Page 23 - Demo

New Hire EventNew hires have 31 days from their actively-at-work date (the date they start to work) to enroll or decline coverage for themselves or their dependents. New hires may choose their actively-at-work date or the first of the month following their actively-at-work date as their effective date of coverage.Important: If choosing the actively-at-work date, the full premium for the month in which the employee was hired will be due, regardless of that date; premiums are not prorated. Employees should be made aware of this when electing coverage to avoid adjustments to the effective date.Making Changes/Special Enrollment EventsA special enrollment event, as defined by the Health Insurance Portability and Accountability Act, provides a special enrollment period for employees and dependents when there is a loss of other coverage or a gain of additional dependents (e.g., birth, adoption/placement for adoption, and marriage).An employee may be able to enroll in coverage, change plan options, or change the dependents he or she covers during a plan year if the employee, or the dependent, has a special enrollment event under applicable law. Changes in employee and/or dependent coverage must be requested within 31 days of the special enrollment event. %u201cRequested%u201d is defined as processing the change in the bswift Enrollment Portal or processing the change in a Third-Party Enrollment Portal. If the employee does not request the appropriate changes during the applicable special enrollment period, the changes cannot be made until the next plan enrollment period or, if applicable, until another special enrollment event occurs.For most special enrollment events, the effective date of coverage will be the first of the month after the event date. Refer to the Effective Date of Coverage charts on page 28- 35 for more information.A change request submitted through a Section 125 vendor (if applicable) will not automatically result in changes to an employee%u2019s TRS-ActiveCare coverage. Changes to TRSActiveCare coverage can be submitted using the bswift Enrollment Portal or processing the change in a Third-Party Enrollment Portal.New DependentsAn employee may have a special enrollment event when a new dependent is added to his or her family as a result of marriage, birth, adoption or placement for adoption. Common law marriage is not considered a special enrollment event unless there is a Declaration of Common Law Marriage filed with an authorized government agency.How are newborns covered by TRS-ActiveCare?Employees must enroll newborns within 31 days from the date of birth. TRS-ActiveCare automatically provides coverage for a newborn child of a covered employee for the first 31 days after the date of birth. However, the employee must add coverage for the newborn by either enrolling the child through the bswift Enrollment Portal, processing the change in a ThirdParty Enrollment Portal or notifying their Benefits Administrator within 31 days from the date of birth. The effective date of coverage for the newborn child is the date of birth.If the enrollment via the bswift Enrollment Portal or the ThirdParty Enrollment Portal is not entered, or the employee does not notify the Benefits Administrator within the above-noted 31-day period, the request to add coverage will be denied %u2014 even if there would be no change in premium. Any employer enrolling through their Third-Party Enrollment Portal must have the Third-Party send the date of birth as the newborns coverage date to prevent a gap in coverage. This is referenced in the TPA%u2019s companion guide.Note: Newborn grandchildren are not automatically covered by TRS-ActiveCare for the first 31 days; however, a covered employee may enroll eligible newborn grandchildren within 31 days after the newborn%u2019s date of birth.It is not necessary to wait for the newborn%u2019s Social Security number to enroll. The employee should use the bswift Enrollment Portal or process the change through a third-party Enrollment Portal without the social security number to add coverage, then update the enrollment record by submitting another change once the number has been issued.Changing plans must be made within 31 days after the newborn%u2019s date of birth (the plan change becomes effective the first of the month following the date of birth).If the intent is to cover a newborn under another commercial plan, this should be provided to the hospital upon admission instead of the TRS-ActiveCare policy information.If the child has been added automatically to the TRSActiveCare plan due to a claim but that was not the intent, please contact BCBSTX Customer Service to have this coverage removed.www.bcbstx.com/trsactivecareba 23