Fla. Admin. Code Ann. R. 60P-2.006 - Contributions, Underpayments of Contributions, and Overpayments of Contributions

(1) Employee contributions.

(a) Employee contributions are due in advance of each month of coverage and shall be paid as follows:

1. The initial month's employee contribution shall be paid by personal check, money order or payroll deduction; however, the initial month's premium for surviving spouses or retirees shall only be paid by personal checks or money orders. If the employee contribution is not received by the Department prior to the end of the month for which coverage is to be effective, such coverage shall not be effective.

2. Employee contributions due after the initial month shall be payroll deducted if there are sufficient funds to make the deduction. If there are insufficient funds for payroll deduction, employee contributions shall be paid monthly by personal check or money order.

3. Premiums due from employees who are off the payroll, surviving spouses ineligible to receive monthly warrants as beneficiaries of deceased employees, retirees, or insureds having continuation coverage shall be paid monthly by personal checks or money orders.

4. It shall be the responsibility of the employing agency to initiate payroll deductions or receive the employee contributions and to timely remit the same to the Department.

(b) Payroll deductions for insurance coverage shall be made in such a manner that a full month's premium has been deducted prior to the requested effective date of coverage.

(c) Double payroll deductions shall be made for an employee on an academic contract or who is regularly employed for less than twelve (12) months. However, double deductions shall not be made for an employee who is paid monthly or applies for a change in coverage. No deduction shall be taken on a supplemental payroll.

(d) Employee contributions shall not be accepted for coverage beyond the end of the month following the month in which the employee terminates employment, except as provided in subsection 60P-2.002(5) and paragraph 60P-2.011(2)(a), F.A.C.

(e) The agency personnel office shall submit all personal checks or money orders, along with purpose, subscriber and agency I.D. and coverage period, from any employee, retiree or surviving spouse to the Department prior to the first day of the applicable coverage month. A late payment from a retiree, surviving spouse or an employee on approved leave without pay, workers' compensation, layoff or suspension, or an insured having continuation coverage will be accepted as a late payment if it is received by the Department on or before the last day of the coverage month; however, payment will not be accepted after such date and coverage will be terminated.

(2) Underpayment of Contributions.

(a) For employees, retirees and surviving spouses on the active or retiree payroll:

1. When it has been determined that a contribution has been underpaid, the Department shall notify the employee, retiree or surviving spouse of the underpayment by certified mail and shall notify the employee's agency of the underpayment. This notice will advise the employee, retiree or surviving spouse of the nature of the underpayment and the methodology used to determine this amount and will request the employee, retiree or surviving spouse to contact his or her agency or the Department to resolve the problem so that future contributions will be correct. The notice shall advise of the following procedures for resolving the underpayment:

a. If the full amount of the underpayment is not received by the Department within thirty (30) calendar days from the date of receipt of the notification of underpayment or if approval is not granted in accordance with sub-subparagraph (2)(a)1.b., or if an administrative hearing is not requested in accordance with sub-subparagraph (2)(a)1.c., the retiree's or surviving spouse's coverage shall be terminated. With respect to the employee, the Department will request the Department of Banking and Finance to initiate involuntary wage deductions where applicable.

b. If the underpayment involves more than one coverage period, the Department may approve an installment payment program provided a written request for such program is received from the employee, retiree or surviving spouse within thirty (30) calendar days from the date of the notification of underpayment; provided, however, that any such installment payment program is subject to approval of the Department of Banking and Finance in accordance with Section 17.04, F.S. Payroll deductions must be used whenever the employee is receiving a state payroll warrant issued by the Department of Banking and Finance.

c. The employee, retiree or surviving spouse may request an administrative hearing pursuant to Section 120.57, F.S., provided such request is received by the Department within twenty-one (21) calendar days from the date of receipt of the notification of underpayment. Such notice shall be mailed to the address on file.

2. When it has been determined that an agency has underpaid its contribution, the Department shall notify the agency of the underpayment in writing. Such notice will advise the agency that the full amount of the underpayment should be received by the Department within forty-five (45) calendar days from the date of the letter. The agency shall take appropriate action to insure that future state contributions are correct. Should any agency become more than sixty (60) days delinquent in payment of this obligation, the Department shall certify to the Comptroller the amount due and request the Comptroller to recover such underpayment in accordance with Section 17.04, F.S.

