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FAQs: TRS-ActiveCare

FAQs: TRS-ActiveCare

General  |   Eligibility and Enrollment   |   Medical   |   Pharmacy

General

If an entity elects to participate in TRS-ActiveCare, can it opt out later?

There are no provisions in the law that allow a participating entity to opt out of the program. [TOP]

How is TRS-ActiveCare enrollment handled?

Each participating entity is responsible for enrolling its employees.  TRS will work closely with the vendors to ensure entities receive the enrollment information and assistance as required. [TOP]

How and when are TRS-ActiveCare premiums to be remitted to TRS?

Districts will receive a monthly invoice from BCBSTX.  Districts will need to send total premiums due to TRS via Texnet by the 6th of the month following the month billed.  If the 6th of the month is not a business day, payment is due by the last business day prior to the 6th. [TOP]

What is House Bill 973? (TRS Rule 41.38)?

House Bill 973 became effective on September 1, 2007, which allows certain individuals to remain on their employer’s group health plan coverage through the end of the plan year when retiring or resigining employment after the last day of the instructional year. [TOP]

What is a special enrollment event?

An event as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that may provide a special enrollment period for individuals and dependents when there is a loss of other coverage or a gain of additional dependents. Such events include marriage, divorce (resulting in a loss of coverage), birth, adoption or placement for adoption, or if an individual with other health insurance coverage involuntarily loses that coverage. [TOP]

Can coverage be dropped throughout the plan year?

Unless restricted due to participation in an Internal Revenue Code Section 125 cafeteria plan, an employee can drop employee-only coverage or drop dependent coverage.  The change will be effective the first of the following month.  If coverage is dropped, the individual will not be eligible to re-enroll in TRS-ActiveCare until the next annual enrollment period unless the individual experiences a special enrollment event.   Preexisting  condition exclusions may apply. [TOP]

Can an employee of a participating entity waive coverage?

Yes. An employee may choose any level of coverage during the initial enrollment period or may waive coverage. [TOP]

If an employee waives coverage during the initial enrollment period, can the employee enroll later on?

Yes, if the employee experiences a special enrollment event or during the next annual enrollment period. Preexisting condition  exclusion may apply. [TOP]

Can plan changes be made?

An employee must keep his or her current plan choice until the next plan enrollment period unless the employee has a special enrollment event. [TOP]

Can plan changes be made if an employee changes employment to another participating district/entity during the same plan year?

An employee must keep his or her current plan choice until the next enrollment period unless a special enrollment occurs. [TOP]

What kind of audit is required for charter schools electing to participate in TRS-ActiveCare? Is it the same audit that we do for TEA each year?

HB 3343 requires that accounts relating to participation in the program be annually audited by a certified public accountant at the school’s expense. You will need to contact TEA to determine whether the audit will be "in addition to" the annual audit required by TEA. [TOP]

Will TRS-ActiveCare provide health care coverage for an existing COBRA enrollee for an entity participating in TRS-ActiveCare?

Yes. TRS-ActiveCare will cover an existing COBRA enrollee through the end of the enrollee’s contract year or eligibility for such coverage. [TOP]

Who will administer COBRA for TRS-ActiveCare?

Health Care Services Corporation will administer COBRA for TRS-ActiveCare PPO options. BCBSTX is a division of the Health Care Services Corporation. HMO participants should contact their HMO plan for information about the COBRA administrator. [TOP]

Because TRS-ActiveCare does not provide optional coverage such as life, dental or vision, who is responsible for the administration of existing COBRA enrollees in these plans for entities participating in TRS-ActiveCare?

Administration of COBRA for optional coverage is the responsibility of the entity through which the enrollee obtained coverage. [TOP]

Does TRS-ActiveCare offer an HSA?

No, but ActiveCare 1-HD meets the current IRS definition of a high deductible health plan for all coverage categories, and ActiveCare 1 meets the IRS definition of a high deductible health plan for employee-only coverage. You are not required to have an HSA to enroll in these plans, but if desired, you can seek an HSA administrator on your own to establish an account. [TOP]

What is a Health Savings Account (HSA)?

An HSA is a special account owned by an individual used to pay for current and future medical expenses. It combines a high deductible health plan with a tax-free Health Savings Account that you and your covered family members can use to pay out-of-pocket expenses. Visit the Treasury’s website at www.ustreas.gov and click on "Health Savings Accounts." [TOP]

 

Eligibility and Enrollment

Who can enroll in TRS-ActiveCare? 

