TRS Member Handbook - Status Changes
Status Changes
Continuation of Coverage
If you or your dependents are no longer eligible under your current coverage, you may be able to continue your SWHP membership through one of the following options:
- Under the COBRA Federal Regulations, you have the right to continue the same coverage through your employer under certain conditions of your loss of coverage and if your employer has 20 or more employees. This coverage is at your own expense. Dependents may also be eligible for COBRA continuation coverage when they become ineligible or upon the death of the contract holder. You should check with your employer for more information on this option.
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Under Texas Continuation of Coverage, you have the right to continue the same coverage through your employer under certain conditions of your loss of coverage and if your employer has less than 20 employees. This coverage is at your own expense. You should check with your employer for more information on this option. This conversion option could extend your SWHP coverage for up to six months.
Continuity of Treatment
In the event of a termination of your PCP or secondary physician, SWHP will notify you within 30 days of the termination. This should give you plenty of time to choose another PCP or specialist to continue your care. If SWHP terminates your physician, SWHP may continue to reimburse your physician if you are seeing him/her under a special circumstance such as a disability, acute condition, or life-threatening illness. Your physician must submit a request to SWHP Medical Director that explains the reasons for continuing treatment under his/her care. If SWHP grants the request, SWHP will reimburse your physician at the contract rate for up to 90 days from the date of his/her termination.
For patients new to SWHP who are in active treatment for medical conditions with non-SWHP network providers, SWHP may grant up to 90 days to transition care to SWHP providers, based on individual case review.