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FAQs: TRS-ActiveCare

FAQs: TRS-ActiveCare

General

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

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

How is TRS-ActiveCare enrollment handled?

Each participating entity is responsible for enrolling its employees. TRS will strive to provide appropriate enrollment information and assistance to the employers.

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

Entities will receive a monthly invoice from WellSystems. Entities will need to send total premiums due to TRS via TEXNET by the 15th of the month. If the 15th of the month is not a business day, payment is due by the last business day prior to the 15th of the month.

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.

Can coverage be dropped for an employee or dependent throughout the plan year?

Yes, unless such action is restricted due to participation in an Internal Revenue Code § 125 cafeteria plan. However, an employee cannot drop coverage for himself without also dropping coverage for all of his dependents. The change will be effective the first day of the following month. If coverage is dropped, for a given individual, that 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.

Can I decline coverage?

Yes. An employee may choose any level of coverage during the initial enrollment period or may decline coverage for himself/herself and his/her dependent.

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

Yes, you can enroll later if you have an applicable special enrollment event or you may enroll during the next annual enrollment period.

Can I change my coverage?

You must keep your current plan choice until the next plan enrollment period unless there is an applicable special enrollment event.

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

No. You must keep your current plan choice until the next annual enrollment period unless there is an applicable special enrollment event.

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

Current law requires that accounts relating to participation in the program be annually audited by a certified public accountant at the charter school's expense. The charter school needs to contact TEA to determine whether the audit will be "in addition to" the annual audit required by TEA.

Will TRS-ActiveCare provide health care coverage for an existing COBRA enrollee of an entity joining 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.

Who will administer COBRA for TRS-ActiveCare?

WellSystems will administer COBRA for TRS-ActiveCare PPO options. Employers should direct HMO participants to their HMO plan for information about the COBRA administrator.

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.

What is a Health Savings Account (HSA)?

An HSA is a special account owned by an individual. It is 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."

Does TRS-ActiveCare offer an HSA?

No, but TRS-ActiveCare 1-HD meets the current IRS definition of a high deductible health plan for all coverage categories. 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.

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Eligibility and Enrollment

Who can enroll in TRS-ActiveCare?

To be eligible for TRS-ActiveCare, you must be employed by a participating 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 entity, he or she can be covered as a dependent of an eligible employee.

Who is eligible for TRS-ActiveCare coverage?

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 entity, not volunteers, and are either active contributing TRS members or are employed by a participating 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 §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. However, only active contributing TRS members will be eligible for state funding.

Who are eligible dependents?

  • Your spouse (including a common law spouse)
  • A child under the age of 26, such as:
    • A natural child
    • An adopted child or a child who is lawfully placed for legal adoption
    • A stepchild
    • A foster child
    • A child under legal guardianship of the employee
  • "Any other child" (other than those listed above) under the age of 26 in a regular parent–child relationship with the employee, meaning all four of the following requirements:
    • The child's primary residence is the household of the employee
    • The employee provides at least 50% of the child's support
    • Neither of the child's natural parents resides in that household of the employee
    • 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 for the reporting year in which coverage of the grandchild is in effect.
  • A child, age 26 or over, of a covered employee, 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 (hereinafter, an "incapacitated child").

Note: A dependent does not include a brother or a sister of an employee unless the brother or sister is an individual under 26 of age who is either (1) under the legal guardianship of the employee, or (2) in a regular parent–child relationship with an employee, as defined in the "any other child" category above. Parents and Grandparents of the covered employee do not meet the definition of an eligible dependent.

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 Aetna have 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.

Can I 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.

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

Yes, you can cover a dependent that is also covered by other health insurance programs such as HealthSelect or UT Select.

Is a common-law spouse eligible for dependent coverage?

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

Are domestic partners eligible for dependent coverage?

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

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.

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.

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.

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.

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.

Can I add dependents throughout the plan year?

No. You can only add dependents during a plan year if a special enrollment event becomes applicable to your situation. You can always add dependents during the annual enrollment period.

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

Enrollment for the dependent is required within 31 days of the special enrollment event. The effective date of coverage will be the first of the month following the date of enrollment under the special enrollment event. There is an exception for a newborn child: enrollment is required within 60 days of the birth and coverage becomes effective on the date of the birth.

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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.

Are there any preexisting condition limitations or exclusions?

There are no restrictions or preexisting condition limitations.

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.

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.

Pharmacy

How do I know if my medication is covered?

When you fill a prescription at a participating network pharmacy or through the Caremark Mail Service Pharmacy, you will be notified if your plan does not cover your medication. To find coverage and pricing details, visit the TRS-ActiveCare website.


Contact our toll-free Customer Service Lines
TRS-ActiveCare Customer Service Number:
Option 1, Aetna (medical)
Option 2, Caremark (prescription drug)
1-800-222-9205
FirstCare: 1-800-884-4901
Scott & White Health Plan: 1-800-321-7947
Allegian Health Plans: 1-855-463-7264
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