Current through Register Vol. 56, No. 18, September 16, 2024
(a) The coverage of
an employee and such employee's eligible dependents shall terminate whenever
such employee's eligibility shall cease for any of the reasons given in (c)
below.
(b) The effective date of
termination shall be the last day of the coverage period corresponding to the
payroll period or month in which the last payroll deduction was made from the
employee's salary for coverage, if any are required, or the last charge shall
have been paid by the State for the employee's and/or the employee's
dependents' coverage or by the local employer for the employee and/or the
employee's dependents, as the case may be.
(c) Coverage for the employee and the
employee's dependents will terminate if:
1.
The subscriber voluntarily terminates coverage;
2. The employee terminates
employment;
3. The employee's hours
are reduced so the employee no longer qualifies for coverage as a full-time
employee. An employee whose coverage terminated as a result of a change from
full-time to part-time status cannot be reenrolled until the employee has
reestablished eligibility for coverage by serving the normal waiting period
prescribed for new enrollees. In no event will the waiting period include any
part-time service rendered by the employee;
4. The employee is on a leave of absence and
the employee does not make required premium payments. The coverage of an
eligible employee and of an employee's dependents during any period of
authorized leave of absence without pay shall terminate on the last day of the
second coverage period following the last payroll period or month for which the
employee received a salary payment if the total charge for the coverage is not
paid by the employee;
5. The
employee enters the Armed Forces, is eligible for government-sponsored health
services and is not receiving differential pay from the State or local
employer;
6. The subscriber's
employer ceases to participate in the SHBP;
7. The subscriber dies;
8. The employee is suspended; or
9. The employee is on a furlough or extended
furlough and fails to make required premium payments in advance.
(d) In addition to the above,
coverage for dependents will end if:
1. The
dependent no longer meets the SHBP definition of an eligible dependent found at
17:9-3.1;
2. The dependent dies;
3. The dependent enters the Armed
Forces;
4. The subscriber fails to
make required premium payment(s) for dependents; or
5. A covered child becomes eligible for SHBP
or SEHBP coverage due to employment, unless the child waives that coverage in
order to continue coverage as a dependent under a parent's SHBP plan.
