Page 27 - Demo

Pooling Funds/Split PremiumMarried employees who are active contributing TRS members may %u201cpool%u201d their local employer and state funding to use toward the cost of TRS-ActiveCare coverage.PoolingIf an employee and spouse both work for the same participating employer, funds may be pooled. Note: Pooling is handled internally at the employer and not tracked or submitted to bswift.%u2022 One employee selects employee and spouse coverage, and the spouse declines coverage; or%u2022 One employee selects employee and family coverage, and the spouse declines coverage.Split PremiumIf an employee and spouse work for different participating employers, they may wish to pool funds. The decision to enter into a split premium arrangement must be made during Annual Enrollment or within the election period of a special enrollment event.%u2022 One employee selects employee and spouse coverage, and the spouse declines coverage; or%u2022 One employee selects employee and family coverage, and the spouse declines coverage.Employees will be billed for the full premium until their application is reviewed and approved. When an application is approved, the change to a split premium will go into effect first of the following month. For example, someone who submits their application on Aug. 10 and is approved on Sept. 2 will move to split premiums effective Oct. 1. For the employee and spouse who choose this option, the cost of coverage will be split between and billed to the two employers. Each employer will be billed 50% of the total cost of coverage. The participating employer employing the spouse who declined coverage will consider the employee as covered under a group health plan for funding purposes and the participating employer%u2019s premium billing statement will list the employee under their spouse%u2019s ID number.Benefits Administrators must complete the online Application to Split Premium Form. This Form should be submitted through the online Application to Split Premium Form at the same time as either (i) an enrollment or change processed through the bswift Enrollment Portal is approved or (ii) an enrollment or change is made through a Third-Party Enrollment Portal.To access the online Application to Split Premium Form go to TRS split bill.Please Note: A child (under 26) who is employed by an employer and is a contributing TRS member can be covered as a dependent on his or her parent%u2019s TRS-ActiveCare coverage. However, under current law, pooling of state and employer funds is only allowed for %u201cmarried couples,%u201d an employee who is covered as a dependent child will not be entitled to state or employer funding.Note: Both participating employers need to have the same effective date of coverage for married employees to enter a split premium arrangement except for the following: If an employee already has employee and family coverage and the spouse is hired by another participating employer, the spouse can decline coverage and complete an online Application to Split Premium Formto be effective on the first of the month following the spouse%u2019s actively-at-work date. Requests for a split premium arrangement must be signed, dated and submitted to the Benefits Administrator within the plan enrollment period and received by bswift within the membership processing guidelines. Requests for exceptions can be made through the bswift Exception and Appeals Portal (https://www.trsactivecare.bswift.com).Important: If either employee changes employment to another participating employer, a new online Application to Split Premium Form will be required. A new form is needed if there is any change to an existing split premium arrangement.www.bcbstx.com/trsactivecareba 27