Hawaii Administrative Rules › Title 6 - DEPARTMENT OF BUDGET AND FINANCE › Division - HAWAII EMPLOYER-UNION HEALTH BENEFITS TRUST FUND ADMINISTRATIVE RULES › Chapter 4.00 - ENROLLMENT PROCEDURES › Section 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 upon thirty (30) days advance written notice 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.
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 forty five (45) days. All such notices
				shall be in writing and shall be sent to the Fund.
(d)
Recovery of
				Benefits.
In all situations in which an ineligible person receives
				benefits under the Fund, or the employee-beneficiary or dependent-beneficiary
				files fraudulent claims for benefits per Rule
				4.12(b), the
				Fund shall be entitled to seek recovery of any benefits that were provided to
				any person or seek recovery of the employer contributions paid for any
				ineligible 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.