SECTION 41.34. Eligibility for Coverage under the Texas School Employees Uniform Group Health Coverage Program

The following persons are eligible to be enrolled in TRS-ActiveCare under terms, conditions and limitations established by the trustees unless expelled from the program under provisions of Chapter 1579, Insurance Code:

(1) A full-time employee as defined in §41.33 of this title (relating to Definitions Applicable to the Texas School Employees Uniform Group Health Coverage Program).

(2) A part-time employee as defined in §41.33 of this title.

(3) Dependents, as defined in §41.33 of this title pursuant to §1579.004, Insurance Code. A child defined in §1579.004(3), Insurance Code, who is 26 years of age or older, is eligible for coverage only if, and only for so long as, such child's mental disability or physical incapacity is a medically determinable condition that prevents the child from engaging in self-sustaining employment as determined by TRS.

(4) Individuals employed or formerly employed by a participating entity, and their dependents, who are eligible for, or participating in, continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. 99-272), through a group health benefit plan sponsored by the individual's employer on the first day that employer first becomes a participating entity if such individuals or their dependents would have met the requirements for eligibility in paragraphs (1), (2), or (3) of this section on the individual's last day of employment with the participating entity. Notwithstanding the foregoing, the individual is eligible to participate in TRS-ActiveCare only for the rest of the duration of the individual's eligibility for COBRA continuation coverage. This subsection will not apply to individuals that receive COBRA continuation coverage offered through an alternative group health plan coverage offered by a participating entity at the same time that the entity is offering coverage through TRS-ActiveCare, and the participating entity terminates the alternative group health plan coverage, or the participating entity is terminated from the program by TRS for violating Section 1579.1045, Insurance Code, and §41.30(e) of this title (relating to 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).

(5) An individual who qualifies for coverage pursuant to §41.38(b) of this title (relating to Termination Date of Coverage), and their dependents.

(6) Full-time or part-time employees as defined in §41.33 of this title and their eligible dependents may participate in an approved HMO if they reside, live, or work in the approved service area of the HMO and are otherwise eligible to participate in the HMO under the terms of the TRS contract with the HMO.

(7) Individuals who become eligible as determined by TRS for continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272), through their participation in TRS-ActiveCare.

(8) Individuals who become eligible for coverage under the special enrollment provisions of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191, 110 Stat. 1936 (1996)).

(9) Any other individuals who are required to be covered under applicable law.

Source Note: The provisions of this §41.34 adopted to be effective August 26, 2002, 27 TexReg 7970; amended to be effective January 28, 2003, 28 TexReg 743; amended to be effective October 27, 2003, 28 TexReg 9289; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective April 9, 2008, 33 TexReg 2825; amended to be effective April 1, 2011, 36 TexReg 2001; amended to be effective September 1, 2011, 36 TexReg 5380; amended to be effective December 22, 2014, 39 TexReg 10029; amended to be effective August 15, 2019, 44 TexReg 4189;amended to be effective October 17, 2021, 46 TexReg 6944