Current through Reg. 49, No. 38; September 20, 2024
The following words and terms when used in this subchapter
or in connection with the administration of Chapter 1579, Insurance Code, shall
have the following meanings unless the context clearly indicates
otherwise:
(1) Dependent--Only those
individuals described by §
1579.004,
Insurance Code, and an individual under 26 years of age ("child") who is
described by any one of the following subparagraphs (A), (B), or (C) at all
times during which the child is receiving coverage under TRS-ActiveCare.
(A) A child under the legal guardianship of a
full-time or part-time employee;
(B) A full-time or part-time employee's
grandchild whose primary residence is the household of that full-time or
part-time employee if the grandchild is a dependent of the full-time or
part-time employee for federal income tax purposes for the reporting year in
which coverage of the grandchild is in effect; or
(C) A child in a regular parent-child
relationship with a full-time or part-time employee, meaning that the child's
primary residence is the household of that full-time or part-time employee, the
full-time or part-time employee provides at least 50% of the child's support,
neither of the child's natural parents reside in that household, and the
full-time or part-time employee has the legal right to make decisions regarding
the child's medical care.
(D) For
clarification and without intending to identify all persons who are not a
Dependent for purposes of coverage, even though the individual may be in a
dependent relationship with a full-time or part-time employee, the following
are not included in the definition of Dependent in this section:
(i) Other than the spouse of a full-time or
part-time employee, a Dependent does not include an individual who is a
"participating member" as defined in paragraph (5) of this section.
(ii) A Dependent does not include a parent or
grandparent of a full-time or part-time employee.
(iii) A Dependent does not include a brother
or a sister of a full-time or part-time employee unless the brother or sister
is an unmarried individual under 26 years of age who is either:
(I) under the legal guardianship of a
full-time or part-time employee; or
(II) in a regular parent-child relationship
with a full-time or part-time employee, meaning that the brother or sister's
primary residence is the household of that full-time or part-time employee, the
full-time or part-time employee provides at least 50% of the brother or
sister's support, neither of the brother or sister's natural parents reside in
that household, and the full-time or part-time employee has the legal right to
make decisions regarding the brother or sister's medical care.
(2) Full-time
employee--A participating member who:
(A) is
currently employed by a participating entity;
(B) is employed in a position that is
eligible for membership in the Teacher Retirement System of Texas;
and
(C) is not receiving coverage
as an employee or retiree from a uniform group insurance or health benefits
program under the Texas Employees Group Benefits Act (Chapter 1551, Insurance
Code), or the State University Employees Uniform Insurance Benefits Act
(Chapter 1601, Insurance Code) or the Texas Public School Retired Employees
Group Benefits Act (Chapter 1575, Insurance Code, also known as TRS-Care).
Notwithstanding this paragraph, an individual who is eligible to Medicare, and
meets the criteria in subparagraphs (A) and (B) of this paragraph will be
considered a full-time employee.
(3) HMO--A health maintenance organization
holding a valid certificate of authority issued by the Texas Department of
Insurance and approved by TRS to provide health care benefits to eligible
full-time and part-time employees and their eligible dependents.
(4) Participating entity--An entity
participating in TRS-ActiveCare including a school district; another
educational district whose employees are members of the retirement system; a
regional education service center; and a charter school that meets the
requirements of Chapter 1579, Insurance Code. An entity is considered to be
participating in TRS-ActiveCare on and after the first date coverage becomes
effective for its employees.
(5)
Participating member--A person defined by §
822.001
and §
822.002,
Government Code, whose membership in the retirement system has not been
terminated as described by §§822.003 -
822.006,
Government Code, and who is required to contribute to the Teacher Retirement
System of Texas pension trust fund in accordance with §
825.403,
Government Code.
(6) Part-time
employee--An individual who:
(A) is currently
employed by a participating entity for 10 hours or more each week;
(B) is employed in a position that is not
eligible for membership in the Teacher Retirement System of Texas or is not
eligible for membership in the Teacher Retirement System of Texas because of a
service or disability retirement; and
(C) is not receiving coverage as an employee
or retiree from a uniform group insurance or health benefits program under the
Texas Employees Group Benefits Act (Chapter 1551, Insurance Code) or the State
University Employees Uniform Insurance Benefits Act (Chapter 1601, Insurance
Code) or the Texas Public School Retired Employees Group Benefits Act (Chapter
1575, Insurance Code, also known as TRS-Care). Notwithstanding this paragraph,
an individual who is eligible to Medicare, and meets the criteria in
subparagraphs (A) and (B) of this paragraph will be considered a part-time
employee.
(7) Plan
year--A plan year begins on the first day of September and ends on the last day
of the following August.
(8)
TRS-ActiveCare--The health benefits program under the Texas School Employees
Uniform Group Health Coverage Act, Chapter 1579, Insurance Code.
(9) Trustee or TRS--The Teacher Retirement
System of Texas acting in its capacity as trustee under Chapter 1579, Insurance
Code.
