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Human Resources Department

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514 W. Quincy St.
San Antonio, Texas 78212
210-554-8400 (phone)

Mandated Web Postings

TRS Compliance Statement 2016-2017

2017-2018 Premium Rate Sheet

Medicare RX Notice


Notice to Employees: Affordable Care Act - English
Notice to Employees: Affordable Care Act - Spanish

Notice of HIPAA Special Enrollment Rights

Certificate of Creditable (or Non-Creditable) Drug Coverage

HIPAA Privacy notice (if applicable) – Upon enrollment.

Women’s Health and Cancer Rights Act Notification – Upon enrollment.

COBRA General/Initial Notice – Provided to employee and spouse within 90 days of commencement of coverage or within 90 days after the plan first becomes subject to COBRA.

Newborns’ and Mothers’ Health Protection Act Disclosure (should be included in SPD)

Self-funded, Non-federal Governmental Plan Opt Out Notice (if applicable)

Certificate of Creditable (or non-creditable) Rx Coverage – Prior to October 15th

Notice of Availability of HIPAA Privacy Notice – Every 3 years.

Self-funded, Non-federal Governmental Plan Opt Out Notice (if applicable) – Prior to the first day of the plan year.

Wellness Program Notice (if subject to HIPAA) – Any time plan materials describing the outcomes-based wellness program are provided to participants.

Summary Annual Report (SAR) (if applicable; fully insured plans only) – Within 9 months of the end of the plan year or two months after Form 5500 filed with extension (information about requirements and model language can be found at 29 CFR § 2520.104b-10(d)(4)).

CHIPRA State Premium Assistance Notice

English  | Spanish

Americans with Disabilities Act (“ADA”) Wellness Program Notice - (if applicable) - Requires employers who offer wellness programs that include disability-related inquiries or a medical exam (including biometric testing) from employees to provide a notice to employees. The notice is not required at a particular time (e.g. within 10 days prior to collecting health information) but employees must receive the notice before responding to disability-related inquiries or undergoing a medical exam or testing, and with enough time to decide whether to participate in the wellness program. Waiting until after an employee has completed a health risk assessment will violate the notice rule.  Sample Notice

Genetic Information Nondiscrimination Act (“GINA”) Wellness Program Notice and Authorization (if applicable) - Wellness programs that include completion of a health risk assessment (“HRA”) must comply with the GINA notice and authorization rules. The health plan or wellness program acquiring genetic information as a part of the wellness program must provide a notice and obtain an authorization by participating employees and spouses.
Sample Notice

Michelle’s Law (if applicable) – When plan is notifying participant of responsibility to certify student status.

COBRA Election Notice – Within 14 or 44 days of qualifying event. English | Spanish

COBRA Early Termination Notice – as soon as practicable following decision to terminate COBRA

COBRA Unavailability Notice – within 14 or 44 days of qualifying event

Qualified Medical Child Support Order (QMCSO) Notices

  • Notification of receipt of order – Promptly after receiving order.
  • Notification of determination – Within a reasonable period after receipt.

For more information

Summary of Benefits and Coverage and Uniform Glossary – For participants and beneficiaries who enroll or re-enroll in group health coverage through an open enrollment period (including re-enrollees and late enrollees), an SBC must be provided with open enrollment materials. For participants and beneficiaries who enroll in group health plan coverage other than through an open enrollment period (including individuals who are newly eligible for coverage and HIPAA special enrollees), you must provide the SBC within 90 days of the special enrollment. The SBC must be distributed to newly eligible employees as part of any written enrollment/application materials that are distributed by your plan. Or, if your plan does not distribute written application materials for enrollment, the SBC must be distributed no later than the first date the participant is eligible to enroll in coverage.

Women’s Preventive Services: Religious-Affiliated and Closely-Held For-Profit Employer Accommodation
If certain requirements are met, the insurer or TPA will provide for contraceptive coverage. The insurer or TPA providing the contraceptive coverage will be required to provide to plan participants and beneficiaries a written notice of the availability of the contraceptive coverage, separate from but concurrent with (to the extent possible) materials you distribute in connection with annual open enrollment. The Eligible Organization must complete a self-certification and provide the certification to the insurer and/or TPA. In the alternative, an Eligible Organization may send a letter to HHS stating its objection to providing coverage for some or all contraceptives, and HHS will notify the TPA or insurance carrier.
GBS Article:
EBSA Form 700 and Alternative Model Notice:

Note: In 2017, President Trump issued an Executive Order, which directed the tri-agencies to expand the accommodation process to include organizations and individuals that object to the contraceptive mandate based on moral or sincerely held religious beliefs. However, shortly after the tri-agencies issued regulations expanding the accommodation process, a federal judge issued a preliminary injunction preventing enforcement of the revised rules allowing organizations to obtain exemptions on moral or religious grounds. For more information please see the articles linked below.
Contraceptives and Moral Objections:

Contraceptives and Religious Objections:

Notice of Health Insurance and Marketplace CoverageAll new employees at time of hire regardless of eligibility. You must provide a written notice to each newly hired employee, informing them of: (1) basic information about the State’s Marketplace; (2) if your plan does not provide minimum value, a statement that the employee may be eligible for a premium tax credit and a cost sharing reduction through the Marketplace; and (3) if the employee purchases a qualified health plan through the Marketplace, a statement that the employee will lose the employer contribution (if any) to any health benefits plan offered by the employer. Must be provided to new employees at time of hire (within 14 days of employee’s start date).

Two model notices were provided with the guidance:
Model notice for employers who offer a health plan to some or all employees:

English | Spanish

Model notice for employers who do not offer a health plan:

English | Spanish

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