| (a) Unless otherwise required by law or this section,
coverage shall terminate at the earliest of:
(1) 11:59 p.m. Austin Time on the last calendar day
of the month in which the covered individual's employer, or the employer
of the individual under whom a dependent qualified for coverage, ceases
to be a participating entity;
(2) 11:59 p.m. Austin Time on the last calendar day
of the month in which a covered individual, or the individual under
whom a dependent qualified for coverage, terminates employment as
determined by the participating entity, except as otherwise provided
under §41.39 of this title (relating to Coverage for Individuals
Changing Employers);
(3) 11:59 p.m. Austin Time on the last calendar day
of the month in which a covered individual, or the individual under
whom a dependent qualified for coverage, is no longer eligible for
coverage under TRS-ActiveCare under §41.34 of this title (relating
to Eligibility for Coverage under the Texas School Employees Uniform
Group Health Coverage Program);
(4) 11:59 p.m. Austin Time on the date specified by
the trustee if the covered individual, or the individual under whom
a dependent qualified for coverage, is expelled from the program;
(5) 11:59 p.m. Austin Time on the last calendar day
of the month immediately preceding the month in which TRS receives
a notification from a participating entity, in the form prescribed
by TRS, that a covered individual failed to make a required monthly
premium payment to the participating entity;
(6) 11:59 p.m. Austin Time on the last calendar day
of the month in which a covered individual enters into active, full-time
military, naval, or air service, except as provided under the Uniformed
Services Employment and Reemployment Rights Act of 1994 (USERRA) or
other applicable law;
(7) 11:59 p.m. Austin Time on the last calendar day
of the month in which the administering firm or TRS receives notice,
in a form acceptable to TRS, that a covered individual, or the individual
under whom a dependent qualified for coverage, has chosen to voluntarily
drop coverage under TRS-ActiveCare;
(8) 11:59 p.m. Austin Time on the last day of the month
for which TRS-ActiveCare received payment if the participating entity
employing the covered individual, or the individual under whom a dependent
qualified for coverage, has failed to make all premium payments due
for a period of 90 days or longer; or
(9) the termination date and time that a health maintenance
organization participating in TRS-ActiveCare provides for in its Evidence
of Coverage for the reasons listed in that Evidence of Coverage.
(b) Notwithstanding subsection (a) of this section,
a covered individual who resigns his employment position with a participating
entity effective after the last day of an instructional year and who
is in "good standing" with TRS-ActiveCare at the time of the effective
date of resignation, is entitled to automatically remain enrolled
in TRS-ActiveCare, through the earlier of (1) the first anniversary
of the date participation in or coverage under TRS-ActiveCare was
first made available to employees of that participating entity for
the last instructional year in which the covered individual was employed
by the participating entity, or (2) the last calendar day before the
first day of the instructional year immediately following the last
instructional year in which the employee was employed by the participating
entity, provided none of the events described in provisions of subsection
(a) of this section occur after the effective date of the covered
individual's resignation. Consequently, if the employer of the covered
individual became a participating entity in TRS-ActiveCare on or before
the September 1st that immediately preceded the effective date of
resignation by the covered individual, then the covered individual
may automatically be entitled to coverage through the August 31st
that immediately follows the effective date of resignation, assuming
termination does not sooner occur due to the occurrence of an event
described in provisions of subsection (a) of this section after the
effective date of the covered individual's resignation. Alternatively,
if the employer of the covered individual became a participating entity
in TRS-ActiveCare after the September 1st that immediately preceded
the effective date of resignation by the covered individual, then
the covered individual may automatically be entitled to coverage through
the end of the 12th month of that participating entity's participation
in TRS-ActiveCare, assuming termination does not sooner occur due
to the occurrence of an event described in provisions of subsection
(a) of this section after the effective date of the covered individual's
resignation. A dependent enrolled in TRS-ActiveCare under a covered
individual who qualifies for continued coverage pursuant to this subsection
is also automatically entitled to remain enrolled in TRS-ActiveCare
only for such time as the covered individual remains enrolled in TRS-ActiveCare.
For purposes of this subsection only, the following applies:
(1) A covered individual is in "good standing" with
TRS-ActiveCare if, on the effective date of the individual's resignation:
(A) the covered individual has not been expelled from
TRS-ActiveCare;
(B) TRS has not received a notification from the participating
entity that employed the covered individual, in the form prescribed
by TRS, that the covered individual failed to make a required monthly
TRS-ActiveCare premium payment to the participating entity; and
(C) neither the participating entity that employed
the covered individual, nor the covered individual under whom a dependent
qualified for coverage, failed to make all premium payments due for
a period of 90 days or longer.
(2) For each participating entity that provides instruction
to students, the term "instructional year" shall be the locally established
calendar period during which that participating entity holds classes,
exclusive of summer school. In no event may this "instructional year"
extend beyond June 30th.
(3) For each participating entity that does not provide
instruction to students, the participating entity may establish an
"instructional year" that begins no earlier than August 1st and does
not extend beyond June 30th.
(4) If a participating entity does not establish an
"instructional year," the "instructional year" shall be deemed to
begin on September 1st and to extend through May 31st.
(5) Each participating entity shall have only one "instructional
year," which shall be applicable to all covered individuals employed
by the participating entity.
(c) For individuals receiving continuation coverage
under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub.
L. 99-272) ("COBRA"), coverage shall terminate the earlier of:
(1) 11:59 p.m. Austin Time on the last calendar day
of the month immediately preceding the date on which TRS fails to
receive a timely and complete monthly premium payment from an individual
receiving COBRA continuation coverage; or
(2) 11:59 p.m. Austin Time on the last calendar day
of the month in which an individual's eligibility for COBRA continuation
coverage expires or otherwise terminates.
|
| Source Note: The provisions of this §41.38 adopted to be effective August 26, 2002, 27 TexReg 7970; amended to be effective December 26, 2002, 27 TexReg 12003; amended to be effective August 25, 2004, 29 TexReg 8134; amended to be effective March 8, 2007, 32 TexReg 1092; amended to be effective April 9, 2008, 33 TexReg 2825; amended to be effective April 1, 2011, 36 TexReg 2001; amended to be effective December 22, 2014, 39 TexReg 10029 |
