Fla. Admin. Code Ann. R. 60P-2.002 - Eligibility and Enrollment
(1) Eligibility
to participate in the Health Program will be in accordance with Section
110.123, F.S.
(2) Eligible dependents may only participate
under a family coverage.
(3) The
surviving spouse may participate in the Health Program with family coverage if
there are eligible children to be covered; otherwise, the surviving spouse may
only participate under an individual coverage.
(4) In order to participate in an HMO, the
subscriber must reside in the HMO Region; if the subscriber is a state
employee, he or she must either reside or work in the HMO Region.
(5) An employee or state officer may apply
for enrollment in the Health Program through the employing agency personnel
office:
(a) During the first sixty (60)
calendar days of state employment or a new term of office;
(b) During open enrollment;
(c) Within thirty-one (31) days of a QSC of
losing other group health coverage;
(d) Within thirty-one (31) days of a QSC of
an increase in the number of work hours for an employee;
(e) Within thirty-one days prior to
termination of employment and before the effective date of
retirement.
(6) The
employing agency shall request an effective date of coverage for enrollment in
the Health Program in accordance with Rule
60P-2.004, F.A.C., and indicate
such date on the application along with the following required employee and
agency information:
(a) Employee's name,
social security number, birth date, sex, home mailing address, employment
status, pay plan, employment date, SAMAS organizational code, I.D. code, and
other insurance carriers;
(b)
Dependent's name, social security number, birth date, sex, date dependent was
acquired, relationship of dependent, documentation verifying dependent
eligibility;
(c) Employee's
requested plan type, type of coverage and Spouse Program eligibility;
(d) Contains the signature and date of the
employee and authorized signature and date of the employing agency certifying
eligibility of the employee.
(7) The employee acknowledges that
eligibility and enrollment are governed by Section
110.123, F.S.; authorizes the
State to reduce salary as often and in amount necessary to continue coverage;
authorizes the State to deduct from salary any underpayment of employee
contribution or overpayment of claims; acknowledges that premiums may change
from time to time; authorizes any licensed physician or medical facility to
release medical records of insureds to the health plan; certifies notification
of COBRA rights and agrees to notify the Department at the time any dependent
becomes ineligible for coverage; and agrees that all statements made on the
application are complete and true.
(8) After completion by the employee and
employing agency, the employing agency shall enter applicable information into
the state insurance computer data base and retain the application.
(9) Upon learning of the death of an insured
employee with family coverage, the agency personnel office, by certified mail,
will notify the surviving spouse of his or her eligibility to continue coverage
under the Health Program. A surviving spouse of a retiree shall be notified by
the Department. Such notice shall advise the surviving spouse of the following:
(a) That family coverage may be continued if
there are eligible children to be covered; otherwise the spouse may continue
participation only under individual coverage;
(b) The amount of the applicable monthly
total premium;
(c) That in order to
continue coverage the surviving spouse must complete an application in
accordance with subsection
60P-2.002(2),
F.A.C. The application must be submitted with one month's total premium to the
personnel office of the deceased employee's agency and forwarded to the
Department, or submitted to the Department for a retiree, either within
thirty-one (31) calendar days after the end of the month in which the deceased
employee died or within thirty-one (31) calendar days after receipt of the
notice of eligibility to continue coverage, whichever is
later.
(10) In no case
shall any subscriber or subscriber's eligible dependent be covered
simultaneously under two coverages within the Group Health Program.
(11) An employee who applies for enrollment
and is enrolled in the Health Program shall automatically be enrolled in the
Pretax Premium Plan of the Flexible Benefits Program unless the employee
submits a signed rejection which shall include the employee's name, social
security number, address, agency and a statement that this decision cannot be
changed until the next open enrollment period.
Notes
Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS.
New 10-8-78, Amended 5-22-79, 10-22-79, 4-15-80, 7-1-80, 9-13-82, 8-7-83, Formerly 22K-1.15, Amended 7-16-86, 9-25-86, Formerly 22K-1.202, Amended 8-22-96, Repromulgated 1-31-02, Amended 3-2-17, 6-2-22, Ratified by Laws of Florida Ch. 2022-160.
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