1. (a) The following words and phrases, when used in this section, shall have the following meanings, unless the context clearly indicates otherwise.

   1. (1) Noncontributory coverage--The coverage provided at no cost to eligible retirees.
   2. (2) Contributory coverage--Coverage for which a contribution is required.
2. (b) The effective date of noncontributory coverage for a retiree shall be the first day of the month following the effective date of retirement unless the retiree has waived coverage in writing.

3. (c) The effective date of contributory coverage for the retiree shall be:

   1. (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. (2) the first day of the month following the receipt of the application by TRS-Care if the application is received after the effective retirement date but within the 31-day enrollment period.
4. (d) Retirees who due to their effective retirement date have a choice of beginning contributory coverage in two different months may defer the effective date of coverage to the first day of the latter month if that election is made in writing and is received by TRS-Care in advance of the beginning of the first month in which the effective date of coverage could have taken place.
5. (e) The effective date of coverage for a surviving spouse or for a surviving dependent child shall be the first day of their eligibility if TRS-Care receives an application within the enrollment period and the deceased participant had the surviving spouse or the surviving dependent child covered under the program before he or she died.
6. (f) Where the surviving spouse or the surviving dependent child was not covered under the program immediately preceding his or her becoming eligible for coverage the effective date of coverage will be the first day of the month following receipt of an application during the enrollment period by TRS-Care.

7. (g) The effective date of coverage for dependents who are eligible to be enrolled and who are enrolled under a retiree's or surviving spouse's coverage will be:

   1. (1) the same date as the retiree or surviving spouse if the enrollment is during the initial enrollment period;
   2. (2) the first day of the month following receipt of the application by TRS-Care if the enrollment of the dependents is after the initial enrollment period; or
   3. (3) the day on which a child is born, if the participant has coverage for children already in effect under TRS-Care.
8. (h) Except as provided in subsections (l), (m), and (n) of this section, the effective date of changes in coverage due to the acquisition of Medicare shall be on the first of the month following the date of receipt of a copy of the participant's or dependent's Medicare card by TRS-Care.
9. (i) Except as provided in subsections (l), (m), and (n) of this section, the effective date of reduction in coverage shall be the first day of the month following receipt of a signed request by TRS-Care for reduced coverage.
10. (j) 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 at midnight on the last day of the month in which the signed notice is received by the program. This section shall also apply to waivers of noncontributory coverage by retirees.
11. (k) All participants and dependents shall be entitled to all applicable rights under the Federal Public Health Service Act (COBRA), Title XXII.
12. (l) Where a participant who has Medicare Part A coverage incorrectly enrolls in an insurance coverage option that provides for coverage without corresponding Medicare Part A coverage and as a result payment is made by Medicare and TRS-Care in a manner that violates the provisions of Insurance Code, Article 3.50-4, which requires TRS-Care to be secondary to Medicare, the Teacher Retirement System of Texas (TRS) is authorized to seek the recovery of funds paid in violation of Article 3.50-4 and to 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.
13. (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 and there is no claim made upon TRS-Care or the legitimate claim is less than the amount of overpaid contributions, TRS-Care is authorized to refund or credit the amount due to the participant and to 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 is received by TRS-Care.
14. (n) Upon discovery by TRS-Care of a participant who does not have Medicare Part A coverage and who is incorrectly enrolled in a TRS-Care coverage option that provides for corresponding Medicare Part A, TRS-Care will contact the participant and advise them 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 Part A coverage is received prior to that date. Claims shall be paid based upon the coverage in effect at the time the services were provided. Any claims already paid as if Part A was in effect shall not be adjusted.

Source Note: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.