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TRS-Care Eligibility and Enrollment

Who can enroll in TRS-Care?

Service Retirees

A service retiree must have at least 10 years of service credit in TRS at the time of retirement. This service credit may include up to five years of military service credit; but it may not include any other purchased special or equivalent service credit. In addition to the “10 years of service credit” requirement, you must meet one of the following requirements at retirement:

the sum of your age and years of service credit in TRS equals or exceeds 80 (with at least 10 years of service credit), regardless of whether you had a reduction in the retirement annuity for early age (years of service credit can include all purchased service);

-OR-

you have 30 or more years of service credit in TRS (including purchased service).

NOTE: Combined service credit under the Proportionate Retirement Program may not be used to establish eligibility for TRS-Care or any type of benefits other than service retirement benefits.
A service retiree is not eligible to enroll in the TRS-Care program if they are eligible for ERS, UT System or A&M System health benefit program coverage.

Disability Retirees

Individuals are eligible to participate in TRS-Care when they become a TRS disability retiree under the TRS pension. Once enrolled in TRS-Care as a disability retiree, participation continues as long as the individual is a TRS disability retiree under the TRS pension. If you are applying for health coverage because of a disability, you may be contacted to validate your Medicare Social Security Disability status.

NOTE: Coverage for a disability retiree with fewer than 10 years of service credit in the TRS pension only continues up to the total number of years of service credit. Consequently, coverage for such a disability retiree will end when disability retirement benefits under the TRS pension end.
A disability retiree is eligible to enroll in TRS-Care even if s/he is eligible for ERS, UT System, or A&M System health benefit program coverage.

Dependents

The following types of dependents are eligible for coverage under TRS-Care health plans:

Your spouse (including a common-law spouse).
A child under the age of 26 who is also:

a natural child;
an adopted child, or one lawfully placed for adoption;
a foster child;
a stepchild; or
a grandchild who lives with you, depends on you for support, and who you claim for federal income tax purposes.

Children (regardless of age) who have a mental disability or physical incapacity to such an extent to be dependent on the retiree or surviving spouse for care and support, as determined by TRS.

Some types of dependents will require additional documentation to establish they meet eligibility criteria.

Other Scenarios

I am already enrolled in TRS-ActiveCare

TRS-Care (for retirees) is a separate and distinct program from TRS-ActiveCare (for working school employees). When you retire, you must submit an application that tells TRS if you’d like to enroll yourself and your dependents in, or defer enrollment in, TRS-Care. Also be sure to contact your school official to verify your TRS-ActiveCare termination date.

Both spouses are TRS pension retirees

If both spouses are TRS pension retirees, and each meet the TRS-Care eligibility requirements individually, it is okay for each to enroll separately in TRS-Care as individuals, which may be financially advantageous. Feel free to call 1-888-237-6762 for additional information.

A TRS pension retiree can be covered under TRS-ActiveCare as a dependent of an active employee who is enrolled in TRS-ActiveCare.

How to Enroll

After you submit your retirement application (Form TRS 30) to TRS and it is processed, you will receive a TRS-Care enrollment packet that includes an application for TRS-Care (Form TRS 700A). If you want to enroll in TRS-Care, you should complete the application and send it back to TRS.

If you’re applying for disability retirement, TRS will send you a TRS-Care enrollment packet if your disability retirement is approved.

During your Initial Enrollment period for TRS-Care, if you choose not to enroll, you do not need to take any action. You only need to submit an application if you want to enroll in TRS-Care.

TRS offers a webinar series called Retire Healthy with TRS-Care for prospective participants. If you are nearing retirement and thinking about your health care options after retirement, sign up for one of these sessions. You can find the schedule for upcoming webinars on the Health Care Events page.

When you May Enroll: Initial Enrollment Period

If you are a service retiree, your Initial Enrollment period is the later of:

the period that begins on the effective date of your retirement and expires at the end of the last day of the month that is 3 consecutive calendar months, but in no event less than 90 days, after your effective retirement date;

-OR-

the period that begins on the last day of the month in which your election to retire is received by TRS and expires at the end of the last day of the month that is 3 consecutive calendar months, but in no event less than 90 days, following the last day of the month in which your election to retire is received by TRS.

**Initial Enrollment Period Examples**
Retirement Date	Form TRS 700A Due
September 30	December 31
October 31	January 31
November 30	February 28 (or 29)
December 31	March 31
January 31	May 1
February 28 (or 29)	May 31
March 31	June 30
April 30	July 31
May 31	August 31
June 30	September 30
July 31	October 31
August 31	November 30

Your application for TRS-Care (TRS Form 700A or 700M) is due no later than the last day of your Initial Enrollment period. Please see the chart “Initial Enrollment Period for TRS-Care” for more information.

If you are a disability retiree, your Initial Enrollment period begins on the date that your disability retirement is approved by the TRS Medical Board and expires at the end of the last day of the month that is 3 consecutive calendar months, but in no event less than 90 days, after the date that your disability retirement is approved by the TRS Medical Board.

When is my coverage effective?

Effective date of coverage

The effective date of coverage will be (1) the first day of the month following your effective date of retirement if TRS receives your TRS-Care Enrollment application (Form TRS 700A or 700M) on or before your effective retirement date; or (2) the first day of the month following the receipt of the application for coverage by TRS-Care if your Form TRS 700A is received after your effective retirement date but within your Initial Enrollment period. If you want your coverage to take effect the first of the month after your retirement date, TRS must receive the application before the retirement date.

