AI-assisted research summary: This section defines when an employee or dependent is considered late-participating for enrollment in a participating employer’s health benefit plan.
Sec. 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. (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; (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. Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.