Hawaii Administrative Rules › Title 24 - HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND ADMINISTRATIVE RULES › Sec2 4.00 - ENROLLMENT PROCEDURES › Section 24-4.12 - Termination of Enrollment; Effective Dates of Termination

Current through June, 2024
(a)
Termination Due to Change in Employment Status.
An
			 employee-beneficiary's enrollment in all benefit plans offered or sponsored by
			 the Fund and all coverages for dependent-beneficiaries under that enrollment
			 shall be terminated upon the employee-beneficiary's loss of eligibility to
			 participate in such plans due to a change in employment status. The effective
			 date of the termination shall be the first day of the pay period following the
			 effective date of the change in employment status, provided the termination is
			 not retroactive. If, by virtue of an administrative error, coverage continues
			 to be provided by the Fund, and paid for by the employee-beneficiary, the
			 effective date of cancellation shall be the last day of the pay period
			 following the date of issuance of a thirty (30) days written notice. Employers
			 shall submit to the Fund the enrollment application within thirty (30) days of
			 the change in employment status causing termination of enrollment. Employers
			 submitting enrollment applications after thirty (30) days of the change in
			 employment status may be responsible for 100% of the premiums, both employer
			 and employee contributions, until such termination.
(b)
Termination Due to Filing of
			 Fraudulent Claims.
An employee-beneficiary's enrollment in all of
			 the benefit plans offered or sponsored by the Fund and all coverages for
			 dependent-beneficiaries under that enrollment may be terminated if the
			 employee-beneficiary files fraudulent claims for benefit. A
			 dependent-beneficiary's coverage in all of the benefit plans offered or
			 sponsored by the Fund may be terminated if the dependent-beneficiary files
			 fraudulent claims for coverage and/or benefits. The effective date of the
			 termination shall be the date that the Fund determines that the
			 employee-beneficiary or dependent-beneficiary, as applicable, has filed
			 fraudulent claims.
(c)
Notice to the Fund; Recovery of Benefits.
If an event
			 occurs that makes a person ineligible for continued enrollment or coverage in
			 the benefit plans offered or sponsored by the Fund, that person or
			 employee-beneficiary shall notify the Fund of the event within thirty (30)
			 days. All such notices shall be in writing and shall be sent to the Fund. In
			 all situations in which an ineligible person receives benefits under the Fund,
			 the Fund shall be entitled to seek recovery of any benefits that were provided
			 to any person after an event that terminated the person's enrollment or that
			 otherwise made that person ineligible for continued enrollment in or coverage
			 by the benefit plans offered or sponsored by the Fund. In seeking to recover
			 benefits under this rule and in situations in which the Fund overpays amounts
			 to an employee-beneficiary or dependent-beneficiary, the Fund shall have the
			 rights of offset and set-off, including without limitation, the right to
			 recover amounts from and out of any and all future payments to the person whose
			 enrollment was terminated, who otherwise ceased to be eligible for continued
			 enrollment or coverage in the Fund's benefit plans or who was
			 overpaid.