The same applies for disability retirees.

During your Initial Enrollment period, you may still make changes to your coverage elections. The effective date of coverage for any new elections is the first day of the month after TRS receives the new application requesting the retirement coverage.

Deferring coverage

During your Initial Enrollment period, you may postpone the effective date of your TRS-Care coverage to the first of any of the three months immediately following the month after your retirement date. For example, if your retirement date is May 31, the TRS-Care coverage effective date (normally June 1) may be deferred to July 1, Aug. 1, or Sept. 1. For a deferred effective date, you must write the coverage effective date in the space provided on the Initial Enrollment application (TRS Form 700A). If you have questions about deferring your effective date, please call 1-888-237-6762.

Special Enrollment Events

Special enrollment events are opportunities to enroll in TRS-Care outside of your Initial Enrollment period. There are two general categories of special enrollment events:

an involuntary loss of comprehensive coverage; and
an individual becomes a new dependent.

Loss of eligibility for other coverage

If a retiree or surviving spouse loses coverage

If you, as a retiree or surviving spouse, are not enrolled in TRS-Care, and through no fault of your own, you lose comprehensive health coverage with another health plan, you may be able to enroll in TRS-Care under a special enrollment event. However, you must otherwise be eligible for TRS-Care and you must be able to show that you involuntarily lost comprehensive health coverage. Loss of disability, specified disease, vision, dental or other coverage that is not comprehensive health coverage does not trigger a special enrollment event.

If you are not already enrolled in TRS-Care at the time you experience an involuntary loss of comprehensive coverage through no fault of your own, you may enroll yourself and your eligible dependents in TRS-Care within 31 days following the loss of coverage under the other comprehensive health plan. However, if you are already enrolled in TRS-Care at the time you lose other comprehensive health plan coverage, you will not be able to enroll any of your otherwise eligible dependents.

Should you lose coverage with another plan, it will be important to keep your notice of termination letter in order to demonstrate to TRS that the loss of coverage was for a qualifying reason.

Among other possible events, the following do not qualify for a Special Enrollment Event:

Dropping other coverage because premiums increase
Termination of coverage for failure to pay your premiums
Termination of coverage for cause (such as making a fraudulent claim or an intentional misrepresentation of a material fact in connection with the coverage)

If a spouse or other eligible dependent loses coverage

When a spouse or other eligible dependent is not enrolled in TRS-Care, and through no fault of their own, they lose comprehensive health coverage with another health plan, you may enroll your eligible dependent in TRS-Care within 31 days following the dependent’s involuntary loss of the other health plan coverage. If you enroll an eligible dependent, you must also become enrolled in TRS-Care (if you are not already enrolled).

New dependents

A retiree or surviving spouse (enrolled or otherwise eligible for TRS-Care) who acquires an eligible dependent through marriage, birth, adoption, placement for adoption, or guardianship, must notify TRS in writing within 31 days of the date they acquire the eligible dependent, in order for the enrollment to be valid. For example, if an otherwise eligible retiree is not currently enrolled in TRS-Care at the time they get married, the retiree may enroll himself or herself, along with any eligible dependents, during a special enrollment period. However, a surviving spouse may not enroll a new spouse if the surviving spouse remarries. Enrollment will take effect the first of the month after TRS-Care receives the request for enrollment in writing. Documentation is required to establish the eligibility for all new dependents. A 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.

If I leave TRS-Care, can I come back?

If a retiree or surviving spouse leaves TRS-Care, he or she will only have the following, limited opportunities to re-enter the program:

at age 65; or
with a special enrollment event.

In most situations, retirees and surviving spouses cannot re-enroll in TRS-Care. However, retirees and surviving spouses may re-enroll in TRS-Care when they turn 65 or if they have a special enrollment event, which are rare. There are two types or areas of special enrollment: 1) an individual becomes a new dependent; and 2) an involuntary loss of comprehensive coverage.

Turning Age 65: A New Enrollment Opportunity

If you’re a retiree or surviving spouse who isn’t yet 65, and you either terminated TRS-Care or didn’t enroll during your Initial Enrollment opportunity, you can enroll in TRS-Care when you turn 65. You may also add eligible dependents at that time. Prior to your 65th birthday, TRS will send a postcard with instructions on how to enroll. To enroll in TRS-Care at 65, you must request an application for TRS-Care (Form 700EO) and submit your application for coverage no later than 31 days from the end of the month in which you turn 65. Call TRS Health at 1-888-237-6762 to request an application.

TRS does not always have information about surviving spouses in its records. Surviving spouses are responsible for requesting and submitting their application for coverage no later than 31 days from the end of the month in which they turn 65.

Please note this enrollment opportunity is not available to dependent spouses or children when they turn 65.

When you become eligible for Medicare, you must purchase and maintain Medicare coverage, including Medicare Part B coverage, to enroll in the TRS-Care Medicare Advantage medical plan and TRS-Care Medicare Rx prescription drug plan. You risk losing all TRS-Care coverage if you do not have Medicare Part B coverage when you’re eligible to purchase it.

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