1. (a) Eligibility. Pursuant to Insurance Code, Article 3.51-6, §1(d)(3), each employee, member or dependent whose coverage under a group policy providing hospital, medical, surgical, or major medical coverage on an expense incurred basis, ceases for any reason shall have the right to conversion or continuation provided:

   1. (1) the person was continuously covered under the group policy for at least three consecutive months immediately prior to termination (or under any policy providing similar benefits which it replaced); and
   2. (2) coverage terminated for any reason except involuntary termination for cause.

2. (b) Ineligibility. A conversion or continuation privilege under Insurance Code, Article 3.51-6, §1(d)(3) shall not be required for any person under the following circumstances:

   1. (1) termination of the group coverage occurred because the person failed to pay any required premium;
   2. (2) any discontinued group coverage was replaced by similar group coverage within 31 days;
   3. (3) the person is or could be covered by Medicare;
   4. (4) the person is covered for similar benefits by another hospital, surgical, medical, or major medical expense insurance policy, or hospital or medical service subscriber contract, or medical practice plan, or any other prepayment plan or any other plan or program;
   5. (5) the person is eligible for similar benefits whether or not covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
   6. (6) similar benefits are provided or available to the person under the requirements of any state or federal law.

Source Note:The provisions of this §3.504 adopted to be effective December 30, 1993, 18 TexReg 9759; amended to be effective July 3, 1996, 21 TexReg 5857.