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

   1. (1) Noncontributory coverage means coverage under the health benefits program under the Texas Public School Retired Employees Group Benefits Act (TRS-Care) provided at no cost to eligible TRS retirees and surviving spouses.
   2. (2) Contributory coverage means TRS-Care coverage for which eligible TRS retirees, surviving spouses, and surviving dependent children must pay at least some part of the cost.
2. (b) For those TRS members who take a service or disability retirement before September 1, 2004, and who enroll or are enrolled in noncontributory coverage during their initial enrollment period as described in §41.1 of this chapter 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 such coverage is the first day of the month following the effective date of retirement unless the retiree has waived coverage in writing.

3. (c) Except as provided in subsection (i) of this section, this subsection applies to the following TRS members: those who take a service or disability retirement after September 1, 2004, and enroll in noncontributory coverage during their initial enrollment period as described in §41.1 of this chapter and those who, regardless of their retirement date, enroll in contributory coverage during their initial enrollment period as described in §41.1. For such members, the effective date of coverage is:

   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 initial enrollment period.
4. (d) Retirees who, due to their effective retirement date, have a choice of beginning 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 before 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 is the first day of his or her eligibility if TRS-Care receives an application within the initial enrollment period as described in §41.1 of this chapter and the deceased participant had the surviving spouse or the surviving dependent child enrolled in TRS-Care before the participant died.
6. (f) 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 the first day of the month following TRS-Care's receipt of an application during the initial enrollment period as described in §41.1 of this chapter.
7. (g) 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.
8. (h) The effective date of coverage for an eligible dependent who is enrolled under a retiree's or surviving spouse's TRS-Care coverage as a result of a special enrollment event under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) is the date specified by HIPAA.

9. (i) The effective date of coverage is the first day of the month following the receipt by TRS-Care of the enrollment application submitted by the retiree who:

   1. (1) took a service retirement between September 1, 2004, and August 31, 2005, inclusive;
   2. (2) was eligible at the time of retirement to enroll in TRS-Care pursuant to Insurance Code, §1575.004(a)(1)(B) as enacted by the Legislature in 2003;
   3. (3) was required to pay the total cost of participation for the retiree and the retiree's dependents in TRS-Care; and
   4. (4) enrolled during the 61-day period, from September 1, 2005, through October 31, 2005, inclusive, authorized under a Resolution Regarding Sixty-One Day Enrollment or Upgrade Opportunity in TRS-Care for Certain Service Retirees, approved by the TRS Board of Trustees on July 8, 2005.

10. (j) The effective date of coverage for a retiree, a surviving spouse, and an eligible dependent who have an additional enrollment opportunity as described in §41.2(b) of this chapter relating to Additional Enrollment Opportunity and who submit an application within the time period described by §41.2 is:

    1. (1) September 1, 2004, if the application for coverage is received by TRS-Care by August 31, 2004; or
    2. (2) October 1, 2004, if the application is received on or after September 1, 2004 but within the enrollment period.

11. (k) The effective date of coverage for a retiree, a surviving spouse, and an eligible dependent who have an additional enrollment opportunity as described in §41.2(c) or §41.2(d) of this chapter relating to Additional Enrollment Opportunity and who submit an application within the time period described by §41.2 is:

    1. (1) the first day of the month following the retiree's or surviving 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 birthday; 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 retiree's or surviving spouse's 65th birthday but within the enrollment period.
12. (l) Except as provided in subsections (o), (p), and (q) 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.
13. (m) Except as provided in subsections (o), (p), and (q) 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.

14. (n) A retiree, surviving spouse, or surviving dependent child may cancel any coverage by submitting the appropriate cancellation notice to TRS-Care.

    1. (1) Cancellations will be effective on:

       1. (A) 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. (B) 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. (C) 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.
    2. (2) This subsection shall also apply to waivers of noncontributory coverage by retirees who take a TRS retirement before September 1, 2004.
15. (o) 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 payment is made by Medicare and TRS-Care in a manner that violates the provisions 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 correct coverage retroactive to the first day of the earliest month for which recovery of such overpaid funds is possible under Medicare rules.
16. (p) 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 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 is received by TRS-Care.
17. (q) 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 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 Part A were in effect will 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; amended to be effective August 25, 2004, 29 TexReg 8132; amended to be effective February 9, 2006, 31 TexReg 709.