Texas Administrative Code
Title 34 - PUBLIC FINANCE
Part 3 - TEACHER RETIREMENT SYSTEM OF TEXAS
Chapter 41 - HEALTH CARE AND INSURANCE PROGRAMS
Subchapter C - TEXAS SCHOOL EMPLOYEES GROUP HEALTH (TRS-ACTIVECARE)
Section 41.30 - Participation in the Health Benefits Program under the Texas School Employees Uniform Group Health Coverage Act by School Districts, Other Educational Districts, Charter Schools, and Regional Education Service Centers

Universal Citation: 34 TX Admin Code § 41.30

Current through Reg. 49, No. 38; September 20, 2024

(a) Applicability. This section is applicable to the election to participate in TRS-ActiveCare by eligible entities such as school districts, other educational districts, charter schools, and regional education service centers, as these terms are defined in Chapter 1579, Insurance Code.

(b) Manner, form and effect of election.

(1) Form of the notice of election. All elections to participate or discontinue participation in the health benefits program, referred to as "TRS-ActiveCare," under the Texas School Employees Uniform Group Health Coverage Act (the "Act"), Chapter 1579, Insurance Code, shall be in writing, in a form prescribed by the Teacher Retirement System of Texas (TRS), as trustee of TRS-ActiveCare.

(2) Incomplete notice of election. An incomplete or unsigned notice of election will not be deemed received by TRS for purposes of determining whether a valid election has been exercised. Written notice of election to participate in TRS-ActiveCare under this section submitted without the information required under § 41.45 of this title (relating to Required Information from School Districts, Other Educational Districts, Charter Schools, and Regional Education Service Centers Electing to Participate in TRS-ActiveCare) will be considered incomplete and will be denied by TRS. In order to reduce the possibility of submitting an incomplete form, entities should reach out to TRS before the election deadline referenced in this section to ask questions and address issues.

(3) Timing of the receipt of the notice of election. A notice of election to participate or discontinue participation that is otherwise valid must be received by TRS no later than December 31 of the year preceding the first day of the plan year in which the election will be effective.

(4) Mandatory Participation and Exclusion Timeframes. Each time an entity submits a notice of election to participate in TRS-ActiveCare in accordance with subsection (b)(1) - (3) of this section, the entity is committing to participate for a minimum of five plan years, after which the entity may choose to submit a notice to discontinue participation. In the same manner, each time an entity submits a notice to discontinue participation in TRS-ActiveCare in accordance with subsection (b)(1) - (3) of this section, the entity is committing to leave the program for a minimum of five plan years, after which the entity may choose to submit a notice of election to participate. Mandatory participation and mandatory exclusion periods will be strictly enforced.

Pursuant to § 1579.154(a), Insurance Code, to be eligible, a charter school must agree to inspection of all records of the school relating to its participation in TRS-ActiveCare by TRS, by the administering firm as defined in § 1579.002(1), Insurance Code, by the commissioner of education, or by a designee of any of those entities, and further must agree to have its accounts relating to participation in TRS-ActiveCare annually audited by a certified public accountant at the school's expense. The agreement of the charter school shall be evidenced in writing and shall constitute a part of a notice of election in a form prescribed by TRS pursuant to subsection (b) of this section.

(d) Effective Date of Participation or Discontinuation of Participation. An entity will become a participating entity or discontinue to be a participating entity in TRS-ActiveCare on the first day of the plan year following the December 31st date on which TRS receives the entity's notice of election to become a participating entity or discontinue being a participating entity referenced in subsection (b) of this section.

(e) Alternative group health coverage prohibition. In accordance with Section 1579.1045, Insurance Code, a participating entity is prohibited from offering or making available group health coverage other than that provided under the TRS-ActiveCare program to the entity's employees or their employees' dependents.

(f) Remedies for failure to comply. If, contrary to subsection (e) of this section and Section 1579.1045 of the Insurance Code, a participating entity offers alternative group health coverage, TRS may pursue remedies for noncompliance, including but not limited to removal from or denial of entry into TRS-ActiveCare. TRS may impose or pursue one or more remedies. The pursuit of one remedy does not constitute a waiver of any other remedy that TRS may have at law or equity. If TRS discovers that a participating entity is in violation of subsection (e) after the beginning of a plan year, in addition to any other available remedy, TRS will remove the entity from the program effective at the end of the month in which TRS discovers the situation; and it will be the entity's liability to procure alternative coverage or provide other remedies for the employees and their dependents that lose coverage under these circumstances.

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