Tex.
Ins. Code Section 846.004
Late-participating Employee or Dependent
(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 (Enrollment; Waiting Period).(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 (Enrollment; Waiting Period);(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.
Source:
Section 846.004 — Late-participating Employee or Dependent, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.846.htm#846.004 (accessed Jun. 5, 2024).
