Benefits and Workers' Comp

The Quinlan ISD benefit plan year begins September 1 and continues through August 31.  Due to IRS Section 125 cafeteria plan restrictions, off-cycle benefit changes are allowed only when an employee experiences a qualifying life event (QLE), also known as life status change.  Please see the definitions below.  Should you experience a QLE, please notify Benefits Coordinator/Risk Manager, Shanna Austin at [email protected] immediately, so that deduction/plan changes and/or modifications can be processed within the 31-day guidelines. 

 

Medical-Eligibility and Enrollment

 

Who is eligible for TRS-ActiveCare?

Someone who is employed by a participating entity and is either an active, contributing TRS member, or employed 10 or more regularly scheduled hours each week.

 

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 eligibility guidelines apply only to TRS-ActiveCare and do not apply to eligibility for membership in the TRS pension plan. Only actively contributing TRS members are eligible for state funding provided by state law.

 

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 of Texas coverage as a State of Texas employee with the Employees Retirement System of Texas (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.

 

I’m a school district employee who doesn’t contribute to TRS—am I eligible for TRS-ActiveCare?

If your school district or charter school participates in TRS-ActiveCare and you work at least 10 hours per week, you may be eligible for the coverage. However, only actively contributing TRS members may receive state funding towards premiums.

 

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, all four of the following requirements must be met:

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 is a special enrollment event?

An event as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) 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.

 

If I decline coverage during the initial enrollment period, can I enroll later?

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

Can I change my coverage throughout the year?

You must keep your current plan choice until the next plan enrollment period unless you qualify for a special enrollment event.

 

Can an employee drop health coverage during the plan year?

Depends.  Quinlan ISD participates in an Internal Revenue Code Section 125 cafeteria plan, an employee cannot drop coverage or remove dependents due to plan restrictions unless they have experienced a special enrollment event.  If he or she drops coverage during the plan year, the individual will not be eligible to re-enroll in TRS-ActiveCare until the next plan enrollment period unless there is a special enrollment event.

 

Definitions

 

Cafeteria Plan- an employee benefit plan that allows staff to choose from a variety of pretax benefits. A cafeteria plan is also referred to as a "flexible benefit plan" or Section 125 plan.

 

Qualifying Life Event (QLE) - A change in your situation — like getting married, having a baby, or losing health coverage can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

 

The following are QLE examples, but not a full list.

Loss of health coverage

Losing existing health coverage, including job-based, individual, and student plans

Losing eligibility for Medicare, Medicaid, or CHIP

Turning 26 and losing coverage through a parent’s plan

Changes in household

Getting married or divorced

Having a baby or adopting a child

Death in the family

TRS Website https://www.trs.texas.gov/Pages/Homepage.aspx

TRS Welcome to MyTRS https://www.trs.texas.gov/Pages/active_member_mytrs.aspx

TRS Handbook https://www.trs.texas.gov/TRS%20Documents/benefits_handbook.pdf

TRS Handbook (en ESPAÑOL) https://www.trs.texas.gov/TRS%20Documents/benefits_handbook_spanish.pdf

TRS ActiveCare (Medical for Active Employees) https://www.trs.texas.gov/Pages/healthcare_trs_activecare.aspx

TRS CARE(Medical for Retirees without Medicare) https://www.trs.texas.gov/Pages/healthcare_trs_care.aspx

TRS CARE(Medical for Retirees with Medicare) https://www.trs.texas.gov/Pages/healthcare_trs_care_medicare.aspx

TRS Steps of Planning for Retirement https://www.trs.texas.gov/TRS%20Documents/steps_planning_for_retirement.pdf

TRS Employment After Retirement https://www.trs.texas.gov/TRS%20Documents/employment_after_retirement.pdf

TRS Request for Refund (English) https://www.trs.texas.gov/TRS%20Documents/request_refund.pdf

TRS Request for Refund (en ESPAÑOL) https://www.trs.texas.gov/TRS%20Documents/request_refund_spanish.pdf