Section 41.7 - Effective Date of Coverage(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.34 Tex. Admin. Code § 41.7
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 by Texas Register, Volume 39, Number 51, December 19, 2014, TexReg 10028, eff. 12/22/2014; Amended by Texas Register, Volume 42, Number 52, December 29, 2017, TexReg 7720, eff. 1/4/2018; Amended by Texas Register, Volume 44, Number 32, August 9, 2019, TexReg 4190, eff. 8/15/2019