in that same coverage tier.
   6. (6) An eligible participant who is enrolled in Medicare Part A at the time of his or her Age 65 Additional Enrollment Opportunity can enroll in any TRS-Care coverage tier and add dependent coverage in that same coverage tier.
   7. (7) An eligible participant, at the time of his or her Age 65 Additional Enrollment Opportunity, can choose to remain in the same TRS-Care coverage tier and add dependent coverage in that coverage tier.

   8. (8) The period to enroll in TRS-Care pursuant to the Age 65 Additional Enrollment Opportunity for eligible participants described in paragraph (2) or (3) of this subsection expires at the end of the later of:

      1. (A) the 31st day following the last day of the month in which the eligible participant becomes 65 years old; or
      2. (B) the 31st day after the date printed on the notice of the additional enrollment opportunity sent to the eligible participant at the eligible participant's last-known address, as shown in the TRS-Care records.

2. (b) Special Enrollment Opportunity.

   1. (1) For a special enrollment event that occurs on or after September 1, 2011, an individual who becomes eligible for coverage under the special enrollment provisions of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)), including a dependent whose coverage under TRS-Care was waived due to the existence of other coverage for the dependent during the Age 65 Additional Enrollment Opportunity described in subsection (a) of this section, may elect to enroll in TRS-Care.

   2. (2) For a special enrollment event that occurs on or before August 31, 2011, except as provided in the exceptions found in subparagraphs (A) - (C) of this paragraph, an individual who becomes eligible for coverage under the special enrollment provisions of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)), including a dependent whose coverage under TRS-Care was waived due to the existence of other coverage for the dependent during the Age 65 Additional Enrollment Opportunity described in subsection (a) of this section, may elect to enroll in TRS-Care.

      1. (A) In no event may an individual who is already enrolled in TRS-Care elect a different plan, for himself or any eligible dependents, but may only add eligible dependents for coverage under the individual's existing plan selection upon the occurrence of a special enrollment event.
      2. (B) In no event may a TRS retiree enroll in TRS-Care as a result of a special enrollment event applicable to his dependent.
      3. (C) In no event, as a result of a special enrollment event applicable to the dependent, may the dependent of a TRS retiree enroll in TRS-Care if the TRS retiree is not enrolled in TRS-Care.
   3. (3) The enrollment period for an individual who becomes eligible for coverage due to a special enrollment event shall be the 31 calendar days immediately after the date of the special enrollment event. To make an effective election, a completed TRS-Care application must be received by TRS within this 31-day period.
3. (c) Enrollment Opportunity Established by TRS. If an eligible TRS retiree or his eligible dependent does not have either an Age 65 Additional Enrollment Opportunity or a special enrollment event, then he may enroll in TRS-Care only during a subsequent enrollment period established by TRS.
4. (d) This section does not affect the right of a TRS service retiree or surviving spouse enrolled in a TRS-Care coverage tier to drop coverage, select a lower coverage tier, or drop dependents at any time.

Source Note:The provisions of this §41.2 adopted to be effective August 25, 2004, 29 TexReg 8128; amended to be effective February 9, 2006, 31 TexReg 709; amended to be effective March 25, 2008, 33 TexReg 2553; amended to be effective September 1, 2011, 36 TexReg 5378.