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Ways to Enroll, Depending on Your Employer The Self-Service bswift%u00ae Enrollment Portal* If this option is available to you, your employer will give instructions for logging in and using the system. If you%u2019re currently covered, your address, dependents, plan and coverage type are already entered. You can change your address, who you%u2019re covering and your plan. You can print a confirmation of your enrollment when you%u2019re done. Some employers may offer electronic enrollment through a web portal other than bswift. Ask your Benefits Administrator for details. Keep a copy of any confirmation of coverage you get from the other enrollment system. The Enrollment, Change and Declination Form Use this form to enroll in, change or decline coverage. Get the form from your Benefits Administrator or at www.bcbstx.com/trsactivecare. To complete the online form: %u2022 Visit www.bcbstx.com/trsactivecare and click Tools and Resources at the top of the home page. %u2022 Click the Downloadable Forms tab%u2022 Click on the Enrollment, Change and Declination Form.%u2022 Enter your information on the form, and provide all information requested. %u2022 Print the form. %u2022 Sign, date and return the form to your Benefits Administrator in the plan enrollment period. *This may not apply to employers with third-party administrators.Enrollment Deadlines for First Time Enrollees and New Hires Enrolling in TRS-ActiveCare for the First Time You%u2019ll need to enroll online through bswift or another electronic web portal from your employer, or by using the Enrollment, Change and Declination Form as instructed in this guide. Do this before: %u2022 the end of the annual enrollment period; or %u2022 31 calendar days after your actively-at-work date; or %u2022 31 calendar days after a special enrollment event. Newborns must also be enrolled within 31 days of their birth, regardless of their coverage. New Hire You have 31 days after your first day of employment to elect health coverage through TRS-ActiveCare. You may choose your actively-at-work date (the date you started work) or the first of the month following your activelyat-work date as your effective date of coverage. If you choose the actively-at-work date, the full premium for the month is due. Premiums are not prorated.bswift is an independent company that contracts directly with TRS to administer their enrollment platform. bswift does not offer any Blue products or services. They are solely responsible for the products and services they do provide.54 www.bcbstx.com/trsactivecare