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Summary of Benefits and CoverageThe Patient Protection and Affordable Care Act requires all insurers and group health plans to give consumers a Summary of Benefits and Coverage. The SBC describes key plan features, benefits and coverage, and provides a glossary of health care coverage terms.To view your plan%u2019s SBC, visit the website or call the number below.TRS-ActiveCare PrimaryTRS-ActiveCare Primary+TRS-ActiveCare HDTRS-ActiveCare 2www.bcbstx.com/trsactivecare 1-866-355-5999Blue Essentials - West Texas HMO www.bcbstx.com/trshmo 1-888-378-1633Blue Essentials - South Texas HMO www.bcbstx.com/trshmo 1-888-378-1633To view a glossary of terms, visit www.tinyurl.com/5ym6kb6s.Initial Notice About Special Enrollment Rights In your group health plan, a federal law called Health Insurance Portability and Accountability Act requires that we notify you about a very important provision in the program. You have the right to enroll in the program under its %u201cspecial enrollment provisions%u201d if (i) you get a new dependent or if (ii) you decline coverage under this program for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons. Special Enrollment Provisions Loss of other coverage (excluding Medicaid or a state CHIP) If you%u2019re declining enrollment for yourself or your eligible dependents (including your spouse) because of other available group health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this program if you or your dependents lose eligibility for that other coverage (or if you move out of an HMO service area, or the employer stops all contributions towards other coverage for you and your dependents). However, you must request enrollment, and BCBSTX must get your request within 31 days after coverage ends for you or your dependents (or you move out of the prior plan%u2019s HMO service area, or after the employer stops all contributions toward the other coverage, including employer-paid COBRA paid premiums). Loss of coverage for Medicaid or a state CHIP If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under the Texas Children%u2019s Health Insurance Program is in effect, you may be able to enroll yourself and your dependents in this program if you or your dependents lose eligibility for that other coverage. However, you must request enrollment, and BCBSTX must get your request within 60 days after you or your dependents%u2019 coverage ends under Medicaid or a state CHIP.IMPORTANT NOTICES 56 www.bcbstx.com/trsactivecare