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. Austin 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 ("end date"). Notwithstanding the preceding sentence, a large school district, as defined hereafter, that becomes a participating entity after September 1, 2003, may recommend an initial enrollment period of not less than 31 days that closes before the end date. A recommended initial enrollment period that closes before the end date is subject to approval by TRS. As used in this section, a large school district shall mean a school district that had 1001 or more employees at any time during the 2001 school year, as reflected on any report received by TRS from that school district for a reporting period in that school year.
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, as defined under provisions of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)) (HIPAA), shall be the 31 calendar days immediately after the date of the special enrollment event. During a special enrollment period, 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. 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 date of the special enrollment event.

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:

   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. 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.

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:

   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. 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.

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:

   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. 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.
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; amended to be effective August 18, 2003, 28 TexReg 6553; amended to be effective March 8, 2007, 32 TexReg 1092.