19 Del. Admin. Code § 2001-7.0 - Termination of Coverage
7.1 Coverage ends on the last day of the month in which the employee terminates employment. A public school or higher education employee (less than 12-month employee) whose employment during a school year continues through the last scheduled work day of that school year shall retain coverage through August 31 of the same year so long as the required employee share has been paid. If an employee works 1 day in the month in which they are terminated, they shall earn State Share for the entire month. In the event an employee fails to make the required payment for any coverage selected, coverage will be terminated effective the first of the month in which the employee terminated coverage.
7.2 Coverage (and dependent coverage, if applicable) ends as of the end of the month in which the employee ceases to be an eligible employee for coverage (due to some change such as a reduction in the number of hours the employee works).
7.3 Coverage of dependents, except for dependents of pensioners and dependents eligible for a survivor's pension and dependent children for covered persons who died in the line of duty after January 1, 2004 in accordance with 18 Del.C. §
6602(a)(5), ends as of the last day of the month of the employee's death. Dependents who lose coverage as a result of the employee's death are eligible for continuation under COBRA. Contact the State's COBRA administrator for details of this continuation option.
7.4 Ex-spouses or ex-civil union partners who are not employed by the State of Delaware are not eligible for coverage under the State Plan even if a divorce decree, civil union dissolution, settlement agreement or other document requires an employee to provide coverage for an ex-spouse or ex-civil union partner.
7.4.1 Coverage for the ex-spouse or ex-civil union partner of an active employee, LTD beneficiary or pensioner covered by a non-Medicare plan will end on the day after the date of divorce.
7.4.2 Coverage for the ex-spouse, ex-civil union partner, or ex-step-children of a pensioner covered in the Medicare supplement plan will terminate on the last day of the month following the date of divorce or civil union dissolution provided the pensioner submits a signed application within 30 days of the date of divorce or civil union dissolution. Termination of coverage must be prospective as required by CMS.
7.4.3 Premiums are paid on a monthly basis and not prorated. The regular officer or employee, LTD beneficiary or eligible pensioner must remit the employee or pensioner share for the plan which included the spouse for the entire month. The regular officer or employee, LTD beneficiary or eligible pensioner must submit a signed application within 30 days before the date of divorce. If the provisions of 29 Del.C. §
5202(d) no longer apply as a result of the divorce, each regular officer, employee, LTD beneficiary or eligible pensioner must pay the employee contribution for the entire month that the divorce occurred. The State Plan will not be responsible for payment of claims when a dependent is no longer eligible for coverage. Also see subsections 5.13 and 5.20 of this regulation.
7.5 Coverage for a dependent child or children will end the earlier of the following:
7.5.1 The end of the month in which the dependent child or children as defined in subsection 2.1.1.3 of this regulation attains age 26; or
7.5.2 The end of the month in which the dependent child or children as defined in subsection 2.1.1.4 of this regulation marries, or attains age 19 (or age 24 if full-time student); or
7.5.3 The date the child or children ceases to be dependent on the regular officer or employee or eligible pensioner for at least 50% support per subsections 2.1.1.4, 2.1.1.5, and 2.1.1.6 of this regulation.
7.6 Coverage for a LTD beneficiary will end as of the end of the month in which their LTD benefits end.
Notes
6 DE Reg. 1515 (05/01/03)
12 DE Reg. 986 (01/01/09)
15 DE Reg. 225 (08/01/11)
15 DE Reg. 1071 (01/01/12)
16 DE Reg. 1003 (03/01/13)
24 DE Reg.
27 DE Reg.
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