Texas § IN.1501.008 - LATE ENROLLEES

§ IN.1501.008. LATE ENROLLEES

LATE ENROLLEES. (a) For purposes of this chapter, an employee or dependent eligible for enrollment in a small or large employer's health benefit plan is a late enrollee if the individual requests enrollment after the expiration of: (1) the initial enrollment period established under the terms of the first plan for which the individual was eligible through the small or large employer; or (2) an open enrollment period under Section 1501.156 (a) or 1501.606 (a). (b) An employee or dependent eligible for enrollment is not a late enrollee if the individual: (1) was covered under another health benefit plan or self-funded employer health benefit plan at the time the individual was eligible to enroll; (2) declined enrollment in writing, at the time of the initial eligibility for enrollment, stating that coverage under another health benefit plan or self-funded employer health benefit plan was the reason for declining enrollment; (3) has lost coverage under the other health benefit plan or self-funded employer health benefit plan as a result of: (A) the termination of employment; (B) a reduction in the number of hours of employment; (C) the termination of the other plan's coverage; (D) the termination of contributions toward the premium made by the employer; or (E) the death of a spouse or divorce; and (4) requests enrollment not later than the 31st day after the date coverage under the other health benefit plan or self-funded employer health benefit plan terminates. (c) An employee or dependent eligible for enrollment is also not a late enrollee if the individual is: (1) employed by an employer that offers multiple health benefit plans and the individual elects a different health benefit plan during an open enrollment period; (2) a spouse for whom a court has ordered coverage under a covered employee's plan and the request for enrollment of the spouse is made not later than the 31st day after the date the court order is issued; (3) a child for whom a court has ordered coverage under a covered employee's plan and the request for enrollment is made not later than the 31st day after the date the employer receives the court order; or (4) a child of a covered employee who has lost coverage under Title XIX of the Social Security Act (42 U.S.C. Section 1396 et seq.), other than coverage consisting solely of benefits under Section 1928 of that Act (42 U.S.C. Section 1396s), or under Chapter 62 , Health and Safety Code, and the request for enrollment is made not later than the 31st day after the date on which the child loses coverage. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.