(b) For subscribers off the payroll:

1. As it applies to the employee, when it is determined that none of the required contribution is paid by the end of the coverage month, coverage will be canceled effective the first day of that month.

2. As it applies to all others, when it is determined that none of the required premium is paid by the coverage month, coverage will terminate effective the first day of the month.

3. If less than the required contribution is paid, the subscriber and the employee's agency will be notified as described in paragraph 60P-2.006(2)(a), F.A.C.

(c) An employee whose coverage is suspended in accordance with subparagraph (2)(b)1., may only apply for reenrollment in the Health Program by settling all underpayment claims and resubmitting an application during the open enrollment period. A retiree, surviving spouse or an insured with continuation coverage whose coverage is terminated in accordance with subparagraph (2)(b)2., may not reenroll in the Health Program.

(d) When it has been determined that an employee contribution has been underpaid, the Department shall notify the servicing agent to suspend the payment of claims until such underpayment has been resolved.

(e) Claims rejected by the Group Health Self Insurance Plan due to underpayment of premium shall be reprocessed upon receipt by the Department of the full amount of the underpayment or an approved signed agreement for installment repayment from the employee, retiree or surviving spouse, provided such claims were initially submitted to the Group Health Self Insurance Plan within sixteen (16) months from the date medical expenses were incurred.

(3) Overpayment of Contributions.

(a) Whenever the employee's agency becomes aware of a total premium payment that is more than the amount required for the type of coverage selected, the agency shall take appropriate action to request a refund for the overpayment of premiums and to correct the contributions for any subsequent periods. The Department shall make such corrections for retired employees, surviving spouses and insureds with continuation coverage.

(b) Requests for refunds of any premium overpayments must be submitted by the employing agency.

(c) If an employee contribution has been overpaid and the Department is aware of a claim overpayment on behalf of any insured, a refund of the employee contribution overpayment shall not be processed until the claim overpayment has been resolved.

(4) State Contribution. Any state officer, full-time employee or part-time employee participating in the Health Program shall be entitled to the state contribution or prorated state contribution if any of the following conditions exist:

(a) The employee is at work or on approved leave with pay for a minimum of one day in the month previous to the month of coverage.

(b) The employee is either on academic contract or is regularly employed for less than twelve (12) months, provided the employee has worked at least eight (8) months during the prior consecutive twelve (12) month period. Such employee shall receive the state contribution for the entire twelve (12) months.

(c) The employee is on Workers' Compensation disability leave.

(d) The employee successfully appeals a suspension and receives full back pay. In such cases, the employee shall receive the state contribution during the time of the suspension provided the employee continued coverage under the Health Program during the period of such suspension and was receiving the state contribution at the time of suspension.

(e) The employee successfully appeals a dismissal and receives full back pay. In such cases, the employee shall receive the state contribution during the time of dismissal provided the employee was receiving the state contribution at the time of dismissal and, upon reinstatement, pays all back employee contributions in order to have continuous coverage under the Health Program.

(f) When the spouse of an employee is also a state officer, full-time employee, or part-time employee, and both are covered under the Health Program, and the spouse is listed as an eligible dependent under the employee's family coverage, the spouse shall also be eligible to receive the designated state contribution beginning with the coverage month following receipt of the applications by the Department.

(g) The state contribution for a part-time employee shall be on a pro rata basis so that the percentage of the cost contributed for the part-time employee shall bear that relation to the percentage of cost contributed for a similar full-time employee that the part-time employee's normal workday bears to a full-time employee's normal workday.

(h) The state contribution for full-time employees or part-time permanent employees shall continue in the respective proportions for a minimum of twelve (12) weeks for any such employee who has been granted an approved medical leave of absence.

Notes

Fla. Admin. Code Ann. R. 60P-2.006

Rulemaking Authority 110.123(5) FS. Law Implemented 110.123 FS.

New 10-8-78, Amended 10-22-79, 4-15-80, 7-1-80, 9-13-82, 8-7-83, Formerly 22K-1.19, Amended 7-16-86, Formerly 22K-1.206, Amended 8-22-96, Repromulgated 1-31-02, Amended by Florida Register Volume 43, Number 030, February 14, 2017 effective 3/2/2017.

New 10-8-78, Amended 10-22-79, 4-15-80, 7-1-80, 9-13-82, 8-7-83, Formerly 22K-1.19, Amended 7-16-86, Formerly 22K-1.206, Amended 8-22-96, Repromulgated 1-31-02, Amended 3-2-17.