To be eligible for TRS-ActiveCare, you must be employed by a participating district/entity and be either an active, contributing TRS member or employed 10 or more regularly scheduled hours each week.

You are not eligible for TRS-ActiveCare coverage if you are:

  • Receiving health care coverage as an employee or retiree under the Texas State College and University Employees Uniform Insurance Benefits Act.
    Example: A school employee who has UT SELECT coverage as an employee with The University of Texas System.
  • Receiving health care coverage as an employee or retiree under the Texas Employee Uniform Group Insurance Benefits Act.
    Example: A school employee who has HealthSelect coverage as an employee with ERS.
  • A TRS retiree receiving, or who waived coverage under, TRS-Care, including a retiree who has returned to work.*

*If a TRS retiree has returned to work and has never been eligible for TRS-Care, he or she would be eligible for TRS-ActiveCare coverage, as long as the retiree meets all the TRS-ActiveCare eligibility requirements.

Note: Although a retiree, a higher education employee or a state employee may not be covered as an employee of a participating district/entity, he or she can be covered as a dependent of an eligible employee.

Who is eligible for TRS-ActiveCare coverage?

Provided no exceptions apply, teachers, administrative personnel, substitutes, bus drivers, librarians, crossing guards, cafeteria workers, and high school or college students are all eligible for coverage if they are employees of the participating district/entity, not volunteers, and are either active contributing TRS members or are employed by a participating district/entity for 10 or more regularly scheduled hours each week.

Independent contractors, and volunteers are not employees and are therefore not eligible for TRS-ActiveCare coverage.

Note: The above eligibility guidelines apply only to TRS-ActiveCare and do not apply to eligibility for membership in the TRS pension plan. Only employees that are active contributing TRS members are eligible for funding provided under Chapter 1581, Texas Insurance Code.

Is an employee eligible to continue TRS-ActiveCare coverage after resigning or retiring from employment?

Under Section 22.004, Texas Education Code, an employee who is participating in TRS-ActiveCare is entitled to continue participating in TRS-ActiveCare if the employee resigns after the end of the instructional year. TRS Rule § 41.38, Texas Administrative Code, will be applied by TRS-ActiveCare in determining the appropriate termination date of TRS-ActiveCare coverage.

Can an employee who is not an active contributing member of TRS obtain coverage under TRS-ActiveCare?

TRS-ActiveCare is available to employees of a participating entity who are not TRS members who are regularly scheduled to work at least 10 hours per week (unless specifically excluded under HB 3343). However, only active contributing TRS members will be eligible for state funding. [TOP]

Who are eligible dependents?

  • Your spouse (including a common law spouse)
  • An  child under the age of  26, such as:
    • A natural child or adopted child or a child who is lawfully placed for legal adoption
    • A stepchild
    • A foster child
    • “Any other child” under the age of 26 (unmarried) in a regular parent-child relationship with the employee, meaning:
      • The child’s primary residence is the household of the employee;
      • The eployee provides at least 50% of the child’s support;
      • Neither of the child’s natural parents resides in that household; and
      • The employee has the legal right to make decisions regarding the child’s medical care
  • A grandchild under age 26 whose primary residence is the household of the employee and who is a dependent of the employee for federal income tax purposes.
  • A child of a covered employee,  age 26 or over, may be eligible for dependent coverage, provided that the child is either mentally  or physically incapacitated to such an extent to be dependent on the employee on a regular basis as determined by TRS, and meets other requirements as determined by TRS. Note: Siblings over age 26 who is either (1) under the legal guardianship of the employee or (2) meets the “Any other Child” criteria (as listed above) is eligible to enroll in TRS-ActiveCare as a dependent.  Parents and Grandparents of the covered employee   do not meet the definition of an eligible dependent. [TOP]

What coverage options are available if a husband and wife both work for a participating entity?

If an employee and wife both work for a participating entity, each can choose employee-only coverage and select the same or different plans.  Or, one employee can select employee and spouse coverage, and the spouse must decline or waive coverage.  If there are dependent children, one employee can choose employee-only coverage and the spouse can choose the same or different plan for employee and child (ren) coverage.  Or, one employee could select employee and family coverage, and the spouse must decline or waive coverage.  Dependent children cannot be covered by both parents.

