| (a) Except as allowed by subsection (c) of this section,
for TRS members who take a service or disability retirement and enroll
in coverage during their initial enrollment period as described in §41.1
of this title (relating to Initial Enrollment Periods for the Health
Benefits Program Under the Texas Public School Retired Employees Group
Benefits Act (TRS-Care)), the effective date of coverage is:
(1) the first day of the month following the effective
date of retirement if the application for coverage is received by
TRS-Care on or before the effective retirement date; or
(2) the first day of the month following the receipt
of the application for coverage by TRS-Care if the application is
received after the effective retirement date but within the initial
enrollment period.
(b) A TRS member who takes a service or disability
retirement and enrolls in coverage during his or her initial enrollment
period may, at any time during his or her initial enrollment period,
make changes to his or her coverage elections. The effective date
of coverage for the new elections is the first day of the month following
receipt by TRS-Care of the application requesting the change in coverage.
(c) Regardless of the date a TRS member submits his
application for retirement, if a TRS member enrolls in coverage during
his initial enrollment period as described in §41.1 of this title,
the TRS member may defer the effective date of coverage described
in subsection (a) of this section for himself and his eligible dependents
to the first day of any of the three (3) months immediately following
the month after the effective date of retirement. This deferment period
runs concurrent with, and does not extend, the enrollment period as
described in §41.1 of this title. In no event may a TRS member
defer the effective date of TRS-Care coverage to a date prior to the
date upon which TRS-Care receives the application for coverage from
the TRS member.
(d) Surviving spouses and surviving dependent child(ren)
who are currently enrolled with the retiree at the time of the retiree's
death will continue to be enrolled in the same coverage plan, subject
to the applicable eligibility requirements of that coverage plan.
(e) If the surviving spouse or the surviving dependent
child was not enrolled in TRS-Care immediately preceding his or her
becoming eligible for coverage, the effective date of coverage will
be, at the election of the surviving spouse or the surviving dependent
child, either the first day of the month following:
(1) TRS-Care's receipt of an application during the
initial enrollment period as described in §41.1 of this title;
or
(2) the month of the death of the deceased TRS service
or disability retiree or deceased active TRS member, provided TRS-Care
receives an application during the initial enrollment period as described
in §41.1 of this title.
(f) The effective date of coverage for an eligible
dependent who is enrolled under a retiree's or surviving spouse's
TRS-Care coverage during the initial enrollment period is the same
date as the retiree or surviving spouse's effective date of coverage
unless the dependent is enrolled after the retiree's effective retirement
date and after the retiree has enrolled but within the initial enrollment
period, in which case the dependent's effective date of coverage will
be the first day of the month following TRS-Care's receipt of the
application to enroll the dependent.
(g) The effective date of coverage for an eligible
individual who is enrolled in TRS-Care as a result of a special enrollment
event, as described in §41.2(b) of this title (concerning Additional
Enrollment Opportunities), is the date specified under the provisions
of the Health Insurance Portability and Accountability Act of 1996
(Pub. L. No. 104-191, 110 Stat. 1936 (1996)).
(h) The effective date of coverage for an eligible
individual who is enrolled in TRS-Care as a result of the Age 65 enrollment
opportunity, as described in §41.2(a) of this title is:
(1) the first day of the month following the month
of the retiree's or surviving spouse's 65th birthday if the application
for coverage is received by TRS-Care before or during the month of
the retiree's or surviving spouse's 65th birthday; or
(2) the first day of the month following the receipt
of the application by TRS-Care if the application for coverage is
received after the month of the retiree's or surviving spouse's 65th
birthday but within the enrollment period.
(i) Except as provided in subsections (k), (l), and
(m) of this section, the effective date of changes in coverage due
to the acquisition of Medicare Part A and/or Medicare Part B is the
first of the month following the date of TRS-Care's receipt of proof,
satisfactory to TRS-Care, of the participant's or dependent's Medicare
Part A and/or Medicare Part B coverage.
(j) A retiree, surviving spouse, or surviving dependent
child may cancel any coverage by submitting the appropriate notice
of cancellation form to TRS-Care. Cancellations will be effective
on the later of:
(1) the first day of the month following TRS-Care's
receipt of the completed notice of cancellation form; or
(2) the date requested by the retiree, surviving spouse,
or surviving dependent child on the completed notice of cancellation
form received by TRS-Care.
(k) Where a participant has Medicare Part A coverage
and TRS-Care has been paying primary to Medicare on Medicare Part
A claims, TRS-Care may seek the recovery of funds and may make the
effective date of the correct coverage retroactive to the first day
of the earliest month for which recovery of such overpaid funds is
possible under Medicare rules.
(l) Where a participant has Medicare Part A coverage
and TRS-Care has been paying primary to Medicare on Medicare Part
A claims, TRS-Care may make the effective date of the correct coverage
retroactive to when the participant was first enrolled in both Medicare
and TRS-Care to a maximum retroactive period of twelve months, including
the month in which proof, satisfactory to TRS-Care, of Medicare Part
A coverage is received by TRS-Care, and based thereon, TRS-Care may
refund or credit the amount due to the participant.
(m) Upon TRS-Care's discovery that a participant does
not have Medicare Part A coverage, in contrast to TRS-Care records
indicating the participant has Medicare Part A coverage, TRS-Care
will contact the participant and advise the participant that the cost
of coverage and the coverage will be adjusted prospectively effective
the first day of the next month unless proof, satisfactory to TRS-Care,
of Medicare Part A coverage is received by TRS-Care prior to that
date. Claims will be paid based upon the coverage in effect at the
time the services were provided. Any claims already paid as if Medicare
Part A were in effect will not be adjusted.
(n) Notwithstanding any other provision of this section
to the contrary, the effective date of coverage of individuals who
enroll in a Medicare plan associated with TRS-Care is subject to the
federal laws, regulations, policies and procedures that control the
Medicare program.
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| Source Note: The provisions of this §41.7 adopted to be effective November 6, 1987, 12 TexReg 3965; amended to be effective February 1, 1989, 14 TexReg 317; amended to be effective March 12, 2003, 28 TexReg 2112; amended to be effective August 25, 2004, 29 TexReg 8132; amended to be effective February 9, 2006, 31 TexReg 709; amended to be effective March 25, 2008, 33 TexReg 2555; amended to be effective March 15, 2009, 34 TexReg 1712; amended to be effective September 10, 2009, 34 TexReg 6121; amended to be effective September 1, 2011, 36 TexReg 5378; amended to be effective January 6, 2013, 37 TexReg 10248; amended to be effectiveDecember 22, 2014, 39 TexReg 10028; amended to be effective January 4, 2018, 42 TexReg 7720; amended to be effective August 15, 2019, 44 TexReg 4189 |
