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 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:

      1. (A) in any plan, for which he or she is eligible under law, located in the next-higher TRS-Care coverage tier (level of coverage), as determined by TRS-Care; and
      2. (B) add dependent coverage in any plan, for which the dependent is eligible under law, located in that same coverage tier (level of coverage).

   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:

      1. (A) in any plan, for which he or she is eligible under law, located in any TRS-Care coverage tier (level of coverage); and
      2. (B) add dependent coverage in any plan, for which the dependent is eligible under law, located in that same coverage tier (level of coverage).

   7. (7) An eligible participant, at the time of his or her Age 65 Additional Enrollment Opportunity, can:

      1. (A) choose to remain in the same TRS-Care coverage tier (level of coverage);
      2. (B) enroll in any plan, for which he or she is eligible under law, located in that same TRS-Care coverage tier (level of coverage); and
      3. (C) add dependent coverage in any plan, for which the dependent is eligible under law, in that same coverage tier (level of coverage).

   8. (8) The period to exercise 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.
   9. (9) This subsection expires December 31, 2017.

2. (b) Age 65 Enrollment Opportunity.

   1. (1) Upon reaching 65 years of age, a retiree or surviving spouse is eligible to be enrolled in TRS-Care under terms, conditions and limitations established by the trustee unless expelled from the program under provisions of Chapter 1575, Insurance Code (the "Age 65 Enrollment Opportunity"). The retiree or surviving spouse may select any coverage provided under TRS-Care for which the individual or a dependent is otherwise eligible.
   2. (2) The enrollment period for an individual who becomes eligible for coverage under paragraph (1) of this subsection shall begin on the date the individual reaches 65 years of age and ends 31 calendar days from the end of the month in which the individual reaches 65 years of age. To make an effective election, a completed TRS-Care application must be received by TRS no later than the end of this enrollment period.
   3. (3) This subsection becomes effective January 1, 2018.

3. (c) Special Enrollment Opportunity under the Health Insurance Portability and Accountability Act (HIPAA).

   1. (1) An individual who becomes eligible for coverage under the special enrollment provisions of HIPAA may elect to enroll in TRS-Care.
   2. (2) The enrollment period for an individual who becomes eligible for coverage due to a special enrollment event under paragraph (1) of this subsection 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.
4. (d) Enrollment Opportunity Established by TRS. An eligible individual may enroll in TRS-Care during an enrollment period established by TRS.
5. (e) This section does not affect the right of a TRS service retiree or surviving spouse enrolled in a TRS-Care plan to drop coverage 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; amended to be effective January 6, 2013, 37 TexReg 10248; amended to be effective December 22, 2014, 39 TexReg 10028; amended to be effective November 14, 2017, 42 TexReg 6378.