If a husband and wife both work for the same participating entity, funds may be pooled for employee plus spouse or employee plus family coverage.

TRS and Blue Cross Blue Shield of Texas also developed an option which will allow a husband and wife employed at different participating entities to “pool” funds to obtain employee plus spouse or employee plus family coverage.  Information about this option is available from your Benefits Administrator. [TOP]

Can an employee cover a dependent that is covered as a retiree under TRS-Care?

Yes, a retiree with TRS-Care coverage may be covered as a dependent of an eligible employee under TRS-ActiveCare. [TOP]

Can an employee cover a dependent who is covered as an employee under the state of Texas(or a state university or college) health insurance program?

Yes, an employee of a participating entity can cover a dependent that is also covered by other health insurance programs such as HealthSelect, or UT Select. [TOP]

Is a common-law spouse eligible for dependent coverage?

Yes, a common-law spouse is eligible for dependent  coverage. [TOP]

Are domestic partners eligible for dependent coverage?

No, domestic partners are not eligible for TRS-ActiveCare coverage. [TOP]

Does a child have to be enrolled in school to be eligible for dependent coverage?

No, there is no full-time student requirement to be eligible. [TOP]

When does coverage for a dependent child terminate?

Coverage for a dependent child terminates at the end of the month that the child no longer meets eligibility requirements. [TOP]

Are eligible employees’ stepchildren that do not reside with the employee eligible for TRS-ActiveCare dependent coverage?

Yes, stepchildren under the age of 26 of eligible employees, regardless of residency, are eligible for TRS-ActiveCare dependent coverage. [TOP]

What if an employee and the employee’s dependent child both work for a participating entity and are both active, contributing TRS members?

An individual that is employed by a participating entity and is an active, contributing TRS member cannot be covered as a dependent child.  The employee and the employee’s dependent child cannot pool funds. [TOP]

Is an employee eligible for coverage if he or she is on leave of absence, Workers’ Compensation, or disability?

Employees on leave of absence, workers’ compensation, and/or disability may be eligible for coverage for up to six months on TRS-ActiveCare, depending on the district’s policy.  Contact your Benefits Administrator for additional information. [TOP]

Can dependents be added throughout the plan year?

An employee can add dependents during a plan year if the employee has a qualified status change or a special enrollment event. [TOP]

What is the effective date of coverage for adding a dependent as a result of a special enrollment event?

When adding a dependent, the effective date of coverage will be the first of the month, following the special enrollment event. There is an exception for a newborn child, for whom coverage becomes effective on the date of the birth. Contact your BA for additional information. [TOP]

Medical

Will deductibles carry over to TRS-ActiveCare?

There is no prior carrier credit.  Deductibles (and other plan maximums) from the employee’s prior health coverage do not carry over to TRS-ActiveCare. [TOP]

Are there any preexisting condition limitations or exclusions?

There are no restrictions or preexisting condition limitations for initial enrollees (those eligible employees and their dependents enrolling for TRS-ActiveCare when it is first made available through their participating entity.)  This may not be true for subsequent enrollment periods.  If an employee waives coverage and does not complete an application during the initial enrollment period, or drops coverage during the initial year, preexisting condition limitations may apply during the next enrollment period. If the employee was covered under TRS-ActiveCare at any point in time since its inception in 2002 and has been hired by a different participating district/entity (or rehired by the same participating district/entity), preexisting limitation exclusions may apply. [TOP]

What is the plan year?

The plan year begins September 1 and ends August 31.  Accumulations toward satisfying any required deductible and/or out-of-pocket maximum must be incurred within that period of time.  In some circumstances the initial plan year may be less than 12 months.  For example, if the employing entity begins participation in TRS-ActiveCare on November 1, the first plan year will be 10 months instead of 12. [TOP]

What happens with the deductible if an employee goes to work for a different participating entity?

Plan year deductibles, out-of-pocket maximums and other accumulations will follow the employee (and his or her covered dependents) and will apply towards coverage at the new entity. [TOP]

Pharmacy

How do I know if my medication is covered?

When you fill a prescription at a participating network pharmacy or through the Home Delivery Pharmacy Service, you will be notified if your plan does not cover your medication. To find coverage and pricing detail visit the TRS-ActiveCare website at http://www.trs.state.tx.us/active.jsp?page_id=/global/welcome_active. [TOP]

General  |   Eligibility and Enrollment   |   Medical   |   Pharmacy


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