34 Tex. Admin. Code § 85.3 – Eligibility and Participation

(a) Dependent care reimbursement plans.
1. (1) Eligibility. Any employee eligible to participate in the Uniform Group Insurance Program may elect to participate in the dependent care reimbursement account.
2. (2) Participation.
  1. (A) An employee who is eligible under paragraph (1) of this subsection may elect to participate by completing and submitting an election form on, or within 30 days after, the date on which the employee begins active duty. The election becomes effective on the first day of the month following the date on which the employee makes the election.
  2. (B) An employee who is otherwise eligible to participate in the Uniform Group Insurance Program but who declined participation in the dependent care reimbursement account prior to the beginning of a plan year, and who, after the beginning of the plan year, has a qualifying life event as defined in §85.7(c) of this title (relating to Enrollment), may elect to participate in the dependent care reimbursement account as provided in §85.7(c).
  3. (C) A qualifying life event as defined in §85.7(c) of this title (relating to Enrollment) will permit a change or revocation of participation during the plan year as provided in §85.7(c).
  4. (D) An eligible employee shall have an opportunity to enroll or change benefit options during the annual enrollment period. The annual enrollment period shall be prior to the beginning of a new plan year. Elections and changes in elections made during the annual enrollment period become effective on the first day of the plan year.
3. (3) Duration of participation.
  1. (A) An employee's election to participate or to waive participation in the dependent care reimbursement plan shall be irrevocable for the plan year unless there is a qualifying life event as defined in §85.7(c) of this title (relating to Enrollment).
  2. (B) An employee returning to active duty following termination of employment, or following a period of approved leave without pay, during the same plan year shall reinstate the election in effect on the employee's last previous active duty date. Reinstatement becomes effective on the date on which the employee resumes active duty, unless the employee requests a change in election as provided in §85.7(c) of this title (relating to Enrollment).
(b) Health care reimbursement plan.
1. (1) Eligibility.
  1. (A) Any employee eligible to participate in the Uniform Group Insurance Program may elect to participate in a health care reimbursement account.
  2. (B) An employee whose employment has been terminated, voluntarily or involuntarily, and who had a health care reimbursement account at the time of termination, shall retain the health care reimbursement account for the applicable period of election. The terminated employee must pre-pay, on a monthly basis, the elected amount and any administrative fee for the plan year. Payments are due on the first day of each month and must be received no later than the 30th day of the month. Failure to pay will automatically cancel enrollment.
2. (2) Participation.
  1. (A) An employee who is eligible under paragraph (1) of this subsection may elect to participate by completing and submitting an election form on, or within 30 days after, the date on which the employee begins active duty. The election becomes effective on the first day of the month following the date on which the employee makes the election.
  2. (B) An employee who is eligible but who declined participation in the health care reimbursement account prior to the beginning of a plan year, and who, after the beginning of a plan year, has a qualifying life event as defined in §85.7(c) of this title (relating to Enrollment), may elect to participate in a health care reimbursement account as provided in §85.7(c).
  3. (C) A qualifying life event as defined in §85.7(c) of this title (relating to Enrollment) will permit the following changes in election during the plan year, as provided in §85.7(c):
    1. (i) an increase in the election amount, if the increase is consistent with the qualifying life event; or
    2. (ii) a decrease in the election amount or cancellation of participation, if the qualifying life event is the death of the spouse or a dependent child of the employee.
  4. (D) An eligible employee shall have an opportunity to enroll or to change benefit options during the annual enrollment period. The annual enrollment period shall be prior to the beginning of a new plan year. Elections and changes in elections made during the annual enrollment period become effective on the first day of the plan year.
3. (3) Duration of participation.
  1. (A) Except as otherwise provided in subparagraph (C)(ii) of paragraph (2), an employee's election to or not to participate in a health care reimbursement account shall be irrevocable for the plan year.
  2. (B) An employee returning to active duty following termination of employment, or following a period of leave without pay, during the same plan year shall reinstate the election in effect on the employee's last previous active duty date. Reinstatement becomes effective on the date on which the employee resumes active duty, unless the employee requests a change in election as provided in §85.7(c) of this title (relating to Enrollment) or a different requirement is imposed by the Family and Medical Leave Act of 1993 (FMLA).
  3. (C) An employee who is enrolled in a health care reimbursement account who terminates employment during the plan year must retain the health care account for the remainder of the year and prepay premiums or make monthly premium payments due for the remainder of the plan year, as described in paragraph (1)(B) of this subsection.
  4. (D) Notwithstanding any provision to the contrary in this Plan, if an employee goes on a qualifying unpaid leave under the FMLA, to the extent required by the FMLA, the Plan Administrator will continue to maintain the employee's health care reimbursement account on the same terms and conditions as though he were still an active employee (i.e., the Plan Administrator will continue to provide benefits to the extent the employee opts to continue his coverage). If the employee opts to continue his coverage, the employee may pay his share of the premium in the same manner as a participant on the non-FMLA leave, including payment with after-tax dollars while on leave. The employee may also be given the option to pre-pay all or a portion of his share of the premium for the expected duration of the leave on a pre-tax salary reduction basis out of his pre-leave compensation by making a special election to that effect prior to the date such compensation would normally be made available to him (provided, however, that pre-tax dollars may not be utilized to fund coverage during the next plan year).

Source Note:The provisions of this §85.3 adopted to be effective August 12, 1988, 13 TexReg 3754; amended to be effective September 28, 1989, 14 TexReg 4787; amended to be effective September 1, 1990, 15 TexReg 4646; amended to be effective September 1, 1991, 16 TexReg 3779; amended to be effective September 1, 1992, 17 TexReg 2874; amended to be effective September 2, 1993, 18 TexReg 5595; amended to be effective November 11, 1996, 21 TexReg 10766; amended to be effective February 12, 1998, 23 TexReg 1313; amended to be effective September 1, 1998, 23 TexReg 4571; amended to be effective September 16, 1999, 24 TexReg 7276.