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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES |
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Subtitle C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES |
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Chapter 846. MULTIPLE EMPLOYER WELFARE ARRANGEMENTS |
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Subchapter A. GENERAL PROVISIONS |
Sec. 846.004. LATE-PARTICIPATING EMPLOYEE OR DEPENDENT
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(a) For purposes of this chapter, an employee or dependent eligible for enrollment in a participating employer's health benefit plan is a late-participating employee or dependent if the individual requests enrollment after the expiration of:
(1) the initial enrollment period established under the terms of the first health benefit plan for which that employee or dependent was eligible through the participating employer; or
(2) an open enrollment period under Section 846.257.
(b) An employee or dependent is not a late-participating employee or dependent 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 is also not a late-participating employee or dependent 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 under Section 846.257;
(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; or
(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.