| (a) Applicability.
(1) The provisions of this section apply to:
(A) an insurer or a group hospital service corporation
subject to Insurance Code Chapter 842 that issues policies providing
hospital, surgical, or major medical expense insurance coverage or
any combination of those coverages on an expense-incurred basis;
(B) an HMO subject to Insurance Code Chapter 1271.
(2) Except as otherwise required by Insurance Code
Chapter 1251, Subchapter G, or Insurance Code Chapter 1271, Subchapter
G, the provisions of this section do not apply to policies providing
benefits for:
(A) a specified disease or diseases only;
(B) accident only;
(C) group Medicare supplement insurance; or
(D) group TRICARE supplement insurance.
(b) Eligibility for continuation of group coverage.
Each employee, member, enrollee, or dependent whose group coverage
is terminated has the right to continuation of the group coverage
provided under and subject to the conditions of Insurance Code §§1251.251,
1251.252, and 1271.301.
(c) Replacement of group coverage. Any person who elects
to continue group coverage under applicable state law must be included
under any group coverage that replaces the existing group coverage.
Coverage under the replacing coverage must be continued until the
completion of the state continuation coverage period.
(d) Termination of continued coverage. Under Insurance
Code §1251.255 and §1271.304, group continuation coverage
may not terminate until the earliest of:
(1) the date the maximum state continuation coverage
period provided by law would end, which is:
(A) for any employee, member, dependent, or enrollee
not eligible for COBRA continuation coverage, nine months after the
date the employee, member, dependent, or enrollee elects to continue
the group coverage; or
(B) for any employee, member, enrollee, or dependent,
eligible for COBRA continuation coverage, six additional months following
any period of COBRA continuation coverage;
(2) the date failure to make timely payments would
terminate the group coverage;
(3) the date the group coverage terminates in its entirety;
(4) the date the insured or enrollee is covered for
similar benefits by another plan or program, including a hospital,
surgical, medical, or major medical expense insurance policy, a hospital
or medical service subscriber contract, or a medical practice or other
prepayment plan; or
(5) for a person covered under a group policy of accident,
health, or accident and health insurance, including a group contract
issued by a group hospital service corporation, the earliest of:
(A) any date in paragraph (1) - (4) of this subsection;
(B) the date the insured is or could be covered under
Medicare;
(C) the date the insured is eligible for similar benefits,
whether or not covered for those benefits, under any arrangement of
coverage for people in a group, whether on an insured or uninsured
basis; or
(D) the date similar benefits are provided or available
to the insured under any state or federal law other than COBRA continuation
coverage.
(e) Coverage after COBRA. Any insured person or enrollee
who elects to continue group coverage under COBRA may elect state
continuation coverage under Insurance Code §§1251.251, 1251.252,
and 1271.301 following the period of COBRA continuation coverage,
provided the insured or enrollee is otherwise eligible under subsection
(b) of this section.
(f) Coverage for Certain Family Members and Dependents.
A group policy or contract delivered, issued for delivery, renewed,
amended, or extended in this state, including a group contract issued
by a group hospital service corporation, that provides insurance for
hospital, surgical, or medical expenses incurred as a result of accident
or sickness, or an evidence of coverage under Insurance Code Chapter
843, must include the options for continuation of group coverage for
certain family members and dependents prescribed in Insurance Code
Chapter 1251, Subchapter G.
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