Current through Reg. 49, No. 38; September 20, 2024
(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.
