Texas Register, Volume 37, Number 40, Pages 7815-8094, October 5, 2012 Page: 7,983
7533-7814 p. ; 28 cm.View a full description of this periodical.
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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 effectivee date of coverage for a special enrollment
event is determined as fellows]
[(-) For a special enrollment event that occurees on or after
September 4- 201- the] effective date of coverage for an eligible indi-
vidual who is enrolled in TRS-Care as a result of a special enrollment
event, as described in 41.2(b)(1) of this chapter (relating to 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)).
() For a special enrollment event that ocurs on or before
August 20 ,the effeive date coverage for an eligible individ-
al who is enrolled under a retiree's or surviving pouse's fRS-are
coverage as a resutt of a special enrollment ev as described in and
limited by 412(b)(2) of this cht is the date specified under the
prosions of the death Insurance Porability and AccountabiliAt
of 4996 (Pub No 14-1914 10Stab T9 .99 6
(h) The effective date of coverage for a retiree, a surviving
spouse, and an eligible dependent described in 41.2(a)(2) or (3) of
this title who submit an application within the time period described
by 41.2(a)(8) of this title is:
(1) the first day of the month following the retiree's or sur-
viving spouse's 65th birthday if the application for coverage is received
by TRS-Care on or before the retiree's or surviving spouse's 65th birth-
day; or
(2) the first day of the month following the receipt of the
application by TRS-Care if the application is received after the retiree's
or surviving spouse's 65th birthday but within the enrollment period.
(i) Except as provided in subsections (1), (m), and (n) of this
section, the effective date of changes in coverage due to the acquisition
of Medicare is the first of the month following the date of TRS-Care's
receipt of a copy of the participant's or dependent's Medicare card.
(j) Except as provided in subsections (1), (m), and (n) of this
section, the effective date of reduction in coverage shall be the first
day of the month following TRS-Care's receipt of a signed request for
reduced coverage.
(k) A retiree, surviving spouse, or surviving dependent child
may cancel any coverage by submitting the appropriate cancellation
notice to TRS-Care. Cancellations will be effective on:
(1) the first day of the month following the date printed on
the notice of cancellation form ("notice date") sent to the retiree at the
retiree's last known address, as shown in the TRS-Care records, if TRS-
Care receives the completed notice of cancellation within fourteen days
of the notice date; or
(2) the first day of the month following TRS-Care's receipt
of the retiree's completed notice of cancellation form if the form is
received more than fourteen calendar days after the notice date; or(3) the first day of the month following TRS-Care's receipt
of a written request to cancel coverage from a surviving spouse or from
or on behalf of a surviving dependent child.
(1) Where a participant who has Medicare Part A coverage in-
correctly enrolls in an insurance coverage option that provides for cov-
erage without corresponding Medicare Part A coverage and payment
is made by Medicare and TRS-Care in a manner that violates the pro-
visions of Chapter 1575, Insurance Code, which requires TRS-Care to
be secondary to Medicare, TRS may seek the recovery of funds paid in
violation of Chapter 1575 and may make the effective date of the cor-
rect coverage retroactive to the first day of the earliest month for which
recovery of such overpaid funds is possible under Medicare rules.
(m) Where a participant who has Medicare Part A coverage
incorrectly enrolls in a TRS-Care coverage option that provides for
coverage without corresponding Medicare Part A coverage and there is
no claim made upon TRS-Care or the legitimate claim is less than the
amount of overpaid contributions, TRS-Care may refund or credit the
amount due to the participant and 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 of Medicare Part
A coverage is received by TRS-Care.
(n) Upon TRS-Care's discovery that a participant does not
have Medicare Part A coverage and is incorrectly enrolled in a
TRS-Care coverage option that requires 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 a copy of a Medicare
card showing Medicare Part A coverage is received 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.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.
Filed with the Office of the Secretary of State on September 19,
2012.
TRD-201204963
Brian K. Guthrie
Executive Director
Teacher Retirement System of Texas
Earliest possible date of adoption: November 4, 2012
For further information, please call: (512) 542-6438PROPOSED RULES October 5, 2012 37 TexReg 7983
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Texas. Secretary of State. Texas Register, Volume 37, Number 40, Pages 7815-8094, October 5, 2012, periodical, October 5, 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth288982/m1/169/: accessed July 17, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu.; crediting UNT Libraries Government Documents Department.