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Loss of CoverageLoss of coverage qualifies as a special enrollment event if:%u2022 The employee or dependent(s) lost other group coverage due to a loss of eligibility.%u2022 The employee or dependent(s) elected to drop the other group health coverage because the employer stopped all employer contributions toward the premium (including any employer-paid COBRA premium).%u2022 The employee and/or dependent(s) exhausted their COBRA continuation coverage. %u2022 Loss of coverage from the following also qualifies as a special enrollment event:%u2022 Medicare%u2022 Medicaid%u2022 CHIP%u2022 HIPP%u2022 Individual coverage when outside the control of the individual. For example: the insurance company claims bankruptcy, the insurance company withdraws from doing business in the state or the insurance company cancels the block of business.For loss of Medicaid, CHIP, or HIPP the employee must notify the Benefits Administrator within 60 days from the date of the notification that coverage has terminated. Loss of Medicaid, CHIP, or HIPP due to incorrect or missing information is not considered a special enrollment event. To qualify for a special enrollment event, the loss must be due to losing eligibility for the coverage due to age, income, etc.The following reasons for loss of other coverage do not qualify as special enrollment events:%u2022 an increase in the premium cost%u2022 a reduction in the employer%u2019s contribution to the premium%u2022 voluntary termination of coverage, including failure to pay premium%u2022 any additional surcharge or benefit reduction for spouse coverage%u2022 any reduction of benefits such as an increase in deductible or change in the coordination of benefits%u2022 a doctor or other health care provider no longer participates in the plan%u2019s network%u2022 failure to act or respond to an employer%u2019s eligibility audit, which results in loss of coverage for dependentsVoluntary terminations of other coverage, such as dropping other coverage during a spouse%u2019s enrollment period or a Section 125 cafeteria plan enrollment period due to premium or benefit changes, including spousal surcharges or coverage restrictions, are not special enrollment events for TRS-ActiveCare. An employee cannot change plans when dropping a dependent, or a dependent aging-out, from TRS-ActiveCare coverage. An involuntary termination may occur when an employee is terminated or leaves employment resulting in an involuntary loss of eligibility. An involuntary loss of coverage is considered a special enrollment event for TRS-ActiveCare.In order to have a special enrollment event when the employee or dependent of an employee loses other health coverage, the employee or dependent must have had other health coverage when coverage under TRS-ActiveCare was previously declined in writing. If the other coverage was COBRA continuation coverage, special enrollment can be requested only after the COBRA continuation coverage is exhausted. If the other coverage was not COBRA continuation coverage, special enrollment can be requested when the individual loses eligibility for the other coverage.If an employee enrolls via the bswift Enrollment Portal or their Third-Party Enrollment Portal due to %u201closs of other coverage,%u201d the employee%u2019s original application must be checked to verify that coverage was declined (in section 6) due to other coverage. If a declination of coverage was not completed, proof of coverage loss in lieu of a declination must be provided by the employee for a special enrollment event. If documentation is not made available, the employee%u2019s request to add coverage will be denied.Dropping CoverageTRS-ActiveCare participants may drop coverage during a plan year, unless restricted from doing so by their employer%u2019s Internal Revenue Code Section 125 cafeteria plan. Please consult your cafeteria 125 plan administrator to determine if this is allowed.Note: An employee cannot change plans when dropping a dependent, or a dependent turning 26, from TRS-ActiveCare coverage.24 www.bcbstx.com/trsactivecareba