Sec. 62.154. WAITING PERIOD; CROWD OUT. (a) To the extent permitted under Title XXI of the Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, and any other applicable law or regulations, the child health plan must include a waiting period and may include copayments and other provisions intended to discourage:
(1) employers and other persons from electing to discontinue offering coverage for children under employee or other group health benefit plans; and
(2) individuals with access to adequate health benefit plan coverage, other than coverage under the child health plan, from electing not to obtain or to discontinue that coverage for a child.
(b) A child is not subject to a waiting period adopted under Subsection (a) if:
(1) the family lost coverage for the child as a result of:
(A) termination of employment because of a layoff or business closing;
(B) termination of continuation coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272);
(C) change in marital status of a parent of the child;
(D) termination of the child's Medicaid eligibility because:
(i) the child's family's earnings or resources increased; or
(ii) the child reached an age at which Medicaid coverage is not available; or
(E) a similar circumstance resulting in the involuntary loss of coverage;
(2) the family terminated health benefits plan coverage for the child because the cost to the child's family for the coverage exceeded 9.5 percent of the family's household income;
(3) the child has access to group-based health benefits plan coverage and is required to participate in the health insurance premium payment reimbursement program administered by the commission;
(4) the commission has determined that other grounds exist for a good cause exception; or
(5) federal law provides that the child is not subject to a waiting period adopted under Subsection (a).
(c) A child described by Subsection (b) may enroll in the child health plan program at any time, without regard to any open enrollment period established under the enrollment procedures.
(d) The waiting period required by Subsection (a) must:
(1) extend for a period of 90 days after the last date on which the applicant was covered under a health benefits plan; and
(2) apply to a child who was covered by a health benefits plan at any time during the 90 days before the date of application for coverage under the child health plan.
Added by Acts 1999, 76th Leg., ch. 235, Sec. 1, eff. Aug. 30, 1999. Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.51(a), (b), eff. Sept. 1, 2003.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 1353 (H.B. 109), Sec. 6, eff. June 15, 2007.
Acts 2015, 84th Leg., R.S., Ch. 1 (S.B. 219), Sec. 3.0204, eff. April 2, 2015.
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