1. (a) A full-time or part-time employee who becomes employed in an eligible capacity with a participating entity has an 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 at 11:59 p.m. Central Time on the 31st day thereafter.
2. (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.
3. (c) 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.
4. (d) 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.

5. (e) 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. (1) change to another approved HMO for which the full-time or part-time employee is eligible; or
   2. (2) enroll in the TRS-ActiveCare preferred provider organization coverage plan, without preexisting condition exclusions.

6. (f) 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. (1) change to another approved HMO for which the full-time or part-time employees and their eligible dependents are eligible; or
   2. (2) enroll in the TRS-ActiveCare preferred provider organization coverage plan, without preexisting condition exclusions.

7. (g) 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. (1) enroll in another approved HMO for which the full-time or part-time employee is eligible; or
   2. (2) enroll in the TRS-ActiveCare preferred provider organization coverage plan, subject to applicable preexisting condition limitations.
8. (h) 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.

Source Note: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.